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Cebu Doctors University

Mandaue City, Cebu College of Nursing

A.Y. 2010 2011

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SUBMITTED BY: (aradela, (ius Augustus (unay, 'isa Marie ,uere-uincia, .i/berly 0allo/a, Maria "ranc1es2a )andigan, Nico Diane )iao, Angeli )oco, Marc 'a3rence 4)N 5 2C
After 6 1ours of varied teac1ing learning e78erience, t1e 'evel $$ students 3ill be able to9

1. define t1e follo3ing ter/s9 1.1 diet 1.: 8eristalsis 1.2 calorie 1.10 gavage 1.; nutrient 1.11 as8iration 1.6 nutrition 1.12 regurgitation 1.< feeding 1.1;dietitian 1.= a88etite 1.16nutritionist 1.> nausea 1.1<1el8less 8atient 1.? anore7ia 2. discuss t1e follo3ing9 2.1 different factors affecting dietary 8atterns 2.2 ty8es of diet 2.2.1 regular diet 2.2.? lo3 sodiu/ diet 2.2.2 lig1t diet 2.2.: lo3@1ig1 calorie diet 2.2.; soft diet 2.2.10 diabetic diet 2.2.6 bland diet 2.2.11 8ureed diet 2.2.< lo3@1ig1 residue diet 2.2.12 das1 diet 2.2.= lo3@1ig1 8urine diet 2.2.1; clear li-uid diet 2.2.> lo3 fat diet 2.2.16 general li-uid diet 2.; different /et1ods in feeding 2.;.1 enteral feeding 2.;.1.1 orogastric tube feeding 2.;.1.2 nasogastric tube feeding 2.;.1.; gastroto/y tube feeding 2.;.1.6 AeAunosto/y tube feeding 2.;.2 total 8arenteral nutrition 2.;.; brec1t feeding 2.;.6 cloc2 face tec1ni-ue 2.6 clients 31o need assistance in feeding ;. e78lain t1e follo3ing ;.1 i/8ortance of feeding 1el8less 8atients ;.2 scientific 8rinci8les a88lied in feeding 1el8less 8atients 6. state t1e i/8ortant nursing res8onsibilities to observe in feeding 1el8less 8atients before, during B after t1e 8rocedure <. de/onstrate beginning s2ills in de/onstrating 1el8less 8atients

1. Diet

food and drin2 considered 3it1 regard to t1eir nutritional -ualities, co/8osition, and effects on 1ealt1 - nutrients 8rescribed, regulated, or restricted as to 2ind and a/ount for t1era8eutic or ot1er 8ur8oses 2. Calorie - a/ount of 1eat needed to raise t1e te/8erature of 12g of 3ater - used to denote t1e 1eat e78enditure of an organis/ and t1e fuel or energy value of food 3. Nutrient - A c1e/ical substance t1at 8rovides nouris1/ent and affects t1e nutritive and /etabolic 8rocesses of t1e body 4. Nutrition - *1e su/ of t1e 8rocesses involved in t1e ta2ing in of nutrients and t1eir assi/ilation and use for 8ro8er body functioning and /aintenance in 1ealt1 - )tudy of food and drin2s as related to t1e gro3t1 and /aintenance of living organis/s 5. Fee in! - An act or 8rocess of 8roviding nutritional inta2e for 8atient 31o is unable to feed 1i/self ". #$$etite - A natural or instinctive desire, suc1 as for food %. Nau&ea - An un8leasant 3ave li2e sensation in t1e bac2 of t1e t1roat, e8igastriu/, or t1roug1out t1e abdo/en t1at /ay or /ay not lead to vo/iting '. #nore(ia - 'ac2 or loss of a88etite, resulting in t1e inability to eat ). *eri&tal&i& - *1e coordinated, r1yt1/ic serial contraction of s/oot1 /uscle t1at forces food t1roug1 t1e digestive tract 1+. ,a-a!e - $ntroduction of nutritive /aterial into t1e sto/ac1 by /eans of a tube 11. #&$iration - #ntry of gastric secretions, oro81aryngeal secretions, e7ogenous food or fluids into trac1eobronc1ial 8assages caused by dysfunction or absence of nor/al 8rotective /ec1anis/s

12. Re!ur!itation - *1e bac23ard flo3 fro/ t1e nor/al direction, as t1e return of s3allo3ed food into t1e /out1 13. Dietitian - An e78ert in food and nutrition 31o su8ervise t1e 8re8aration and service of food, develo8 /odified diets, 8artici8ate in researc1, and educate individuals and grou8s on good nutritional 1abits 14. Nutritioni&t - A s8ecialist 31o study and advise on 1u/an diet 15. .el$le&& $atient - A client 31o is unable to 1el8 1i/self 8erfor/ t1e various activities of daily living.


