PART 1: HOT SITZ BATH CONTRAINDICATIONS:

A SITZ BATH is a hipbath, that is, a bath in which a person sits  Open wounds
covered with water up to the hips.  Menstruation
 Pregnant women
- A therapeutic technique that involves soaking the pelvic region in
warm water

KEY TERMS: PART 2: Preparing a Child for Diagnostic

 HIP BATH. A type of bath where only the hips and buttocks
are immersed in water.
 Sterilization. The process of eliminating all forms of microbial
life, including bacteria, viruses, fungi, and spores, to prevent
contamination and infection.
 Hemorrhoids. Swollen veins in the rectum or anus that can
cause pain, bleeding, and discomfort during bowel
movements.
 Perineal Area. The area of skin and tissue between the anus
and the genitals.
 Vasodilation. The widening of blood vessels, which allows for
increased blood flow and decreased blood pressure.
 EPISIOTOMY. A surgical incision made in the perineum during
childbirth to enlarge the vaginal opening and facilitate
delivery
 Lumbar Region. The lower part of the back, consisting of the
five vertebrae between the rib cage and the pelvis.
 Anal Fissures. Small tears in the skin around the anus, which
can cause pain and bleeding during bowel movements.
 Vaginal Infections. Infections caused by bacteria, viruses, or
fungi that affect the vagina and surrounding areas, leading to
itching, burning, and discharge.
PURPOSE:
 To relieve discomfort in your perineal area by applying
heat.
 To reduce inflammation in the perineal and anal area
 To promote healing and reduces the pain, itching and
irritation felt
IMPORTANCE:
Sitz bath helps clean and treat certain problems in the anal area,
genital area, and the perineum.
Procedures
TERMINOLOGIES:
 Diagnostic Procedure is a procedure that is performed
on a PATIENT in order to diagnose a condition disease or
illness.
 Chest X-ray is a non-invasive procedure that provides a
picture of a child's heart, lungs and bones in the chest.
 Electrocardiogram is a record or display of a
person's heartbeat produced by electrocardiography
 Computed Tomography (CT) is a procedure that uses a
computer linked to an x-ray machine to make a series of
detailed pictures of areas inside the body.
 Magnetic Resonance Imaging (MRI) is a procedure that
uses radio waves, a powerful magnet, and a computer
to make a series of detailed pictures of areas inside the
body.
 Ultrasound is a procedure that uses high-energy sound
waves to look at tissues and organs inside the body.
Purpose of Diagnostic Procedures
 To help determine whether a patient has or does not
have a particular condition.
 To detect a disease, its outlook, and its spread
throughout the body.
 To narrow down the possible options to come up with a
final diagnosis.
Benefits of Diagnostic Procedures
 Improve the effectiveness of treatments.

A sitz bath may be done to:  Avoid long-term complications for the infected patient.

 Help ease pain and itching from hemorrhoids.  Evaluate the severity of disease
 Help ease pain from an anal fissure.
 Bathe and soothe the perineum after childbirth.  Estimate prognosis
 Increases blood circulation and soothes irritated skin in
 Monitor the course of disease (progression, stability, or
the area around your vagina and rectum and promotes
resolution)
faster healing.
 Clean and soothe the anal area or perineum after  Detect disease recurrence
surgery or childbirth Clean the anal and genital areas if
you can ’t take a bath or shower  Select drugs and adjust therapy.

INDICATION AND CONTRAINDICATION: COMMON DIAGNOSTIC PROCEDURES:

INDICATIONS: 1. MRI – Magnetic Resonance Imaging

2. Pediatric Chest X-ray
 Hemorrhoids 3. Pediatric Computed Tomography(CT)
 Anal Fissures/Surgery 4. Pediatric Ultrasound
 Episiotomy 5. Renal, bladder, and pelvic exam
 Uterine Cramps 6. Pediatric Electrocardiogram
PART 3: SUCTIONING
 Suctioning is the aspiration of secretions through a
catheter connected to a suction machine or wall suction
outlet
 HYPERVENTILATION very deep, rapid respirations
 Hypoventilation refers to very shallow respirations.
 Ventilation The movement of air in and out of the lungs;
the process of inhalation and exhalation
 Hyperinflation giving the client breaths that are greater
than the client’s normal tidal volume set on the
ventilator through the ventilator circuit or via a manual
resuscitation
 Hyperoxygenation Increasing the oxygen flow before
suctioning and between suction attempts to avoid
suction-related hypoxemia
 Hypoxia Insufficient oxygen anywhere in the body
IMPORTANCE:
 Clear air passages.
 Maintain a patient airway and improve oxygenation.
 Prevent hypoxia when tracheostomy and endotracheal
suctioning are administered.
 Clients who have increased secretions because of
pneumonia or inability to clear secretions because of
altered level of consciousness .
PURPOSES:
1. Oropharyngeal, Nasopharyngeal, and Nasotracheal
Suctioning
 To remove secretions that obstruct the airway.
 To facilitate ventilation.
 To obtain secretions for diagnostic purposes.
 To prevent infection that may result from accumulated
secretions.
2. Tracheostomy or Endotracheal Tube Suctioning
 To maintain a patent airway and prevent airway
obstructions.
 To promote respiratory function (optimal exchange of
oxygen and carbon dioxide into and out of the lungs)
 To prevent pneumonia that may result from
accumulated secretions
INDICATIONS AND CONTRAINDICATION:
1. FOR OROPHARYNGEAL SUCTIONING:
INDICATION:
o Difficulty coughing up secretions and swallowing
o Decreased consciousness
o Visible secretions that obstruct the airflow
o Vomitus in the mouth
o Noisy breath sounds
CONTRAINDICATION:
o Injuries or surgery to the mouth, throat, or airways
o Conscious patient with an intact gag reflex.
o Severe bleeding disorders or clotting abnormalities
o Recent head or neck surgery or trauma
o Patients with a history of tracheal stenosis or
tracheomalacia
o Patients with unstable cervical spine injuries
o Patient with foreign body obstructing the airway
2. FOR NASOPHARYNGEAL SUCTIONING:
INDICATION:
o Increased audible/visible secretions.
o Unable to cough effectively to clear these secretions.
o Decreased oxygen saturations (if measured).
o Abnormal breathing patterns.
o Change in color (for example starts to go blue around
the lips).
CONTRAINDICATION:
o Recent nasal/sinus surgery
o Nasal trauma or bleeding disorders
o Congenital anomalies or deformities of the nasal
passages
o Increased intracranial pressure
o Suspected or actual basal skull or facial fracture
o Ongoing or active nosebleeds (coagulopathy or risk of
bleeding)
o Severe respiratory distress or hypoxia
3. FOR TRACHEOSTOMY SUCTIONING:
INDICATION:
o Long-term mechanical ventilation
o Airway obstruction due to tumors, trauma, or other
conditions
o Respiratory distress due to neuromuscular disease or
paralysis
o Risk of aspiration due to swallowing difficulties or
neurological impairment
o Inability to tolerate endotracheal intubation
CONTRAINDICATION:
o Bleeding disorders or clotting abnormalities
o Unstable cervical spine fractures
o Severe respiratory distress or hypoxia
o Patients with a history of severe tracheal stenosis or
tracheomalacia
o Infections or abscesses in the neck or throat
4. FOR ENDOTRACHEAL SUCTIONING:
INDICATION:
o Respiratory distress or failure due to increased copious
and conditions such as pneumonia, pulmonary edema,
or acute respiratory distress syndrome (ARDS) (may
include signs of increased respiratory rate, tachycardia,
gasping, and difficulty talking)
o Airway obstruction due to tumors, trauma, or other
conditions
o Inability to oxygenate or ventilate effectively due to
neurological impairment or drug overdose
o Need for general anesthesia during surgery or other
procedures
o Protection of the airway in patients who are at risk of
aspiration
o Retained secretions
CONTRAINDICATION:
 o Severe facial or neck trauma that makes intubation 1. To restore the fluid volume that is lost from the body due to
difficult or impossible hemorrhage, vomiting, diarrhea, drainage etc.
o Upper airway obstruction due to anaphylaxis or other 2. To meet the patient’s basic requirements for calories, water,
causes minerals, and vitamins.
o Patients with bleeding disorders or clotting 3. To prevent and treat shock and collapse.
abnormalities 4. To supply the body with adequate amounts of fluids,
o Patients with severe cervical spine injuries or instability electrolytes, and other nutrients when the patient is unable
o Infections or abscesses in the mouth or throat to taken inadequate amount by mouth or oral intake in
contraindicated or impracticable.
5. To administer medicines.
PART 4: IVF TERMINATION
Intravenous Therapy IMPORTANCE:
is a way to give fluids, medicine, nutrition, or blood directly into 1. Allows providers to deliver emergency drugs quickly and
the blood stream through a vein. The word intravenous simply efficiently when they are needed.
means “within a vein” but is most used to refer to IV therapy 2. Most efficient way to get fluid levels back up.
3. Complement a treatment plan that the physician has
IV fluid infusions are prescribed by health care providers to
implemented, or it can be used to help provide people with
restore or maintain hydration and electrolyte status within the
the immune support they need.
body.
INDICATION:
The most used primary IV fluid bag contains 1,000 mL. There are
also 500 mL, 250 mL, 100 mL, and 50 mL bags o Fluid volume deficit
o Patient in need of a blood transfusion
o Administration of medication intravenously
There are three types of intravenous fluid concentrations: o Direct nutrient supply to the blood stream.
isotonic, hypertonic, and hypotonic fluids. o NPO
o Surgery
1. Isotonic fluids are typically administered for fluid and
o Emergency (Stroke, Excessive Bleeding, Poisoning,
electrolyte replacement
Anaphylaxis
2. Hypertonic fluids have a higher concentration of solutes than
blood. CONTRAINDICATION:
3. Hypotonic fluids have a lower concentration of solutes than
blood. o Extremities that have massive edema, burns or injury.
o Infection on extremities
o Collapsed vein.
KEY TERMS:
PARTS OF IV SET INSFUSION
 IV Infusion - the administration of substances into the body
through a vein or veins. What is an IV infusion set?
 Venipuncture Site - the site for puncturing a vein with a
needle to gain venous access, either for phlebotomy (the It is an infusion set that is used to administer intravenous therapy,
collection of blood) or the provision of intravenous therapy. wherein a liquid substance is delivered directly into the patients’
 Infusion Site - the anatomic site through which fluid is vein.
introduced into the body.
The IV infusion set is divided into two types:
 Peripheral Intravenous Catheter (PIC) - a thin plastic tube
inserted into a vein using a needle. • Microdrip set: This infusion set is used for pediatric
 Patency - the quality or state of being open or unobstructed. patients and specific adult patients who require a small,
 IV drip - is a type of intravenous treatment that is slowly closely regulated dose of IV solution as it delivers a small
infused into the bloodstream via a plastic catheter inserted quantity with each drop.
into the vein. • Macrodrip set: This set infuses large quantities of IV
 Collapsed vein - is a blown vein that has caved in, which solution at rapid rates as it delivers a large quantity with
means that blood can no longer flow freely through that each drop.
vein.
 Aseptic Technique - using practices and procedures to
prevent contamination from pathogens.
 Cannula - a thin tube inserted into a vein or body cavity to
administer medicine, drain off fluid, or insert a surgical
instrument.

Intravenous Therapy

PURPOSE:

FUNCTIONS:
1. Spike: Spike allows the flow of fluid from the reservoir
bag/ bottle to the drip chamber.
2. Solution Filter: Filters out particles from the IV fluid.
3. Drip Chamber (Fluid Chamber): Inside the drip chamber,
we can see the fluid, drip down into the IV tube. So, it
helps to measure the manual IV setup. By counting the
number of drops per minute, the rate of flow can be
measured.
4. Tubing: Allows the fluid to travel from the reservoir bag
to the patient.
5. Roller Clamp (Regulator): By rolling the clamp along the
IV tube, the rate of flow of fluid can be controlled.
6. Injection Site: Allows for the IV injection into the
cannula when the IV set is in use.
7. Luer Connector: This connects to the IV cannula.
8. Needle: Allows for injection into the cannula.
POTENTIAL LOCAL COMPLICATIONS OF PERIPHERAL IV THERAPY
1. Phlebitis. The inflammation of the vein’s inner lining, the
tunica intima.
2. Infiltration. Accidental leakage of non-vesicant solutions (IV
Fluids) out of the vein into the surrounding tissue.
3. Extravasation. Accidental leakage of Vesicant solutions (IV
Medications) out of the vein into the surrounding tissue,
causing damage to surrounding tissue.
4. Hemorrhage & Hematoma. Leakage of blood from the blood
vessel into the surrounding soft tissue. S & Sx: redness,
swelling, pain, disfiguring bruise, and bleeding at IV site
5. Local infection at IV site. Indicated by purulent drainage from
site, usually two to three days after an IV site is started.
Monitoring IV Patency
What is IV patency? • A patent IV line is one that is correctly
placed, allowing the treatment to flow directly into the patient's
vein.
If the flow of fluid is slowed or stopped, find out the cause. One of
the following reasons may be found:
1. Spasm of the vein
2. Displacement of the needle
3. Kinking or external pressure on the tube.
4. Minor displacement of the needle has occurred within the
vein.
5. Low pressure within the I.V. fluid
PART 5 : INTAKE AND OUTPUT MONITORING
Key Terms
 Intake: measurement of all those fluids entering the client’s
body such as water, ice chips, juice, milk, coffee, ice-
creams, and fluid include: parenteral, central line, feeding
tube, and blood transfusion
 Output: measurement of all fluid level that leaves the
clients body such as urine, perspiration, exhalation,
diarrhea, vomiting, drainage, bleeding, and wounds
 Intake and Output Chart: is used to assess how much fluid
you drink, measure urine volume, record how often you
pass urine over 24 hours and to show any episodes of
incontinence
Purpose of Monitoring Intake and Output
 Prevent circulatory overload
 Assess hydration and fluid retention
 Evaluate client’s fluid and electrolyte balance
 Evaluate the effectiveness of the diuretic or rehydration
therapy
 Document the client’s ability to tolerate oral fluids
 Recognize significant fluid losses
Importance of Monitoring Intake and Output
 Helps caregivers ensure that the patient has a proper intake
of fluid and other nutrients
 Provides information about retention or loss of sodium and
the ability of the kidneys to concentrate or dilute urine in
response to fluid change
 Measurement of intake and output can monitor the progress
of treatment or of a disorder
INDICATIONS
 Patients with renal failure
 Patients with heart failure
 Patients with electrolyte imbalance
 Patients experiencing severe vomiting and diarrhea
 Patients with nasogastric tubes and drainage collection
devices
 Patients receiving intravenous therapy
 Patients taking medicines such as diuretics and
corticosteroids
CONTRAINDICATIONS
 Patient who has consistent, adequate intake and output
PART 6: BLOOD TRANSFUSION
DEFINITION AND TERMS:
o Formed Elements - cells and cell fragments in the blood
o Whole Blood - term used to indicate that the blood
composition has not been altered
o Fractionated Blood - is prepared by separating whole blood
into its constituent elements using a centrifuge
o Anemia - a condition in which the blood is deficient in red
blood cells or hemoglobin
o Thrombocytopenia - decreased platelet count
 o Leukopenia - low white blood cell count 4.
o Hypoproteinemia - is a condition in which a person has very
low protein levels in the blood
o Antibodies - also called immunoglobulins, is part of the
body’s plasma proteins, that defend primarily against the
extracellular phases of bacterial and viral infections.
o Antigen - a substance capable of inducing the formation of
antibodies
o Agglutinins - specific antibodies formed in the blood
o Agglutinogens - a substance that acts as an antigen and
stimulates the production of agglutinins Purpose:
o Agglutination - the aggregation of red blood cells due to
1.
interactions between surface antigens and plasma
antibodies. 2.
o Hemolysis - the breakdown of red blood cells. 3.
o Rhesus Factor - is an inherited protein that can be found on
the surface of the red blood cell
4.
o Blood Typing - is a method to tell what type of blood you
have
o Crossmatching - is a method used to test the compatibility
of the donor’s blood and the recipient’s blood Importance:
o Blood Transfusion - is generally the process of receiving 1.
blood or blood products intravenously. 2.
Different Blood types and Rh Factors 3.
1. Blood typing is determined by the molecules on the
surface of the red blood cells (RBCs). INDICATION AND CONTRAINDICATION:
2. Rh factor (or Rhesus factor) is a type of protein on the
outside or surface of your red blood cells
1.
TYPES OF BLOOD TRANFUSION
1. Red blood cell Transfusions
o Increases a patient's hemoglobin and iron levels, while
improving the amount of oxygen in the body
o Time it takes: 90-120 minutes, but with severe
hemorrhage 5-10 minutes
o 200-300 ml/unit with 75% hematocrit
o Components: floating in a small volume of plasma and
saline, as well as some preservatives and citrate for
anticoagulation.
2. Platelet Transfusions
2.
o A platelet transfusion can help those who have lower
platelet counts, such as from chemotherapy or a platelet
disorder.
o Time it takes: 30-60 minutes per unit
o The rate is usually 10–20 milliliters per hour. One unit of
plasma is 200-250 mL.
o The initial recommended dose for adults is 10 mL/kg,
and is 10-15 mL/kg for pediatric patients. At 20°C. It
includes both labile and stable factors, albumin, γ-
globulin, fibrinogen, and factor VIII.
3.
3. Plasma Transfusions
o Plasma contains proteins important for health. A person
may receive a plasma transfusion if they have
experienced severe burns, infections, or liver failure.
o This transfusion usually takes 30–60 minutes per unit.
Approximately 350-400mL.
o The initial recommended dose for an adult is 6 units of
pooled random donor platelets or one apheresis unit;
for pediatrics, the dose is 5-10mL/kg.
Whole blood Transfusion
o A person may receive a whole blood transfusion if they
have experienced a severe traumatic hemorrhage and
require red blood cells, white blood cells, and platelets.
o 400-550 ml
o Components: red cells, platelets, plasma,
cryoprecipitated AHF (cryo), and granulocytes
o
IMPORTANCE AND PURPOSE OF BLOOD TRANSFUSION
To restore blood volume after severe hemorrhage
