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NPO feedings

NPO or supplemental feedings

QuestionAnswer
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