Enteral & parenteral nutrition

Ngt - clean technique Tpn - sterile technique

• GIT • outside GIT

Insertion of Ngt:
• high-fowler's, sitting, upright
Ngt is used for:
• hyperextend - initially before inserting
• gavage • flex / lean forward - if there is
• lavage resistance on nasopharynx
• decompress • instruct to swallow
• medication
• pt w/ difficulty of
swallowing Feeding through ngt :
• semi- fowler's;
• measure: nose-earlobe-xiphoid • after feeding, still Semi-fowler's (30
mins)
Examples of clean technique: Removal of ngt :
1) gi • Semi-fowler's (hold breath)
2) eyes • monitor for nausea and vomiting
3) vagina

Nursing responsibilities:
1) placement → X-ray (initial & confirmatory) 2) patency
• aspiration per day (ph 0-4) - best way! • flushing (distilled water)
residual volume - N depends on the volume you • 30-60 cc
give • intermittent = before &
< 50% = continue after
• continuous = every 4 hrs
> 50% = hold and reinstill
ph 6-7 (intestines)
Types of Ngt
ph 7 > (lungs) • continuous feeding - every 8 h
• auscultate - least accurate • intermittent - every before meals
- gurgling sound
Tpn - inserted @ veins - jugular; Insertion: (subclavian vein)
subclavian • supine, head of bed lowered (trendelenburg)
• to increase blood flow of the area not allowing
indicated for: air to pass (pulmonary embolism)
• for long term NPO
• inflammatory bowel disease Removal:
• burns (severe) • supine, head of bed lowered (trendelenburg)
• pancreatitis (acute)
Complications:
• severe malnutrition 1) hyperglycemia - too rapid tpn
Contains: • give regular insulin (only insulin that can be
• glucose (Cho) injected iv)
• CHON 2) hypoglycemia - abruptly stopped
• lipids • dextrose (d10)
• amino acids 3) infection - site + glucose
• vitamins • aseptic technique
• minerals • antibiotics

How to compute BMI: Range:

BMI = wt (kg) / ht(m)^2
Height - 5'5"
Weight - 168 lb = 28.022
Height - 5'9 3/4"
Weight - 238 lb = 34. 56
Underweight (below 18.5)
Normal (18.5 - 24.9)
Overweight (25 - 29.9)
Obese (30 >)