2 Nutrition and Metabolismwrghrejweoeowojwoioowwi.pptx

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1. Feeding a patient NUTRITION & METABOLISM

2. Objectives At the end of this unit you will be able to: Identify essential nutrients for human body Define Enteral Feeding (EF) Identify indications and contraindications of Enteral Feeding (EF) Identify indications for nasogastric tube insertion Demonstrate the procedure for insertion of nasogastric tube Demonstrate the procedure for feeding of patient via nasogastric tube

3. Nutrients   A substance  used by an organism to survive , to function properly, grow, & reproduce The six essential  nutrients   include: Carbohydrates Protein Fat Vitamins Minerals Water

4. Fluid & Electrolyte Normal body function depends on a relatively constant volume of water and electrolyte Water Is the most essential nutrient of life 60-65 % of the body weight is water No physiology can function without it. Electrolyte Is a compound that dissociate in a solution to break up in to separate electrically charged particles

5. Therapeutic nutrition   Is the provision of nutrients to maintain and/ or restore optimal  nutrition  and health

6. Enteral Nutrition(EN) Delivering nutrients directly to GIT through feeding a tube It is important to decide on site and size of the tube Site; Can be nasal, oral or percuteneous (e.g. stomach, duodenum, jejunum) Size; Depends on need for medications, feeding( 8-12Fr), gastric suctioning, decompression (14-18Fr) EN can be cyclic, bolus and intermittent

7. Indications Nutritional support for pt’s with a functioning GIT Neurological conditions like stroke Coma Malnutrition due to cancer Critical care in ICU Psychological problems causing lack of appetite

8. TYPES OF ENTERAL FEEDING Nasogastric Tube Nasoduodenal or jejunal Gastrostomy Jejunostomy Tubes

9. Delivery methods Bolus =feeding large /time short Continuous=slowly over several hours Intermittent =bolus with set intervals Cyclic=continuous over specific time Types of nutritional formulas Standard and specialized

10. Contraindications of nasogastric tube insertion Maxillofacial Trauma/ base of skull fracture Oesophageal abnormalities/ strictures/ varicies Upper GI disorders/ carcinomas Altered Mental status & impaired defenses Patients with severe coughing. Caution with patients with coagulation disorders Caution with facial burns

11. Complications Patient discomfort Trauma to nasopharynx Epistaxis Oesophageal perforation Metabolic imbalance-in case of gastric suctioning Nausea Blockage of tube

12. Inserting a Nasogastric (NG) Tube Purposes To administer tube feedings and medications to clients unable to eat by mouth or swallow ( G avage ) To establish a means for suctioning stomach contents ( Suctioning ) To remove laboratory contents for laboratory analysis (Aspiration) To wash the stomach ( Lavage )

13. Indication Feeding ( Gavage ) Administering medications Washing stomach ( Lavage ) Gastric decompression(Suctioning)

14. Equipment Clean tray Nasogastric tube 5-8, 8- to 12-Fr, 12-16 50 ml syringe Adhesive tape Emesis basin (gully pot) Lubricant jelly Bath towel Facial tissues Clean gloves Penlight Tongue blade

15. Gastrostomy It is the deliver of nutrients directly into the stomach through a surgically or endoscopically placed tube. Tube Size12-16 Pediatrics , 18-28F Adult Indication Neurological conditions Head and neck cancer

16. Types of Gastrostomy Tubes Percutaneous Endoscopic Gastrostomy tube : Most common Insertion of a feeding tube using endoscopic guidance Surgical Gastrostomy Tube: Placed via an open surgical procedure. Used when endoscopy is contraindicated.

17. Gastrostomy Tubes Care and Maintenance Daily Care: Clean the stoma site with warm water and mild soap. Inspect the site for redness, swelling, or discharge.

18. Gastrostomy … Tube Flushing: Flush the tube with 20–50 ml of water before and after feeding to prevent blockages. Use sterile water for immune compromised patients. Monitoring and Replacement: Check the tube for wear, leakage, or balloon integrity.

19. Gastrostomy … Potential Complications Infectious: Peristomal infection or abscess. Cellulitis at the insertion site. Mechanical: Tube dislodgement or blockage. Buried bumper syndrome (internal fixation device embeds in the stomach wall).

20. Gastrostomy … Gastrointestinal: Nausea, vomiting, or diarrhea due to intolerance. Aspiration, though rare.

21. Gastrostomy … Nursing Responsibilities Before Feeding: Verify tube placement. Assess for signs of infection or complications at the site. During Feeding: Ensure the patient’s head is elevated (30–45°) to prevent aspiration. Administer feeds as per the prescribed schedule and monitor for tolerance. After Feeding: Flush the tube to prevent clogging. Document the type and volume of feed, as well as the patient’s response.

22. Gastrostomy … Benefits of Gastrostomy Feeding Ensures adequate nutrition for patients with long-term feeding challenges. Supports growth and development in pediatric patients with chronic conditions. Reduces aspiration risk compared to oral or nasogastric feeding.

23. Gastric Lavage Clearing stomach contents It is emergence medical procedure Indication Poisoning Upper gastrointestinal bleeding Preparation for surgery

24. Gastric lavage … Contraindication Unprotected airway or decreased level of consciousness without airway protection Ingestion of corrosive substances (acids, alkalis, strong oxidizers)- Risk of further injury and perforation of the esophagus or stomach. Esophageal Strictures or Varies: Uncontrolled seizures

25. Gastric lavage Complications Aspiration pneumonia Esophageal perforation Electrolyte imbalance Hemorrhage