1. */0&iolo!i1al 2a1tor& 2. *&01/olo!i1al 2a1tor& - )o/e 8eo8le over eat 31en stressed, de8ressed, or lonely but ot1ers eat only a little under t1e sa/e circu/stances 3. 3i2e&t0le - Certain lifestyles are lin2ed to food related be1avior 4. .ealt/ &tatu& - $llnesses and disorders /ay 8revent a 8erson fro/ obtaining ade-uate nouris1/ent 5. Me i1ation - #ffects /ay vary considerably. *1ey /ay alter a88etite, or disturb taste 8erce8tion ". *eer !rou$& %. *er&onal in2luen1e an uni4uene&& - (eo8le /ay develo8 li2es and disli2es based on associations 3it1 a ty8ical food '. Reli!ion - An individuals belief /ay affect 1is nutritional inta2e ). # -erti&in! - "ood 8roducers /ay 8ersuade t1e 8eo8le to c1ange fro/ t1e 8roduct t1ey currently use to t1e brand of t1e 8roduct of t1e 8roducer 1+.#l1o/oli1 5e-era!e&

*1e calories contained in alco1olic drin2s include bot1 t1ose of t1e alco1ol itself and of t1e Auices or ot1er beverages added to t1e drin2

11.#!e - Nutritional re-uire/ents vary t1roug1out t1e life cycle of a 8erson 12.Beie2& a5out t/e /ealt/ e22e1t& o2 2oo - Many 8eo8le ac-uire t1eir beliefs about food fro/ t1e /edia 13.Et/ni1it0 an 1ulture 14.So1io6e1ono7i1 &tatu& - (eo8le 3it1 li/ited inco/e /ay not be able to afford so/e nutritional food needed in t1eir diet 15.T/era$0

2.2.1 Re!ular iet a full, 3ell balanced diet containing all of t1e essential nutrients needed for o8ti/al gro3t1, tissue re8air, and nor/al functioning of t1e organs. In i1ation For U&e "or a/bulatory or 8atients 31ose conditions do not necessitate a /odified diet. Foo Sele1tion ,ui e All foods are allo3ed 2.2.2 3i!/t iet 'ig1t diet s1ould be given in convalescence follo3ing t1e fluid and soft diets, and in t1ose cases not needing s8ecial dietary consideration. In i1ation For U&e 0esting or inactive 8erson

often 8rescribed for gastrointestinal illness or before or after certain ty8es of surgery involving t1e /out1 or gastrointestinal tract. Foo Sele1tion ,ui e: Fruit&: fruit Auices or coo2ed fruits Cereal 2oo &: 3ell coo2ed cereals, strained if necessaryC rice and /acaroniC t1in dry toast. 8e!eta5le&: fres1 s8inac1C celeryC strained 8easC 8otatoes, ba2ed, boiled, or /as1ed. Fat&: butter, t1in crea/ Meat&: not /ore t1an one s/all serving a day of broiled c1o8 or stea2C /eatbrot1s Mil9: 8lain, in eggnog, in crea/ sou8s, in si/8le desserts. Si7$le e&&ert&: custards, Aun2et, ice crea/, gelatin desserts, coo2ed fruits or cereal 8uddings. 2.2.3 So2t iet follo3s t1e regular diet 8attern but /odified in consistency. foods allo3ed are t1ose 31ic1 are easy to digest, suc1 as fruits and vegetables 3it1 lo3 cellulose content, and /et 3it1 little or no toug1 connective tissue li2e elastin. In i1ation 2or U&e (ost o8erative cases 31en 8atient cannot tolerate a full diet "evers and /ild infections %astro intestinal disturbances Convalescence *ransition diet fro/ li-uids to a regular diet Condition in 31ic1 ease of c1e3ing, s3allo3ing and digestion are desired e7tre/e 3ea2ness, c1e/ot1era8y and radiation t1era8y Foo Sele1tion ,ui e: 8e!eta5le&: #llo:e : Dell coo2ed

#-oi e : 0a3 Fruit&: #llo:e : 0i8e /ango, avocado, atis, banana, 8a8aya, 2ai/ito, c1ico, and gra8es 3it1out s2in and seeds, orange sections 3it1out /e/braneC CANN#D E0 CEE.#D9 8ared a88les, c1erries, 8eeled a8ricots, 8eac1es, 8ears, 8lu/s, guavas 3it1out s2in and seedsC strained Auices. A) *E'#0A*#D9 canned 8inea88le, figs, lyc1ees, berriesC ste3ed dried fruits #-oi e : All ra3 e7ce8t t1ose on A''ED#D list. Meat or &u5&titute: #llo:e : 4E$'#D, 4A.#D E0 40E$'#D9 tender, ground or /inced beef, liver, tongue, lean 8or2, brain, c1ic2enC CANN#D9 corned beef, Fienna sausage, /eat loafC eggs coo2ed any 3ay e7ce8t friedC ba2ed or boiled vege/eat, tokwa, or tofuC legu/es 3it1out s2inC /ild 8rocessed, crea/ and cottage c1eese. #-oi e : Meats 3it1 e7cessive fat and connective tissuesC fried and 1ig1ly s8iced canned or cured /eats, fis1 or 8oultryC s1ar8 or s8icy c1eese and c1eese s8reads.