To restore the oxygen-carrying capacity of the blood
To provide plasma factors, such as antihemophilic factor
(AHF) or
factor VIII, or platelet concentrates, which prevent or treat
bleeding
To recover the blood lost from a surgery or an illness
Inability to make enough blood
To prevent complications from an existing blood or bleeding
disorder
Red Blood Cell Transfusion
Indications
• symptoms of reduced oxygen-carrying capacity or tissue
hypoxia
• acute blood loss refractory to administration of
crystalloids
• hemoglobinopathies (such as sickle cell disease)
Contraindications
• RBC transfusion may be contraindicated in patients with
anemia amenable to other therapies
Platelet Transfusion
Indications
• thrombocytopenia
• patients with Disseminated Intravascular Coagulation
(DIC)
• patients with massive hemorrhage
Contraindications
• Thrombotic Thrombocytopenic Purpura
• Heparin-Induced Thrombocytopenia
Plasma Transfusion
Indications
• massive hemorrhage with coagulopathy
• liver disease or failure
• congenital thrombotic thrombocytopenic purpura (TTP)
• severe burns - to help with blood clotting and to boost
their blood volume, which can prevent and treat shock
• vitamin K antagonist therapy reversal
• transplant surgery
• thrombotic microangiopathic anemias
 Contraindication follows the same pathway through the throat and
esophagus and into the stomach.
• Plasma should not be transfused to:
6. Brecht feeder
• increased blood volume or albumin levels
 A syringe that in place of a needle has a piece of
• treat coagulopathy that can be addressed by adjusting
warfarin dose, vitamin K administration, and/or tubing attached its nipple end.
prothrombin complex concentrate  The length of hollow tube can vary, but it is
• normalize abnormal coagulation test results if there is actually about 1 to 2 inches long.
no bleeding 7. Brecht feeding
• as prophylaxis for coagulopathy or bleeding, such as  Is a type of feeding used for cleft lip and cleft
patients with acute pancreatitis and patients who are palate clients.
critically ill (noncardiac and nonsurgery) 8. Cleft palate
 An opening in the roof of the mouth (the palate)
due to failure of the palatal shelves to come fully
4. Whole Blood Transfusion together from either side of the mouth and fuse,
Indication as they normally should, during embryonic
• severe traumatic hemorrhage and require red blood development.
cells, white blood cells, and platelets 9. Cleft lip
• compatible donor-recepient blood type  The presence of one or two vertical fissures (clefts) in the
upper lip. It can be on one side only (unilateral) or both
Contraindication
sides (bilateral).
• availability of monocomponent therapy
• ( use RBCs to treat anemia or use FFP to treat
10. Total Parenteral Nutrition (TPN)
coagulopathy for it can cause volume overload)
 The intravenous administration of a nutritionally
complete solution containing macronutrients,
POSSIBLE COMPLICATIONS AND TRANSFUSION REACTIONS micronutrients, electrolytes, and vitamins to meet
the nutritional needs of patients who are unable
1. Hemolytic reaction to consume or absorb nutrients through the
2. Febrile reaction gastrointestinal tract.
3. Mild allergic reaction
11. Enteral
4. Severe allergic reaction
 through the GI system
5. Circulatory overload
6. Sepsis 12. Regurgitation
 or spitting up, during or after a feeding is a
common occurrence during the first year.
PART 7: FEEDING THE HELPLESS 13. Malnutrition
 is commonly defined as the lack of necessary or
PATIENT
appropriate food substances, but in practice includes
KEY TERMS: both undernutrition and overnutrition.

