Nutritional support

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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Nasally inserted feeding tube.

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Enteral feeding solution being administered by feeding pump


Percutaneous endoscopic gastrostomy (PEG) feeding

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• Stomach empties to right. Duodenum located below liver.

• Stomach empties into duodenum. Duodenum becomes jejunum.



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


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


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)




Type of enteral feed


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PARENTERAL NUTRITION


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".


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.


PICC line

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Multilumen catheter


Total parenteral nutrition -infants

http://reidhosp.adam.com/graphics/images/en/21775.jpgMaria Carmela L. Domocmat, RN, MSN

http://health.stateuniversity.com/article_images/gem_05_img0648.jpgMaria Carmela L. Domocmat, RN, MSN

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http://www.impactinformation.com/products/images/tubefeed_01.jpg


http://www.nutrinox.com/assets/auto_generated_images/img_30941b80.jpg

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Health & Medicine

Nutritional support