Fat&: #llo:e : 4utter, /argarine, /ayonnaise, crea/, s/oot1 8eanut butter. #-oi e : All ot1ers including nuts and fried or greasy foods. Su!ar: #llo:e : $N MED#0A*$EN9 8lain candies, Aellies, Aa/s and /ar/alade /ade fro/ allo3ed fruits, syru8s. #-oi e : #7cessive a/ounts. 2.2.4 Blan Diet

*1e 4land diet regi/en is a 8rogression of diets /ade u8 of foods 31ic1 do not unduly increase gastric acid 8roduction and are non irritating to t1e gastro intestinal tract. *1e diets range fro/ t1e very restricted 4land $ to t1e rat1er liberal 4land F. 4land Diets $ to $$$ are essentially lo3 fiber diets and are deficient in so/e vita/ins and iron. 4land $F, so/eti/es called )oft 4land, is 8atterned after t1e )oft Diet 3it1 additional restrictions on coffee, tea, alco1ol and certain s8ices and condi/ents. D1en 3ell 8lanned, t1e diet /ay be ade-uate but 8ro81ylactic su88le/entation 3it1 vita/ins and iron desirable. 4land F, so/eti/es called "ull 4land, is t1e "ull or 0egular Diet 3it1 t1e sa/e restrictions as 4land $F. In i1ation& For U&e %astric and duodenal ulcers (e8tic Ulcer Disease G(UDH %astroeso81ageal disease G%#0DH %astritis #so81ageal varices (ost eso81ageal, gastric, duodenal and 8ancreatic surgery Foo Sele1tion ,ui e Blan I 8e!eta5le& D1ite 8otatoes 3@o s2in 5 boiled, baked, or mashed Strained lo3 fiber vegetables li2e carrots, c1ayote, s-uas1. Well-cooked All vegetables not carrots, s-uas1, under A''ED#D list. c1ayote, u8o, green 8a8aya, 8eas, young 8atola, cooked to/ato and Blan II Blan III Foo & to a-oi ;unle&& tolerate <

egg8lant 3@o s2in and seeds. Fruit& None 0i8e bananaC strained /ango, 8a8ayaC canned 8eac1es, 8earsC dilute orange and ot1er fruit Auices. All fruits included in bland $$C avocado, ri8e /ango, c1ico, tiesa, /elon tagalongC scraped cantalou8eC seeded atis, seeded and peeled gra8esC baked a88le 3@o s2inC all canned fruits e7ce8t figs and 8inea88le. 0a3 e7ce8t t1ose in A''ED#D 1stC canned and freshfgis and 8inea88le.

Meat= Fi&/ an *oultr0 None

Boiled, steamed or baked c1ic2enC Pureed lean /eatC Steamed or boiled tender fis1 G3@o scales or toug1 s2inH.

Tender, baked, broiled creamed, stewed; beef, c1ic2en, fis1, s1ri/8s, tur2ey.

"atty /eatsC toug1 /eats 3it1 gristleC salted, s/o2ed, cured and s8iced as sausage, bologna, sala/iC gravy.

Fat& 4utter Margarine and 4utter Margarine and 4utter, crea/, Nuts /argarine vegetable oils, coo2ing fat, s/oot1 8eanut butter.

S:eet& )ugar /oderation in )ugar, Aelly, syru8, 8lain 1ard candiesC 8anoc1a, /ata/is na bao. )ugar, Aelly, syru8, 8lain 1ard candiesC 8anac1a, /ata/is na bao. Candy containing nuts, glaIed fuit, Aa/, /ar/alade, c1e3ing gu/.

2.2.5 .i!/>3o: Re&i ue Diet .i!/ Re&i ue Diet *1is diet is very restricted in t1e allo3ance of fruits and vegetables so t1at it is very lo3 in fiber content. Ade-uate in energy value and 8rotein, but s1ould be su88le/ented 3it1 vita/ins and /inerals 31en used for 8rolonged 8eriods. In i1ation& For U&e atonic consti8ation s8astic colon Girritable bo3el syndro/eH diverticulosis Foo *lan an Sele1tion ,ui e )a/e as for bland $$$, but 3it1 t1e follo3ing /odifications9 Fegetables "ruits Mil2 Meat grou8 4everages 3o: Re&i ue Diet Allo3 only strained Auices and boiled or ba2ed 8otato 3it1out s2in. Allo3 strained Auices only. )2i//ed /il2 only, and if tolerated. 4eans not allo3ed. Coffee, tea, cola beverages are allo3ed.

