Nutritional Support
Maria Carmela L. Domocmat, RN, MSNInstructor, NCM 106School of Nursing Northern Luzon Adventist College
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Maria Carmela L. Domocmat, RN, MSN
http://www.stockmedicalart.com/medicalartstudio/enteral-feeding.htmlMaria Carmela L. Domocmat, RN, MSN
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Maria Carmela L. Domocmat, RN, MSN
Nasally inserted feeding tube.
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Maria Carmela L. Domocmat, RN, MSN
Enteral feeding solution being administered by feeding pump
Maria Carmela L. Domocmat, RN, MSN
Percutaneous endoscopic gastrostomy (PEG) feeding
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Maria Carmela L. Domocmat, RN, MSN
• Stomach empties to right. Duodenum located below liver.
• Stomach empties into duodenum. Duodenum becomes jejunum.
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Category Subcategory Characteristics Indications
Standard Similar to average diet
Normal digestion
High nitrogenProtein>15% of total kcal
• Catabolism
• Wound healing
• Fluid restrictionPolymeric
Caloric dense 2 kcal/ml
Fluid restriction
• Volume intolerance
• Electrolyte imbalance
Fiber containing Fiber 5-15 g/L
Regulation of bowel function
Maria Carmela L. Domocmat, RN, MSN
Category Subcategory Characteristics Indications
Monomeric
Partially hydrolyzed One or more nutrients are
hydrolyzed.Composition varies.
Impaired digestive and absorptive capacityElemental
Peptide based
RenalLess protein, low electrolyte content
Renal failure
Hepatic
High branched chain amino acids (valine, isoleucine and leucine, which are known as the stress amino acids), low Hepatic encephalopathy
Disease-Specific
aromatic amino acids (phenylalanine; tyrosine; tryptophan), low electrolyte content
PulmonaryHigher % of calories from fat instead of carbohydrates
ARDS
Diabetic Low carbohydrates Diabetes mellitus
Immune-enhancing
Arginine, glutamine, omega-3 fatty acid, antioxidants
• Metabolic stress
• Immune dysfunctionMaria Carmela L. Domocmat, RN, MSN
Administration of feedings
• Bolus• Intermittent• Continuous
Maria Carmela L. Domocmat, RN, MSN
Indications Advantages Disadvantages
Bolus
• Noncritically ill patient
• Home TF
• Rehabilitation patient
• Easy to administer
• Inexpensive
• Short administration time (usually 15 minutes)
Highest risk of aspiration, N/V, abdominal pain and distention, and diarrhea
Intermittent
• Noncritically ill patient
• Home TF
• Rehabilitation patient
• Flexibility in feeding schedule
• Inexpensive
• Feeding over shorter time
• Higher risk of aspiration, N/V, abdominal pain and distention, and diarrheaIntermittent • Feeding over shorter time
allows patient more free time
diarrhea
• May require formula with more calories and protein
Continuous
• Initiation of tube feedings
• Critically ill patient
• Small bowel feeding
• Intolerance of intermittent or bolus
• Pump assisted
• Minimizes risk of high gastric residuals and aspiration
• Minimizes risk of metabolic abnormalities
• Restricts ambulation
• Infused over 24 hours/day
• Increased cost (need pump)
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Type of enteral feed
Maria Carmela L. Domocmat, RN, MSN
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Maria Carmela L. Domocmat, RN, MSN
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Maria Carmela L. Domocmat, RN, MSN
PARENTERAL NUTRITION
Maria Carmela L. Domocmat, RN, MSN
Peripheral IV• INTRAVENOUS; IV• An intravenous catheter is a
small tube that is inserted into a vein for the purpose of delivering fluids or medications. "Intravenous" means "in a vein". It is usually referred to as an I.V.referred to as an I.V.
• An IV catheter can be inserted into the veins of the arms or legs. This type of IV is called a "Peripheral IV". The term peripheral means "outer boundaries", therefore, a peripheral IV is located in the veins that are "away from the centre".
Maria Carmela L. Domocmat, RN, MSN
Central venous line in subclavian site
• A "Central Venous Catheter" or Central IV
• is a catheter that • is a catheter that is inserted into large veins that are closer to the right side of the heart.
Maria Carmela L. Domocmat, RN, MSN
PICC line
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Maria Carmela L. Domocmat, RN, MSN
Multilumen catheter
Maria Carmela L. Domocmat, RN, MSN
Total parenteral nutrition -infants
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Maria Carmela L. Domocmat, RN, MSN
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Maria Carmela L. Domocmat, RN, MSN
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Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN