Chapter 11 Nutrition

Copyright 2008 Lippincott Williams & Wilkins.

Functions of Carbohydrates
Provide energy; spare protein Prevent ketosis Absorb water to increase fecal bulk Decease intestinal transit time Slow gastric emptying Lower serum cholesterol level Delay glucose absorption

Copyright 2008 Lippincott Williams & Wilkins.

Functions of Proteins
Tissue growth and repair Component of body framework and body fluids Regulation of fluid balance Regulation of acidbase balance Detoxification of harmful substances Formation of antibodies Transportation of fat and other substances in blood Provide energy when carbohydrate intake is inadequate
Copyright 2008 Lippincott Williams & Wilkins.

Functions of Fat
Provides energy Provides structure Insulates the body Cushions internal organs Necessary for the absorption of fat-soluble vitamins

Copyright 2008 Lippincott Williams & Wilkins.

Factors Affecting Nutritional Status

Socioeconomic status Psychosocial factors Medical conditions involving malabsorption

Age
Medical conditions affecting desire to eat Culture

Medications
Substance abuse Religion
Copyright 2008 Lippincott Williams & Wilkins.

Assessments Made Before Assisting a Patient to Eat

Check the type of diet that has been ordered for the patient Assess for any food allergies, religious, or cultural preferences as appropriate Make sure the patient does not have any lab or diagnostic studies that may impact meal schedule Assess for any swallowing difficulties

Copyright 2008 Lippincott Williams & Wilkins.

Expected Outcomes When Assisting a Patient with Feeding

The patient consumes 50% to 60% of the contents of the meal tray The patient does not aspirate during or after the meal

The patient expresses contentment related to eating as appropriate

Copyright 2008 Lippincott Williams & Wilkins.

Indications for a Nasogastric (NG) Tube

Receive nutrition through a tube feeding using the stomach as a natural reservoir for food Decompress or drain unwanted fluid and air from the stomach Monitor bleeding in the gastrointestinal (GI) tract Remove undesirable substances (lavage), such as poisons Help treat an intestinal obstruction

Copyright 2008 Lippincott Williams & Wilkins.

Assessments Made Before Inserting a NG Tube

Assess the patency of the patients nares Assess the patients history for any recent facial trauma, polyps, blockages, or surgeries

Inspect the abdomen for distention and firmness

If the abdomen is distended, consider measuring the abdominal girth at the umbilicus to establish a baseline

Copyright 2008 Lippincott Williams & Wilkins.

Types of Tube Feedings

Continuous feeding An external feeding pump is needed to regulate the flow of formula

Intermittent feedings
Delivered at regular intervals using gravity for instillation or a feeding pump to administer the formula over a set period of time Might also be given as a bolus, using a syringe to instill the formula quickly in one large amount

Copyright 2008 Lippincott Williams & Wilkins.

Unexpected Situations and Associated Interventions With NG Tube Removal

Within 2 hours after NG tube removal, patients abdomen is showing signs of distention Notify physician

Physician may order nurse to replace NG tube

Epistaxis occurs with removal of NG tube Occlude both nares until bleeding has subsided

Ensure that patient is in upright position

Document epistaxis in patients medical record
Copyright 2008 Lippincott Williams & Wilkins.

Irrigating a Nasogastric Tube Connected to Suction

NG tubes can be used to decompress the stomach and to monitor for GI bleeding The tube is usually attached to suction when used for these reasons or the tube may be clamped The tube must be kept free from obstruction or clogging and is usually irrigated every 4 to 8 hours

Copyright 2008 Lippincott Williams & Wilkins.

Documentation of NG Tube Irrigation

Document assessment of the patients abdomen Record if the patients NG tube is clamped or connected to suction, including the type of suction

Document the color and consistency of the NG drainage

Record the solution used to irrigate the NG tube and ease of irrigation or any difficulty related to the procedure Record the patients response to the procedure and any pertinent teaching points that were reviewed

Copyright 2008 Lippincott Williams & Wilkins.

Expected Outcomes When Caring for a Gastrostomy Tube

The patient ingests an adequate diet The patient exhibits no signs and symptoms of irritation, excoriation, or infection at the tube insertion site

The patient verbalizes little discomfort related to tube placement

The patient will be able to verbalize the care needed for the gastrostomy tube

Copyright 2008 Lippincott Williams & Wilkins.

Wiping Gastric Tube Site With CottonTipped Applicators

Copyright 2008 Lippincott Williams & Wilkins.

Cleaning Gastrostomy Tube With Soap, Water, and Washcloth

Copyright 2008 Lippincott Williams & Wilkins.

Turning or Rotating Guard on Gastrostomy Tube

Copyright 2008 Lippincott Williams & Wilkins.