A lo: re&i ue iet is a diet designed to reduce t1e fre-uency and volu/e of stools 31ile 8rolonging intestinal transit ti/e (rovide a food and drin2s t1at are easily digested and al/ost co/8letely absorbed to 8roduce only a /oderate a/ount of stool. In i1ation& For U&e acute diarr1ea 3it1 abdo/inal cra/8ing Ulcerative colitis (artial intestinal obstruction, rectal bleeding and stenosis of eso81ageal or intestinal lu/en. Acute 81ases of infla//atory condition of t1e bo3el suc1 as ulceratives colitis, Cro1ns disease, diverticulitis, radiation enteritis Gdue to radiation t1era8yH. $nter/ediate diet after intestinal or rectal surgery as a 8erson 8rogresses fro/ a li-uid to a regular diet #so81ageal varies, ileosto/ies, colosto/ies or narro3ed intestinal lu/en. Foo Sele1tion ,ui e D1ite bread, refined 8asta and cereals, and 31ite rice 'i/ited servings of canned or 3ell coo2ed vegetables t1at do not include s2ins Moderate fres1 fruits 3it1out 8eels or seeds, certain canned or 3ell coo2ed fruits *ender, ground, and 3ell coo2ed /eat, fis1, eggs, and 8oultry Mil2 and yogurt Gusually li/ited to 2 cu8s 8er dayH, /ild c1eese, ricotta, cottage c1eese 4utter, /ayonnaise, vegetable oils, /argarine, 8lain gravies and dressings (ul8 free, strained, or clear Auices 2.2." 3o:>.i!/ *urine Diet

*1e 8urine content of t1e diet outlined belo3 is about 120 to 1<0 /g., 31ereas t1e regular diet /ay contain as /uc1 as =00 to 1000 /g. 8er day. "oods /oderately 1ig1 in 8urines suc1 as /eat, fis1, 8oultry and beans are allo3ed in li/ited a/ounts on t1is diet, 31ile t1ose very 1ig1 in 8urines suc1 as glandular organs, anc1ovies and glandular organs are avoided. (urine a co/8ound t1at is /ainly found in ani/al 8rotein and is /etaboliIed to uric acid in t1e body. In i1ation& For U&e )u88le/entary to /edical /anage/ent of 8atients 3it1 uric acid 8roble/s. %out &y8erurice/ia Uric acid stones Foo Sele1tion ,ui e Foo ,rou$& 8e!eta5le& Fruit& #llo:e All e7ce8t Avoid list. All #-oi e >Re&tri1te t1ose on As8aragus, cauliflo3er, /us1roo/, s8inac1. None

Meat or &u5&titute

4eef, 8or2 and c1ic2en, Anc1ovies, sardines, up to 3 oz. per da ; glandular organsC c1eese and eggs legu/es and lentilsC ot1ers in e!cess of allowance. Coffee, tea, cocoa Alco1olic beverages

Be-era!e& 2.2.' 3o: So iu7 Diet

is a diet t1at includes no /ore t1an 1,<00 to 2,600 /gs of sodiu/ 8er day. *1e 1u/an re-uire/ent for sodiu/ in t1e diet is about =: /g 8er day, 31ic1 is ty8ically less t1an one tent1 as /uc1 as /any diets

Jseasoned to tasteJ. "or certain 8eo8le 3it1 salt sensitive blood 8ressure, t1is e7tra inta2e /ay cause a negative effect on 1ealt1. $ndividuals 3it1 t1e follo3ing /edical conditions are advised to follo3 a lo3 sodiu/ diet9 Congestive 1eart failure, Cirr1osis, .idney disease, MKniLreMs disease, &y8ertension, and Diabetes. Un8rocessed, fres1 foods, suc1 as fres1 fruits, vegetables, lean /eats, 8oultry, fis1 and un8rocessed grains are lo3 sodiu/. 2.2.) 3o: Calorie iet is any diet 8lan t1at allo3s ?00 calories or less in a dayC and t1e diet is overseen by a 81ysician. often 8rescribed for 1y8ertension and ede/atous states. $ndividuals 31o usually go on suc1 a diet are very over3eig1t or suffer fro/ severe obesity. C1ildren, adolescents, and 8regnant 3o/en s1ould not go on t1is diet. 4oiled 8otatoes, Celery, 4roccoli, Mus1roo/, *o/atoes, A8ricot, Melon, 'ean 1a/, 4eef, D1ite eggs, 'o3 fat c1eese are e7a/8les of lo3 calorie foods. .i!/ Calorie iet is a diet furnis1ing /ore calories t1an needed to /aintain 3eig1t, often /ore t1an ;<0056000 calories 8er day. "or 8eo8le 3it1 &untingtonMs Disease it is i/8ortant to eat ade-uately to 8revent 3eig1t loss. (otatoes 8re8ared 3it1 added fat suc1 as butter, /argarine and 31ole /il2, %ranola and ot1er cereals 3it1 dried fruit, Fegetables 8re8ared 3it1 added fat G/argarine, butter, crea/ c1eese, and c1eeseH, Canned fruit in 1eavy syru8, "ried /eats, Meats covered in crea/ sauces or gravy, D1ole /il2 and /il2 8roducts Gyogurt, ice crea/, c1eeseH, D1i88ing crea/ or 1eavy crea/, Crea/ed and /eat sou8s. 2.2.1+ Dia5eti1 iet

