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NPO feedings
NPO or supplemental feedings
| Question | Answer |
|---|---|
| Consider: (first 5) | time for oral transit, amt/freq of asp, silent asp, risk/hx of developing pneumonia, pt/family preferences, dx/severity of med condition |
| Consider (last 4) | ability to do postures/cough ability, recovery prognosis, respiratory status, alertness |
| 3 most common reasons for tube feedings: | 1. pt's inability to sustain nutrition orally, although the swallow response is safe. 2. the requirement for sufficient calories on a short term basis to overcome an acute medical problem. 3. risk of tracheal asp if pt. is allowed to eat orally |
| Nasogastric | fed through nose-pharynx-esophagus into stomach. varying sizes, larger ones interfere w swallowing. fed liquid boluses followed by water. reflux is a concern |
| Gastrostomy Tube Gtube | placed surgically through abdomen directly into stomach. |
| PEG tube | percutaneous endoscopic gastrostomy, placed w endoscope, formula passed through catheter |
| Jejunostomy Jtube | in jejunum. b/c stomach is bypassed, predigested formulas needed. |
| Fundoplication (Nissen brand) | gastric fundus (upper part) of stomach is wrapped around lower end of esophagus and stitched in place, reinforcing the closing fx of the lower esophageal sphincter. Laparoscopic procedure. |
| Nasogastric Risks | uncomfy, poor cosmoses, distend PES/UES, may promote reflux, nasal ulceration, sinusitis, delays swallow, may trigger vagal bradycardia |
| Nasogastric Benefits | easy insertion, no anesthesia, tube can be small bore & well tolerated, good short term nutrition, pt can eat w tube in place |
| Gastrostomy Risks | requires surgical placement, infection @tube site, tube may fall out, reflux if stomach fills too fast, diarrhea |
| Gastrostomy Benefits | good long-term option, out of visual sight, easy tube replacement, easily removed, pt can eat w tube in place |
| Jejunostomy Risks | requires surgical placement, cont. drip feeding, requires hospital visit if dislodged, intolerance of special formula |
| Jejunostomy Benefits | may reduce reflux, out of visual sight, good nutrition if stomach not available |
| PEG Risks | asp. during procedure, infection @ tube site, potential for reflux |
| PEG Benefits | inserted under local anesthesia, gen. well tolerated, OR time not needed |
Created by:
kaskas