MEDICAL NUTRITION THERAPY TUBE FEEDINGS

WHAT IS MNT? Clinical indications

 MNT refers to a comprehensive nutritional • Condition that prevents food intake (e.g.,
assessment based on swallowing & chewing problems, mouth
 identified client needs upon which therapeutic infections)
treatment of disease • Disease state that prevents/limits food
 processes can be based. absorption (e.g.,intestinal disease,
 It is provided by a dietician in conjunction with malabsorptive states)
collaborative management by health care • Increase metabolic needs when oral intake
providers. cannot meet needed nutrient requirements
 It is used to: (e.g., malnutrition, burns, & trauma)
• Correct & replace nutrient deficiencies Site Selections
• Provide adequate nutrition for clients
with defined health problems o NG – nasogastric tube
o ND – nasoduodenal tube
FIRST-LINE TREATMENT
o NJ – nasojejunal tube
 It is important to include nutrition as a part of a
sound foundation on which to base identified
TUBE ENTEROSTOMY
needs, expected outcomes, and response to
treatments.  Involves placement of tubes through a
surgical opening to provide nutrient/fluid
IMPORTANCE OF NUTRITION IN THE OVERALL
intake
MANAGEMENT
Indications
 Dietary factors greatly influence disease risk and
progression. • Specific malabsorptive problems requiring long-
 A stable weight pattern within range of IBW is term therapy
associated with a decreased risk of disease
progression. Site Selections
 Clients feel better when they eat better and are o PEG tube – percutaneous endoscopic
in an acceptable weight range pattern (per BMI). gastrostomy
o PEJ tube – percutaneous endoscopic
jejunostomy
NUTRITIONAL SUPPORT METHODS
PARENTERAL NUTRITION
INDICATIONS FOR NUTRITIONAL SUPPORT
 Nutrients/fluids are delivered through the
 Client physical conditions parenteral route to maintain adequate
 Therapeutic bowel rest metabolic balance.
 Severe PCM/PEM
Site Selections
TYPES OF SUPPORT METHODS
o PPN – peripheral parenteral nutrition
1. ORAL SUPPLEMENT o TPN – total parenteral nutrition
2. TUBE FEEDINGS
3. TUBE ENTEROSTOMY
4. PARENTERAL NUTRITION
NUTRITIONAL REQUIREMENTS FOR CLIENTS WITH
Oral Supplement SUPPORTIVE METHODS

 provides calories & nutrients • Macronutrients

 In liquid or powdered form & are usually • Micronutrients
packaged in ready-to-use formulations.
 Is categorized into 4 types according to • Water
formula types.

MEMBERS OF THE HEALTH CARE TEAM

•Physician

• Dietician

• Nurse

• Client & Family

 ENTERAL NUTRITION

 It refers to a method of feeding clients who MEDICATION

have a functioning GI tract but are unable to
take a diet orally or whose diet is
inadequate.
 Feedings can be delivered either orally or
via a tube placement.
Indications:
• Short-term – via nasogastric tubes or oral route
• Long-term – via enterostomy place surgically or
percutaneously
Clinical indications:
• Condition that prevents food intake (e.g.,
swallowing & chewing problems, mouth
infections)
• Disease state that prevents/limits food
absorption (e.g., intestinal disease,
malabsorptive states)
• Increase metabolic needs when oral intake
cannot meet needed nutrient requirements
(e.g., malnutrition, burns, & trauma)
2 TYPES OF FEEDING
1. Continuous Drip Method
 EN via feeding pump for 24 h/day
2. Discontinuous Method
a. Intermittent Tube Feedings
 EN over 20-60 min, in every 4-6 h
with/without feeding pump
b. Bolus Feedings
 EN over short time period at specified
interval via gravity drip or syringe.
c. Cyclic Feedings
 EN via feeding pump for less than 24
h/day.
FORMULA SELECTIONS
Characteristics of formula include:
1. Medications must be of liquid form. Crush
tablet- form medications (refer to pharmacist).
Flush with 20cc of water.
2. Do not mix together multiple medications
simultaneously unless compatibility is known.
3. Do not hang more than the documented
amount of formula.
4. Change solution/tubing per hospital protocol.
5. Monitor pertinent labs and document daily
weights.
• Work with the health care team members in order
maintain nutritional balance and skin integrity.
• Incorporate the concepts of altered nutritional
status & body image in developing plan of care.
• Be aware that the placement of feeding tubes may
be long-term in nature given the client’s underlying
medical condition.
PARAMETERS TO MONITOR
 Tube placement
 Urine glucose q shift
 Gastric residuals q 4H
 BM and consistency
 Tolerance to feedings
 Record daily weight and I&O
Record weekly
• Serum e- and blood counts
• Chemistry profile
• Nitrogen balance
COMPLICATIONS
Mechanical
• Clogged tube
• Tube dislodgment
• Defected infusion pump

 Protein classification Metabolic

 Nutrient density • DHN
 Amounts of residue and fiber • E- imbalances
NURSING INTERVENTIONS • Altered blood glucose levels