is a diet 8rescribed in diabetes /ellitus, usually li/ited in t1e a/ount of sugar or readily available carbo1ydrate. *1e diet /ost often reco//ended is 1ig1 in dietary fiber, es8ecially soluble fiber, but lo3 in fat Ges8ecially saturated fatH. 2.2.11 *uree iet

also 2no3n as )trained soft diet is 31en t1e /eat is ground and vegetables and fruits are 8ureed. Used for 8atients 3it1 difficulties in c1e3ing and s3allo3ing, acute infections@so/e gastrointestinal disturbances and as a transitional ste8 fro/ t1e li-uid to an unrestricted diet in 8ost o8erative 8atients. 2.2.12 D#S. iet Dietary A88roac1es to )to8 &y8ertension is a diet 8ro/oted by t1e National &eart, 'ung, and 4lood $nstitute to control 1y8ertension. *1is eating 8lan is ric1 in fruits, vegetables, 31ole grains, and lo3 fat dairy foodsC includes /eat, fis1, 8oultry, nuts and beansC and is li/ited in sugar s3eetened foods and beverages, red /eat, and added fats. *1e diet reduced systolic blood 8ressure by = // &g and diastolic blood 8ressure by ; // &g in 8atients 3it1 nor/al blood 8ressure. *1ose 3it1 1y8ertension dro88ed by 11 and =, res8ectively. 2.2.13 Clear li4ui iet

$s /ade u8 of clear li-uid foods 31ic1 leave no residue in t1e gastro intestinal tract. $t is non distending, non irritating and non sti/ulating to 8eristaltic action. $t is very ade-uate nutritionally in all res8ects and its use s1ould t1erefore be li/ited to 26 1ours to 6? 1ours. A clear li-uid diet is i/8ortant in so/e cases of diarr1ea and vo/iting Clear snac2 drin2s li2e &iC, .oolaid, and /ost Auice bo7es, (o8sicles, 4ullion or clear brot1 Gs2i//ed of fatH, Cranberry, gra8e and a88le Auices, )o/e ty8es of soda 8o8C non caffeinated, no

artificial s3eeteners, and /ost carbonation GfiIIH s1ould be gone GT/e&e 7u&t 5e ilute 50 one6/al2 :it/ i1e or :ater 2ir&t.< 2.2.14 ,eneral li4ui iet

a li-uid diet includes clear li-uids or o8a-ue fluids t1at are co/8letely or 8artially fluid in consistency. %enerally your doctor /ig1t reco//end you a li-uid diet in case you are about to undergo certain /edical tests, surgery or any ot1er /edical 8rocedures t1at re-uire your sto/ac1 or intestine to be devoid of solid food 8articles. *1e ot1er scenario in 31ic1 you /ig1t be advised to follo3 a li-uid diet is 31en you suffer fro/ ail/ents of t1e digestive syste/ and suffer fro/ 8roble/s li2e diarr1ea or vo/iting. $n addition to t1is if you 1ave trouble s3allo3ing or c1e3ing, t1e doctor /ig1t reco//end you a li-uid diet until t1e 8ro8er c1e3ing and s3allo3ing functions are restored. Nuices, /il2, ice crea/, 8udding, strained crea/ sou8s, fruit nectar 3it1 8ul8, soft coo2ed cereals li2e oat/eal or even 31eat are e7a/8les of li-uids under t1is diet.

DIFFERENT MET.ODS IN FEEDIN,: #. ENTER#3 FEEDIN, $s a very useful /et1od of ensuring ade-uate inta2e of nutrients in 8atients 31o, for a variety of reasons are unable to use t1e oral route, or are unable to ta2e sufficient nutrients to /aintain gro3t1 and develo8/ent. 1. Na&o6,a&tri1 Tu5e Fee in! O refers to t1e 8rocess of 8lacing a soft 8lastic nasogastric GN%H tube t1roug1 a 8atients nostrils, 8ast t1e 81aryn7 and do3n t1e eso81agus into t1e 8atients sto/ac1. O is t1e /ost co//on route for enteral feeding. O4enefits include9 $t is easy to establis1

$t is /ini/ally invasive O ris2@dra3bac2s associated 3it1 N% tube feeding include9 *1e 8rocedure for inserting t1e tube is trau/atic for t1e /aAority of c1ildren *1e tube is very noticeable 4abies and young 8atients and uncoo8erative c1ildren are li2ely to 8ull out t1e tube /a2ing regular re insertion necessary As8iration O N% tube feeding is 8articularly useful in t1e s1ort ter/. O 1o3ever, in t1e ter/, gastrosto/y feeding /ay be /ore suitable O CEN*0A$ND$CA*$EN) to 8assing a naso gastric tube9 Anato/ical defor/ity *rau/a 0ecent oral, nasal or eso81ageal surgery )evere gastro eso81ageal reflu7 desease G%#0DH O $ND$CA*$EN) for enteral nutrition include t1e follo3ing9 (rolonged anore7ia )evere 8rotein energy under nutrition Co/a or de8ressed sensoriu/ 'iver failure $nability to ta2e oral feedings due to 1ead or nec2 trau/a or neurologic disorders