1. Nasogastric (NG) feeding

 is where a narrow feeding tube is placed through PURPOSE OF FEEDING:
your nose down into your stomach. The tube can
1. Brecht
be used to give you fluids, medications and liquid
• To facilitate feeding when newborn has difficulty in
food complete with nutrients directly into your
sucking.
stomach.
• To prevent discomfort from increased amount of
2. Orogastric feeding
swallowed air.
 is where a narrow feeding tube is placed through
• To prevent aspiration upon feeding.
your nose down into your stomach. The tube can
• To provide efficient safe feeding
be used to give you fluids, medications and liquid
• To avoid any local bruising
food complete with nutrients directly into your
• Facilitate swallowing without regurgitation
stomach.
3. Enteral feeding
2. Nasogastric tube and Orogastric tube
 refers to intake of food via the gastrointestinal
• To introduce a passage into the GI tract and obtain a
(GI) tract.
specimen of the gastric contents.
• To administer tube feedings and medications to clients
4. Nasogastric (NG) tube
unable to eat by mouth or swallow a sufficient diet
 This type of tube is inserted into the nose and
without aspirating food or fluids into the lungs.
down through the throat. It is threaded into the
• To establish a means for suctioning stomach contents to
esophagus and rests in the stomach.
prevent gastric distention, nausea, and vomiting.
5. Orogastric tube
• To remove stomach contents for laboratory analysis.
 This is the same type of tube as the NG tube, but
• To lavage (wash) the stomach in case of poisoning or
it is inserted into the mouth instead. It then
overdose of medications.
 • Feeding clients without intact gag and cough
3. Total Parenteral Nutrition and Enteral Feeding reflexes since the risk of accidental placement
• Sustains and improves nutritional status in patients of the tube into the lungs is much higher in
unable to receive adequate nutrition orally or enterally. those clients
• Provides essential nutrients for patients with severe • Recent nasal surgery and severe midface
malnutrition, gastrointestinal dysfunction, or impaired
nutrient absorption.
trauma.
• Supports healing, recovery, and growth in critically ill or • Nasopharyngeal or esophageal obstruction.
postsurgical patients. • Esophageal abnormalities, such as recent
• To administer medications. caustic ingestions and stricture, because of a
high risk of esophageal perforation.
IMPORTANCE OF FEEDING:
3. OGT
1. Brecht Feeding
 Lower the chances of injury to the lip. INDICATIONS:
 Facilitate swallowing without regurgitation.  Gastric suctioning and/or decompression in the
intubated patient
 Nutrition/feeding administration (prematurity, critical
2. NGT, OGT, Enteral, TPN Feeding illness, anatomic defects)
 Helps provide adequate nourishment to help and not to  Medication administration
hinder restoration of health.  Evacuation of stomach contents
 Helps provide with the fluids and nutrition that the body
needs while patient is unable to eat or drink adequate CONTRAINDICATIONS:
amounts.  Nil in this setting
 Suspected/known basilar skull fracture
INDICATION & CONTRAINDICATION  Maxillofacial trauma

1. Brecht Feeding
4. Enteral
Indication Indications
• Clef lip and palate
 Indicated in patients who cannot maintain adequate oral
• Babies with impaired sucking ability
intake of food or nutrition to meet their metabolic
demands
Contraindication  Patients with dysphagia
• Absence of cleft lip and/or cleft palate  Prolonged anorexia
• Caution in infants with poor swallow  Severe protein-energy undernutrition
 Coma or depressed sensorium
reflex
 Liver failure
• Immediately before and after surgical  Inability to take oral feedings due to head or neck
repair of cleft lip and palate trauma
• When the baby is feeling tired  Critical illnesses (eg, burns) causing metabolic stress
• If the mother desires to breastfed her
baby
Contraindications
2. NGT  Hemodynamic instability with poor end-organ perfusion.
Enteral feeding in patients with bowel ischemia or
Indication: necrosis can make a bad situation worse
 Active GI bleeding
• Difficulty swallowing (dysphagia)  Small or large bowel obstruction
• Head and neck cancers.  Paralytic ileus secondary to electrolyte abnormalities,
• Altered mental status/unconsciousness. peritonitis
• Malnutrition.
5. TPN
• Inflammatory bowel disease (IBD).
• Endotracheal intubation. Indications:
• Stomach decompression
 Severe malnutrition or inability to tolerate oral/enteral
intake.
Contraindication:  Bowel obstruction or dysfunction impairing nutrient
absorption.
 Major gastrointestinal surgery or trauma.
 Prolonged ileus or paralytic ileus.
 Severe burns or extensive skin loss.
 Intractable diarrhea or vomiting.
 Intestinal failure or short bowel syndrome.
 Hypermetabolic states (e.g., sepsis, burns, trauma).

Contraindications:

 Intact gastrointestinal tract functioning adequately for

enteral feeding.
 Patients with reversible conditions that may impair bowel
function but are expected to recover within a short
period.
 Uncontrolled sepsis or shock.
 Non-viable bowel.
 Untreated or uncontrolled hyperglycemia.