Nutritional Therapy
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| Factors that Effect Oral Intake | Cultural practices, religious practices, specialty diets, chewing abilities, illness & surgery, neuromuscular disorders, swallowing abilities, altered meal times (late night snacking), allergies, taste, cost, age, appetite, meds
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| Dysphagia Neuromuscular/neurological causes | CVA, ALS, Tremors, myasthenia gravis
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| Dysphagia Traumatic/surgical causes | Oral/throat surgery. Cancer therapy. Ingestion of caustic substances
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| Dysphagia signs and symptoms | Coughing or gagging while eating, choking, aspiration, drooling, pockets of food retained in the mouth, gargly sounding voice, sensation of food getting stuck in the throat
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| Nursing diagnosis | Risk for aspiration, constipation, diarrhea, imbalanced nutrition: less than/more than body requirements, feeding self-care deficit
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| Types of Therapeutic Diets | Clear liquids, full liquids, pureed, mechanical soft, soft/low residue, high fiber, low sodium, low cholesterol, diabetic, regular
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| Interventions for Dysphagia | Know what time the client's tray arrives, allow sufficient time to assist the client, high fowler's position with head tilted slightly forward, feed slowly in a relaxed atmosphere, discourage talking while chewing, encourage small bites
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| Easy to swallow food | Thickened liquids: milkshake, slushy. Pureed/Smooth food: pudding, mashed potatoes. Other: cooked veggies, ground meat, creamed soup, iced fruit
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| Total Parenteral Nutrition (TPN) | Hyperalimentation. Infused into a central line. Hypertonic Solution. Used for those with: difficulty absorbing nutrients, persistent nausea & vomiting, need for complete bowel rest. Complications: infection, fluid overload, metabolic imbalances
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| Continuous feeding | Long term, Start slow. Progress
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| Bolus feeding | Feed like "meals". Set amount given at set intervals.
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| Lavage | Removal of stomach content. Accidental poisoning, overdose, may instill NS to "wash" the stomach.
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| Decompression | For slow GI motility. Connected to low intermittent wall suction. Treats: bowel obstructions, paralytic ileus, and prevents distension.
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| Levin | Nasogastric tube. Clear, larger, firm plastic tube. Manipulate to soften tubing. Used for feeding and decompression. Check placement with gastric pH. Confirm placement only with X-ray.
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| NG tube placement | Place pt in fowler's position. Determine length by measuring NG tube from tip of nose to helix or tip of ear to the xiphoid process. Mark tubing or note striped marking on tube. Place tube in dominant nostril.
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| NG tube procedure | Have pt tilt head forward. Instruct pt procedure will be uncomfortable. Advance tube while asking pt to swallow. Secure to nose.
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| Corpak | Smaller tube diameter NG tube. Softer plastic: soak in an ice bath to firm up plastic for easier insertion. Used only for feeding: can not aspirate or tube wall will collapse. Check placement with gastric PH. Confirm only with X-ray.
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| Gastrostomy | Inserted through abdominal wall directly into stomach. Surgical procedure (difference from PEG tube is how they are inserted). Incision in abdominal wall. Sutured in place. For long term use.
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| PEG Tube | Inserted through the abdominal wall directly into stomach. Endoscopic procedure. Incision in the abdominal wall. Sutured in place. For long term use. Inserted from inside body to outside. Less invasive.
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| Jejunostomy | Tube placed directly into the jejunum. Regurgitation and aspiration is prevented. The stomach is bypassed. Emesis may still occur.
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| Esophagostomy | Tube is inserted directly into the esophagus. Located above the clavicle to one side of the trachea. Used for ambulatory clients with mouth/throat pathology. Feeding can be done without removing clothing.
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| Nursing responsibilities for enteral tubes | Always assess tube placement before use. If ordered, maintain suction. Maintain patency, monitor I & O, provide nasal and oral care
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| When do you shut off suction in a continuous enteral tube | Shut off suction for abdominal assessment. Shut off for 30 mins after administering meds
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| How do you maintain patency with an enteral tube | Irrigate with 30-60 ml of warm water. Carbonated beverage if the tube is clogged. 1TBLS meat tenderizer in 30 ml warm water.
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| Tube feeding administration | Fowler's position: verify placement. Check residual. Clean technique. Formula should be kept at room temp. Hang only enough to infuse in 8 or less hours. Formula may be diluted. Label tubing/syringe with the date and time.
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| Check gastric residual volume (GRV) | Aspirate gastric content via the tube Measure the amount aspirated Return aspirated contents to the stomach Check MD order for acceptable residual amount prior to feeding Usually notify provider if residual is greater than 200 ml-pt at risk for aspiration
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| Medication Administration | Liquid form of medication is preferred. Many tablets can be crushed and dissolved in water. Do not crush enteric coated or time released capsules. Many capsules can be opened and dissolved in water, check drug guide
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| Complications of tube feeding | Diarrhea: most common, more frequent with continuous feedings. Dry mouth. Aspiration. Obstruction. Displacement. Mucosal/skin irritation. Electrolyte imbalance. Elevated blood glucose levels. gastric distention. Occlusion.
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| Nursing Responsibilities TPN | I&O. Daily weights. Assess and manage central line. Monitor lab values: glucose, urine ketones and specific gravity. BUN. Electrolytes
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