2. Oro!a&tri1 tu5e 2ee in! O is a long, narro3 tube inserted t1roug1 t1e /out1, 31ic1 descends do3n t1e t1roat directly into t1e sto/ac1. O$ND$CA*$EN)9 (rolonged 8ositive 8ressure ventilation (referred route in ne3borns o .ee8s nose o8en for ventilation %astric lavage

Jto 3as1J o suc1 devices are nor/ally used on a 8erson 31o 1as ingested a 8oison or overdosed on a drug or consu/ed too /uc1 alco1ol

ADFAN*A%#) $t is easier to insert an oro gastric feeding tube t1an a naso gastric tube and t1e tube is /ore easily tolerated during use, according to t1e UC' $nstitute of C1ild &ealt1. $t is also a less trau/atic /et1od of feeding for an infant or c1ild. D$)ADFAN*A%#) $f t1e infant is ta2ing so/e breast or bottle feeds, t1e tube s1ould be 8assed as re-uired and re/oved bet3een feeds.

3. ,a&tro&to70 Tu5e Fee in! O !% tube+ is a tube inserted t1roug1 t1e abdo/en t1at delivers nutrition directly to t1e sto/ac1. O $ND$CA*$EN)9 Congenital G8resent fro/ birt1H abnor/alities of t1e /out1, eso81agus, sto/ac1 or intestines )uc2ing and s3allo3ing disorders, 31ic1 are often related to 8re/aturity, brain inAury, develo8/ental delay, or certain neuro/uscular conditions li2e sever cerebral 8alsy. C1ilds inability to gain 3eig1t and gro3 a88ro8riately Advantage9 o used for long ter/ enteral nutrition O t1e t1ree /et1ods for inserting a % tube are9 a. (ercutaneous #ndosco8ic %astrosto/y G(#%H - *1e /ost co//on tec1ni-ue, uses an endosco8e Ga t1in, fle7ible tube 3it1 a tiny ca/era and lig1t at t1e ti8H inserted t1roug1 t1e /out1 and into t1e sto/c1 to guide t1e doctors 8ositioning of t1e % tube b. 'a8arosco8ic *ec1ni-uie

- Done by /a2ing several s/all incisions in t1e abdo/en and inserting telesco8e t1at 1el8s surgeons see t1e sto/ac1 and surrounding organs c. E8en )urgical (rocedure - A good a88roac1 for re8lacing a gastrosto/y tube but usually is severed for cases 31ere t1e c1ilds anato/y 3ont allo3 for a (#%C if t1ere is scar tissue fro/ a 8revious surgery, 8rocedure, or illnessC or if t1e c1ild re-uires anot1er surgical 8rocedure at t1e sa/e ti/e. 4. ?e@uno&to70 Tu5e Fee in! O t1e N tube is surgically i/8lanted in t1e u88er section of t1e s/all intestine called t1e AeAunu/ 31ic1 is Aust belo3 t1e sto/ac1. *1e tube 3ill be located lo3er and /ore to3ards t1e center of t1e abdo/en, 31en co/8aring it to t1e location of a % tube O tube is 8laced for t1e 8atient 31o is unable to ta2e in enoug1 food or drin2 t1roug1 t1e /out1 to /aintain body 3eig1t. Most 8eo8le 31o receive a N tube are t1ose 31o 1ave trouble digesting food or e/8tying t1eir sto/ac1, as8irate food into t1eir lungs O "eeding t1roug1 a N tube is al3ays done using a feeding 8u/8. A visiting nurse or 1o/e care co/8any 3ill 1el8 arrange for your feeding 8u/8 and instructions on 1o3 to use t1e 8u/8 at 1o/e.

B. TOT#3 *#RENTER#3 NUTRITION Also referred to as 1y8erali/entation $s t1e intravenous infusion of 3ater, 8rotein, carbo1ydrates, electrolytes, /inerals and vita/ins t1roug1 a central vein.

Co7$onent& o2 *arenteral Nutrition Co7$onent *rotein De&1ri$tion )u88lied as crystalline synt1etic a/ino acidsC contains essential and nonessential a/ino acids G6 calories@ gra/ of 8roteinC 1 gra/ nitrogen@ =gra/s 8roteinH )u88lied as de7trose at ;.6 calories@gra/. (eri81eral ad/inistration 0P to 10P de7troseC central ad/inistration u8 to <0P, alt1oug1 usual is 20P to 2<P. Added to for/ula9 can include sodiu/, 8otassiu/, c1loride, acetate, calciu/, 81os81orus, /agnesiu/C ad/inistration according to need. Added to for/ulaC can include Iinc, c1ro/iu/, /anganese, and co88erC ad/inistered according to need. 0eco//ended allo3ances of vita/ins A, t1ia/in, riboflavin, 4=, 412, C, D, #, folic acid, niacin, biotin, and 8antot1enic acid. Contains 8ri/arily essential fatty acidsC re-uires se8arate container due to stability 8roble/s.

