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Dietary considerations when treating illness
- Proteins - Essential for synthesis of body tissue growth, maintenance, and repair
- Essential amino acids must be provided for by dietary intake
- Nitrogen Balance -
- Intake of Nitrogen = Output of Nitrogen
- POSITIVE NITROGEN BALANCE NEEDED FOR HEALING
- “IT DOES A BODY GOOD”
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Nutritional considerations with the elderly
- Older Adults Nutritional Screening Required
- Metabolic rate slows with age: vitamin and mineral requirements remained unchanged may require supplementation
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Nutrient absorption in the elderly
- Alcohol consumption (oz./day)
- Liver Mass
- Renal function
- G.I. Peristalsis
- HCl and digestive enzymes
- Polypharmacy/ Chronic medications
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Identifying nutritional imbalances
- Complete physical examination – remember from Health Assessment:
- General survey
- Alterations in vital signs
- Poor skin turgor, wound healing
- Concave abdomen/ ascites
- Change in muscle mass
- Laboratory results:
- Changes in blood glucose, serum albumin
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Diet Progression
- DAT – diet as tolerated
- NPO – nothing by mouth
- Diet after procedure / surgery –
- --Clear liquids
- --Full liquids – liquids such as milk shake. Also includes ice cream and custards.
- --Pureed – puree food with liquid
- --Ground-for those with chewing/swallowing difficulties
- --Mechanical soft – more calories than full but little chewing involved
- --Soft – little or no chewing
- --Regular – YEAH!
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How can you Stimulate Appetite
- Frequent small meals
- Restrict liquid intake with meals
- Keep environment tidy
- Provide nutrient dense foods
- Patient preferences
- Pain Control
- Food tray considerations
- Patient Positioning
- Oral Hygiene
- Nutritional Supplements
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Diets and their restrictions
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When your patient cant eat
- Enteral feedings: Nutrients given via the GI Tract
- Parenteral Feedings: Accomplished via central venous access when gut access is prohibitive
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Gastrointestinal intubation
- NG (nasogastric) tube –
- Why might you insert?
- Provision of nutrition in a functional GI tract
- Removal of GI secretions – giving the gut a rest / obstruction/ hyperemesis
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Enteral Nutrition
- Nutrients provided via: Tubes
- NG
- Jejunal
- Gastric tube(PEG)
- Preferred route with a functioning GI tract
- Formulas differ in nutrient density and composition and are disease specific
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Short term NG therapy
- NG tube –
- Salem sump for suctioning (S=suction)
- Dobhoff for feeding (D=dinner)
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Proper prep of NG tubes
- Determine level of cooperation with procedure
- Positioning of patient-chin to chest
- Measure correctly
- Supplies –
- Tube
- Water
- Tape
- Towels
- Lubricant
- Syringe
- Checking placement
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Assessing placement of NG tubes
- Gold standard is by radiology – tubes actually have a radiopague strip or a wire that can be seen on x-ray. Must do for eteral feeding tubes
- Aspirate contents and check pH level: 0-4
- You will still see insertion of air and ausculation the stomach – not as accurate
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Tube care and pt comfort
- Nare care – saline drops? No vaseline! Keep it clean!
- Oral hygiene – remember this can be a source of infection if oral care isn’t done
- Patency – make sure the suctioning is working and the line is patent
- Secure the line – tape but remember assess the skin first and document
- Drainage-Color/amount
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What's a PEG tube?
- Long –Term
- Nutrition Therapy
- Gastrostomy (PEG) tube
- Jejunostomy
- Require Incisional assessment & care
- Check for residual q4h. Should be <100ml.
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Enteral feeding tube assessment
- Change feeding container and tubing q24h
- Only hang 4 hours worth of solution
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Adminstering Enteral feedings
- Assessment
- Tube feeding (amount)
- Should be in high Fowlers
- Bolus vs continuous
- Water
- Continuous Infusion pump & pole
- Bolus infusion - syringe or bag
- Gravity considerations
- Medication administration
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Preventing aspiration
- Prevention of aspiration is key!!!
- Tube Placement & Residual s
- Observe for distention Auscultate BS
- Positioning of patient
- HOB elevated 30 degrees.
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Removal of tubes
- Have pt take a deep breath and hold it to close epiglotis to prevent aspiration.
- Pull hand over hand
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