FEEDING Formula-related

1. Inspect the formula to be used. • Diarrhea

2. Check placement of tube prior to any feeding, • Cramps
flush, or medications administration. • Abdominal distention
a. Aspiration of gastric contents • Constipation
b. Introduction of air with auscultation • Nausea
c. X-ray • Vomiting
3. Position the client to semi-fowlers to high- Dermatologic
fowler’s position.
4. Flush the tube before and after feedings (30- • Skin irritation
50ml). • Infection
5. Irrigate tubes every 6-8 H.
6. Include the amounts of flush or irrigation used
in the client’s I & O.
 therapy. DO NO STOP TPN ABRUPTLY – It can
cause rebound hypoglycemia.
PARENTERAL NUTRITION • As TPN is stopped, enteral feeding routes are
increased to a greater percentage of the total
WHAT IS PARENTERAL NUTRITION?
intake. When enteral feedings are being
 It is the administration of nutrients by a route tolerated by the patient (60% of caloric intake),
other than the GI tract, usually intravenously. the client is ready to be taken off from TPN.
• Collaborate with RND & AP in the assessment
2 TYPES
and evaluation of client response.
a. Total Parenteral Nutrition (TPN) • Provide education and support to patient and
b. Peripheral Parenteral Nutrition (PPN) SOs.
• Document pertinent findings relative to TPN
therapy.
• Inspect IV site for S/Sxs of potential irritation &
infection.
• Use a dedicated line for infusion. Always use an
infusion pump with filter.
• Change solutions bag q 24H per agency
protocol – decrease risk of infection.
• 2 RNs must verify solution prior to hanging:
o Prescription of Tx
LIST OF NUTRIENTS o Contents of bag with original order
• Communicate with the entire health care team.
• Dextrose (Carbohydrate source)
• Continuously assess for complications.
• Amino acids (protein source)
• Lipids (fat source)
• Water
• Electrolytes
• Micronutrients
• Vitamins
• Additives

Note: Nutrient needs are calculated by RND.

TNA: TOTAL NUTRIENT ADMIXTURE

 Lipid emulsions are added to dextrose and
amino acid mixtures
 Also called as 3-in-1 mixture
 Advantage: allows infusion over 24 hours PARAMETERS TO MONITOR
Every 8 H
• VS
• Urine fractionals

Daily
• Wt
• I&O
• Serum e-, glucose, crea, BUN
NURSING INTERVENTIONS (TPN) • until stable; then twice weekly

• Verify TPN prescription with 2 RNs using 5/10 Weekly

Rights of Medication principles.
• Serum Mg, Ca, Ph, Albumin
• Run TPN through a dedicated line.
• Liver function Tests
• Change TPN solutions & tubing per protocol q
• CBC
24 hours.
• Review of actual, oral, enteral,
• Ensure that a pharmacist mixes all TPN
• and TPN intake
solutions.
• Inspect TPN products prior to hanging for Fluid Disorders
“cracking” (lipid separation). Do not hang if it is
present. Return it to the pharmacy. • Urine Na or fractional Na excretion
• Infuse TPN using an infusion pump per protocol. • Serum osmolality
• Continuously assess for complications. • Urine specific gravity
• When client is progressing and TPN therapy is to Protein Status
be stopped, follow protocol for discontinuing
• Nitrogen balance, serum prealbumin
 • LSLF, DM(Diabetes mellitus) Diet (Low salt, Low
fat)
Lipid Disorders • NPO
• Serum triglycerides • Soft diet with sap, npo if dyspneic
• Respiratory quotient • LSLF No fruits in diet
• Essential fatty acids • Renal diet
• LSLF Diabetic diet
Hepatic Encephalopathy • DAT (Diet As Tolerated)
• NPO (nothing per Orem)
• Plasma amino acids
• BF- Breastfeeding
Gastrointestinal Losses • DIET FOR AGE WITH AP
• DFA (Diet For Age)
• Serum trace elements • OF (Osteorized Feeding) OF 760N KCAL 4
• Stool exam FEEDINGS POTASSIUM RICH FOODS 1
Baseline Assessment • BANANA PER MEAL DAT EXCEPT DARK COLORED
FOODS
• Weight, height, BMI • 1500 KCAL/ DAY DIVIDED INTO 4 FEEDINGS 1
• Chemistry profile, CBC, BANANA/ MEAL
• coagulation profile, FE, Total • DAT NCCF (No Choco Colored Food)
• Fe-binding capacity and Mg • OF- Osteorized Feeding/ Blenderized Feeding
• Lipid profile
• Liver function tests
• Measures of protein status
• (Albumin, prealbumin, &
• transferrin)

On-going Assessments
• Q shift – VS & I&O
• Daily weights & 24H I&O
• Pertinent labs
• Client’s progress towards
• resumption of normal feeding
• route
• Response to Tx

COMPLICATIONS
Catheter-related
• Occlusion due to
• thrombosis
• Development of air
• embolism
• Incorrect placement

Metabolic-related
• Acid-base
• imbalances
• E- imbalances
• Nutrient deficiencies
• DHN
• Fluid retention

Common Hospital Diets (GTLMH)

• 1600 KCl in 6 divided feedings Diabetic diet

• Soft diet
• DAT NDCF (No Dark Colored Foods)
• Low salt, Low Fat
• DM Diet
• DAT with SAP(Strict Aspiration Precaution)
• No Dark colored foods
• Low Purine Diet