Car5o/0 rate





*(N for/ulas 8rovide all of t1e 2no3n essential nutrients in -uantities t1at $ro7ote :ei!/t !ain= :oun /ealin!= ana5oli&7= an = in 1/il ren= !ro:t/.

A t1oroug1 nutritional assess/ent is re-uired to deter/ine t1e a88ro8riate *(N regi/en. *raditionally, t1e de7trose, a/ino acids, electrolytes, vita/ins, and /inerals are /i7ed toget1er in one container and infused as t1e 8ri/ary solution.

$ndicated for t1e follo3ing clients9 *1ose, 31o for 8rolonged 8eriods, are unable to ingest food because of trau/a, a co/atose state, or a disease 8rocess *1ose 31o are unable to absorb food via t1e gastrointestinal tract, e.g., a client 3it1 8aralytic ileus *1ose 31o are /alnouris1ed or at ris2 for /alnutrition and 31o 3ill need t1e (arenteral nutrition for longer t1an < days *1ose in 31o/ t1e bo3el or ot1er organs need to rest, suc1 as t1ose 3it1 infla//atory bo3el disease or 8ancreatitis. *1e client receiving *(N is at ris2 for t1e sa/e co/8lications as are clients 3it1 a CFC9 e7a/8le, Cat1eter /is8lace/ent (neu/ot1ora7 cause9 incorrect 8lace/ent of cat1eter )@)9 absence of breat1 sounds on affected side, c1est or s1oulder 8ain, sudden s1ortness of breat1, tac1ycardia, cyanosis. Air e/bolis/ Causes9 o8ened cat1eter syste/, disconnected $F tubings, Air on $F tubings

)@)9 a88re1ension, c1est 8ain, dys8nea, 1y8otension, ra8id and 3ea2 8ulse, res8iratory distress, loud c1urning sound over 8ericardiu/. )yste/ic infection or infection at t1e infusion site causes9 8oor ase8tic tec1ni-ue, cat1eter conta/ination, conta/ination of solution )@)9 c1ills, fever, elevated D4C, #ryt1e/a or disc1arges at insertion site. Metabolic co/8lications G8ossibleH

(otential Co/8lications9 &y8erglyce/ia &y8oglyce/ia Acidosis #lectrolyte deficiency or e7cesses suc1 as9 1y8er2ale/ia, 1y8onatre/ia, and 1y8ocalce/ia. Potential complications durin# therap . *1e nurse /ust9 Monitor t1e clients fluid balance and 3eig1t gain daily. 4lood glucose levels to assess for blood glucose i/balances. $/8le/ent ase8tic /easures to 8revent conta/ination of t1e 8arenteral nutrition solution and t1e infusion cat1eter. )1ould 1andle solutions and infusion tubing carefully, es8ecially 31en setting u8 or c1anging t1e tubing. re"uire meticulous monitorin#

Ma@or Co7$li1ation& a&&o1iate :it/ T*N *ro5le7>1ue& .0$er!l01e7ia: May occur if 1y8ertonic glucose infusion is too fast or if t1ere is too little insulin in t1e solution Si!n& A &07$to7& (resence of sugar in t1e urine GglucosuriaHC 1ig1 blood sugarC e7cessive t1irst G8olydi8siaHC e7cessive urination G8olyuriaHC e7cessive 1unger G8oly81agiaH *re-enti-e #1tion& Ad/inister concentrated glucose solutions very slo3ly via infusion 8u/8. Monitor blood glucose levels. $f infusion rate slo3s, /aintain 8rescribed dri8 rateC never increase t1e infusion rate. Use an infusion 8u/8 to ad/inister t1e infusion, and /aintain 8rescribed flo3 rate. Monitor blood glucose levels. AdAust infusion rate, or decrease insulin in infusion. I77e iate #1tion& Decrease infusion rate if too fastC notify 81ysician, 31o /ay order t1e insulin be added to t1e infusion.

.0$o!l01e7ia: May occur if infusion flo3 sto8s abru8tly or if t1ere is too /uc1 insulin in t1e solution

4lood glucose level belo3 =0/g@dlC dia81oresisC tac1ycardiaC an7ietyC tre/blingC 1ungerC diIIinessC 8ersonality c1angeC


C. BREC.T FEEDIN, Also called as 4rec1t feeder, is a ty8e of feeding used for cleft li8 and cleft 8alate clients. $ndicated for breast feeding because t1e bul2 of t1e /ot1ers breast tends to for/ a seal against t1e inco/8lete u88er li8. An eyedro88er or an Ase8to syringe 3it1 a s1ort 8iece of rubber tubing on t1e ti8. )u88ort t1e baby in an u8rig1t 8osition. *1e dro88er or syringe is used carefully to dri8 for/ula into t1e ne3borns /out1 at a rate slo3 enoug1 to allo3 t1e ne3born to s3allo3.

D. C3OCB F#CE TEC.NICUE Used by 1ealt1care 8roviders to feed 8atients es8ecially for blind 8atients. (ur8ose9 *o assist 8atients 3it1 vision 8roble/s. A3areness t1at t1ey can benefit fro/ verbal clues. *o learn s8ecial tec1ni-ues to feed t1e/selves inde8endently.

