presentation on gastrostomy and jejunostomy feeding

an easy go through for learners on the topic of gastrostomy and jejunostomy feeding procedure.

1. GASTROSTOMY AND JEJUNOSTOMY FEEDING Miss. Sanjivi Govekar, 1st year MSc Nursing, Medical surgical nursing, MCON, MAHE

2. objectives Introduction Indications Types of schedule Articles Steps of procedure Common problems Nursing responsibilities

3. What is ostomy? OSTOMY: an Ostomy is a surgical opening from inside of an organ to the outside. The stoma is the part of the ostomy attached to the skin.

4. TRANSABDOMINAL TUBE FEEDING To access the stomach, duodenum, or jejunum, the doctor may place a tube through the patient’s abdominal wall. This procedure may be done surgically or percutaneously.

5. Types of tube feeding

6. gastrostomy

7. jejunostomy

8. Indications for gastrostomy feeding:

9. Indications for jejunostomy feeding:

10. Tube feeding schedule

11. Articles required : GLOVES STETHESCOPE MACKINTOSH KIDNEY TRAY TOWEL LITMUS PAPER

12. WATER MEASURING CUP DRESSING MATERIAL LEUR LOCK SYRINGE FORMULA FEED WITH FEEDING BAG AND TUBINGS

13. Procedural steps : PRE PROCEDURAL: Preparation of equipment- check the expiry date on commercially prepared feeding formulas. If prepared by the dietitian or pharmacist, check the preparation time and date. Discard any opened formula >1 day old.

14. Be sure formula is at room temperature. Place client in high fowlers position, or elevate the head of the bed at 30 degrees.

15. INTRA-PROCEDURAL: Confirm patient’s identity using two patient identifiers according to facility policy. Explain the procedure to the patient and relative. Verify physicians order for formula feed, rate, route and frequency .

16. ASSESSMENT- Asses clients need for enteral tube feeding. Evaluate clients nutritional status. Obtain baseline weight and laboratory values. Assess client for fluid volume excess or deficit, electrolyte imbalance, metabolic abnormalities. Auscultate bowel sounds before feeding. Assess the ostomy site for breakdown, irritation, or drainage .

17. Perform hand hygiene. Prepare feeding container : - check expiry date of formula and integrity of container. - connect tubing to container as needed or prepare ready to hang container. - shake formula container well before filling. - open the stopcock on tubing and fill with formula to remove air from tubing. . Hang on to IV pole.

18. Apply gloves and verify tube placement: -gastrostomy tube: attach syringe, and aspirate 5-10ml of gastric secretions, observe appearance and pH. -jejunostomy tube: aspirate intestinal secretions, observe their appearance, and check pH.

19. Check for gastric residual. -connect syringe to tubing and aspirate gastric content. -return aspirated content to stomach unless the volume exceeds 200ml. Flush tubing with 30ml of water.

20. A) Syringe feeding. -pinch proximal end of the feeding tube. -remove plunger from syringe, attach barrel of syringe to end of tube. -fill syringe with measure amount of formula. Empty gradually by gravity; refill; repeat until prescribed amount has been delivered to the client.

21. - if feeding bag is used, hang feeding bag on an IV pole. -Allow bag to empty gradually over 30-60minutes by setting rate adjusting roller clamp on tubing or placing on a feeding pump. B)Continuous drip method. -connect distal end of the tubing to the proximal end of the feeding tube. -connect tubing through the infusion pump and set the rate.

22. Administer water via feeding tube as ordered with or between feeding. flush feeding tubing with 30ml of water after feed is over. Remove gloves and perform hand hygiene. Clamp/close the proximal end of feeding tube. Rinse bag and tubing with warm water whenever feedings are interrupted.

23. POST-PROCEDURAL : Monitor- random blood sugar level if indicated. - intake and output chart every 8hourly and calculate daily total. -weight of client if feasible. -lab values as instructed by physician. -any unexpected outcomes and notify.

24. Observe clients respiratory status and bowel sounds, the ostomy site for signs of infection. Document the procedure, the type of feed, quantity, patency of tube, condition of ostomy site, clients response. Instruct the patient not to sleep immediately after the feeding. If intermittent delivery is used, head should remain elevated for 30-60min.

25. Common problem of tube feeding :

26. NURSING MANAGEMENT OSTOMY CARE POSITIONING NURSING MANAGEMENT

27. The impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults A semi-structured interview approach was developed to obtain participants views on the impact of living with a PEG. A cross-sectional qualitative purposive sampling design was used. 15 patients and 19 caregivers were interviewed.

28. The key issues that emerged included relief of pressure to consume an oral diet, disturbed sleep, restricted ability to go out, restricted choice of clothing, difficulties finding place to feed, missing being able to drink and eat, social occasions, negative attitude of others towards feeding and burden on caregiver. They highlighted the need for social support for both patients and their career's, planned on an individual basis.

29. conclusion

30. A gastrostomy or jejunostomy (G or J) tube is useful for feeding malnourished patients and is preferred to prolonge use of total parenteral nutrition. Because enteral feeding has become common place in both the hospital and home setting, it is vital that health care workers instruct caregivers on the treatment of individuals with G tubes and/or J tubes.

31. Many problems can be prevented when caregivers know how to care for the patient and troubleshoot potential concerns. Tubes may be passed into the stomach (gastrostomy) or the jejunum (jejunostomy) in patients who cannot obtain adequate nourishing via oral feeding. Following placement, nurses are typically responsible for management of gastrostomy or other enteral tube devices in both the acute and home care settings.

32. Assignment: Find about advancing the rate of tube feeding both for continuous and intermittent feeding.

33. Evaluation criteria: SR NO AREA TO BE EVALUATED MARKS ALLOTED MARKS OBTAINED 1 Organization of content 6 2 Neatness 2 3 Timely submission 2 TOTAL 10

34. reference Black, J. M., & Hawks, J. (2009). Medical surgical Nursing, 8th edt . New Delhi: Elsevier. Brotherton, A., J, A., & P, A. (2006). The impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults. J Hum Nutr Diet . Chintamani. (2004). Lewi's Medical surgical nursing. Canada: Robin Carter. kaur , l., & kaur , m. (2009). a textbook of nursing foundations, 2nd edt . Jalandhar: p.K. jain . Perry, P. (2009). Fundamental of Nursing, 7th edt . Delhi: Reed Elsevier. Timby , B. K. (2017). fundamental nursing skills and concepts, 11th edt . china: lippincott , wolters kluwer .