Nursing intervensions to support nutrtion for the pt w/malnutrition
High-Calorie, High-Protein Diet
Commercially available products
Carnation Instant Breakfast (CIB)
Indications for enteral nutrition (tube feedings)
Nutrition provided through GI tract via a tube, catheter or stoma that delivers nutrients distal to the oralcavity for:
Head and neck cancer
Considered safer, more physiologically efficient, less expensive than parental nutrition. Obviously, GI system has to work to be able to feed enterally.
types of tubes
Types of Tubes
Nasogastric Tube (NGT)
Gastrostomy Tube (PEG)
Nursing management of enteral tube feedings
Positioning- HOB 30-45 degrees
Tube Patency- Flush before and after
Tube Position - Placement check
Aspiration Risk - HOB elevation/Residual check
Formula- strength/hang time. Do not dilute with water. May -->diarrhea.
Administration – pump/gravity(bolus/intermittent)
Medication Administration - crush meds well!
--daily weights, glucose checks,
--change tubing q24 hrs, free water
--label w/ date/time hung, I&O
--Gastric residual: check q 4 hrs. for 1st 48 hours then q6-8 hrs for stable patient; q4h critical pts (>200 = gastric intolerance).
What are some complications of enteral feedings?
Aspiration: keep HOB 30-45 degrees; hold TF when HOB lowered; check residuals; ambulation; gastric emptying agents, suction for any s/sx aspiration, clear airway!!!!!
Clogged Tube: crush meds well; flush before and after meds; dilute viscous solutions; use liquid meds if available; follow hospital protocol for unclogging tube
Displacement of tube
Infection: assess for s/sx infection; clean around site q shift with water initially then soap and water.
Thrush: Oral care!!!!!!!
General info about TPN feeding
GI tract not functioning properly
Administration of nutrition IV:
--Total Parental Nutrition (TPN)
--Peripheral Parental Nutrition (PPN)
TPN vs. PPN
Short term nutritional needs
Protein/calorie requirements low
CVC Contraindicated-use peripheral IV
Supplement inadequate oral intake
Hypertonic (Glucose concentration 10%)
Long-term nutritional support needed
High protein/calorie requirements
Must be given in Central Line (CL)
Glucose concentration (20-50%)
Hypertonic 1600 mOsm/L (blood 280 mOsm/L)
Nursing management of Parenteral nutrition
VS q 4-8 hrs.
Labs, esp glucose.
DSG change according to protocol
Change label/bag/tubing/filter q 24 hours no matter how much is left in the bag or even if the condition looks fine. Just do it.
IV site assessment:
Signs of phlebitis: erythema, tenderness or exudate; systemic infxn: fever, chills, N/V, malaise. Cultures (x2) may be performed and line may be D/C’d with tip cultured if no source of infection can be identified. Central line usually not replaced right away r/t risk of seeding new IV with bacteria.
Glucose q 6 hrs. risk for hyperglycemia
Administer PN ONLY via pump!!!
Complications of TPN
Fungus/ Gram +/ Gram - bacteria
Altered Renal Function
Electrolyte/vitamin/mineral excess or deficiency
Pathophysiology of n/v
preconditions for n/v
SE of drugs
assessment and intervensions for n/v
When does it occur
Description of contents
Nutritional therapyBRAT diet
Upper Gastrointestinal Bleeding
Most common sites
SnSs of UGI bleed
Severity Depends on Origin
--Hematemesis (bright red/coffee ground vomit)
--Melena (black/tarry stool)
--Hematochezia (maroon colored stool)
--Guaic-Positive Stools/Nasogastric Aspirate
Emergency Assessment and management of pt w/UGI bleed.