$ndicated for9 blind 8atients, geriatric 8atients

C3IENTS D.O NEED #SSIST#NCE FEEDIN, T/e .an i1a$$e 5 t1ese include t1e blind 8atients, 8aralyIed 8atients li2e t1ose 31o re/ain in a bac2 lying 8osition or t1ose 31o cannot use t1eir 1ands T/e El erl0 5 t1ose 8atients 31o are 3ea2ened and -uic2ly fatigued, also t1ose 8atients 31o are c1ronically or acutely ill t1at cannot su88ort t1e/selves C/il renE in2ant&E t/e 7ental6ill $atient& 5 t1ose 3it1 sensory /otor dysfunction Un1on&1iou&>1o7ato&e $atient& or t/o&e $atient& :/o /a-e un er !one &ur!er0 t1ey need i//ediate assistance Gvia $.F. t1era8yH

IM*ORT#NCE OF FEEDIN, .E3*3ESS *#TIENTS (ro/otes regular eating 1abits of 8atients Meets clients nutritional needs (ro/otes nurse client relations1i8 (ro/otes early recovery of 8atients t1roug1 /aintenance of good nutritional deficiencies Corrects nutritional deficiencies $t ensures continual 8ro8er nutrition even if t1e 8atient cannot feed t1e/selves "ood is t1e source of our energy "ood contains essential nutrients, vita/ins and /inerals

SCIENTIFIC *RINCI*3ES #**3IED IN FEEDIN, .E3*3ESS *#TIENTS &u/an Anato/y and (1ysiology 5 t1e digestive syste/ brea2s do3n food and 8rovides nutrients t1at 1el8 8rovide our body 3it1 t1e energy 3e need C1e/istry 5 essential nutrients are 8roteins, carbo1ydrates, fatGli8idsH, 3ater, vita/ins, and /inerals. Car5o/0 rate& are t1e /aAor source of energy for t1e body. *rotein& serves as a source of energy, as substrates for tissue gro3t1 and /aintenance, and for certain biological functions, 3i$i & consist of fats and oils. 8ita7in& are c1e/ical co/8ounds t1at are re-uired for nor/al gro3t1 and /etabolis/ . Mineral& 8lay vital roles in several 81ysiological functions, including critical involve/ent in nervous syste/ functioning, in cellular reactions, in 3ater balance in t1e body, and in structural syste/s, suc1 as t1e s2eletal syste/. Dater is 1el8ful as a conduction syste/ for trans8ortation of vital nutrients and unnecessary 3aste, and as a /ode of te/8erature regulation. Microbiology 5 /icroorganis/s are able to enter t1e body t1roug1 our food and drin2 so t1e food /ust be 8ro8erly coo2ed before eating and utensils /ust be cleaned also before1and (syc1ology 5 t1e 1ealt1 care 8rovider s1ould 8resent a clean and 8leasant environ/ent for t1e 8atientC t1e food s1ould also loo2 a88etiIing so t1at t1e 8atient 3ill eat it (1ysics 5 cleaning of t1e utensils re-uires t1e force of friction to re/ove dirtC 31en doing tube feeding 81ysics is a88lied in ter/s of t1e 1eig1t of t1e feeding *i/e and #nergy 5 8re8are all t1e /aterials needed before starting

4ody Mec1anics 5 observe 8ro8er body /ec1anics to avoid bac2 strains (1ar/acology 5 8atients are given various /edication t1roug1 t1e different feeding tec1ni-ues )ociology 5 t1e nurse s1ould establis1 ra88ort 3it1 t1e 8atient in order to reduce an7iety and /aintain coo8eration NURSIN, RES*ONSIBI3ITIES IN FEEDIN, .E3*3ESS *#TIENTS: Be2ore: - Do /edical 1and 3as1ing - C1ec2 t1e 8atients c1art - %reet and infor/ t1e 8atient of 31at you are about to do - Ferify t1at t1e 8atient 1as been given t1e correct tray - #nsure t1at food is at desired te/8erature - (lace a to3el on 8atients c1est - (rotect clot1ing 3it1 to3el@na82in - 0e/ove un8leasant odor and sig1t fro/ t1e environ/ent Durin!: - Arrange t1e tray conveniently - Al3ays tell t1e 8atient 31at food is being fed or given - Dont rus1 t1e 8atient - 4e t1era8eutic in conversing 3it1 t1e 8atient - (rovide fluids as re-uested - Di8e t1e 8atients /out1 in one event of s8illage #2ter: - C1ec2 t1e 8atients gar/ent for any s8illage - Di8e one 8atients c1in and /out1 starting fro/ t1e least conta/inated to t1e /ost conta/inated - As2 t1e 8atient about 1is@1er feedbac2 about t1e e78erience - Allo3 t1e 8atient to rest - Effer oral care and 1and 3as1ing - Ma2e t1e 8atient co/fortable - 0ecord i/8ortant data - Do after care