*MODES OF FEEDING

* There are four major types of feeding

1. Enteral
2. Parenteral
3. Tube feeding
4. Oral feeding

*Modes of feeding
* Definition
It is a therapy where a feeding tube supplies
nutrients to people who cannot get enough
nutrition through eating

*TUBE FEEDING
* The endoscope is inserted through the mouth
and down the oesophagus which leads to the
stomach. After the endoscopy tube is inserted
the skin the over the left side of belly area is
cleaned and numbed. The doctor makes a small
surgical cut in this area. The g-tube is inserted
through this cut into the stomach.

*PROCEDURE
* Definition
* It refers to nutrition administered via the
gastrointestinal tract either orally or via a tube
or catheter.

*ENTERAL FEEDING
1. Nasogastric tube - from nose to stomach
2. Orogastric tube – mouth to stomach
3. Nasoenteric tube – nose to intestines
4. Oroenteric tube – mouth to intestines
5. Gastrostomy – skin of abdomen the the
stomach
6. Jejunostomy – skin of abdomen to intestine

*TYPES OF ENTERAL
TUBES
1. Aspiration – food going to lungs
2. Skin irritation – insertion of tube
3. Diarrhoea – liquid diet
4. Tube blockage

* COMPLICATIONS OF ENTERAL
FEEDING
* Definition
* Assisting a helpless patient to take food and
fluids through the mouth and this aims to assist
the patient meet his nutritional needs

*ORAL FEEDING
* Check physicians order
* Plan diet according to the need of the client
* Ensure that the ordered diet is prepared
properly and safely
* Find out food habits of the clients
* Check the patient’s ability to cfollow
directions
* Check the general condition of the patient

*ASSESSMENT
* Tray containing prepared diet
* A glass of water
* Face towel – to wipe the face
* Mackintosh and towel – to protect the bed and
garments
* Back rest and cardiac table – for positioning
* Fork and spoon
* Feeding cup with water and a kidney tray – to
wash the mouth before and after feed

*PLAN
* Create a pleasant environment
* Send the visitors away tactfully
* Help the client to dress and appear neat
* Positioning
* Help the client to wash his face and hands

*Preparation of client
and unit
* Wash your hands
* Sit by the bedside
* Feed the client’s slowly
* Give food in order
* Talk pleasantly
* When the client has eaten the food in
sufficient amount stop the feeding and offer a
glass of water

*IMPLEMENTATION
* Help the client wash his mouth face and hands.
Dry the face hands. Provide comfortable
position, tidy up the bed, take all the articles
and the food tray to the utility room, discard
the waste clean the articles in cold water first
then with warm soapy water, clean them and
dry them. Replace them in their proper places
wash hands and record in the nurse’s record.

*CONT.
* Parenteral – feeding intravenously (through a
vein). Parenteral means outside of the
digestive tract .
* Parenteral nutrition bypasses your entire
digestive system from mouth to anus unlike
enteral nutrition where food is delivered
directly into the stomach/ small intestines

*PARENTERAL MODE
OF FEEDING
1. Partial parenteral nutrition (PPN) – is a parenteral
nutrition given to supplement other kinds of feeding
(e.g in cases of malnutrition) Given temporarily to
people who need an immediate boost of calories
before transitioning to a longer term solution either
enteral or gradual mouth feeding
2. Total parental nutrition (TPN) – is complete nutrition
delivered intravenously to people who can’t use their
digestive systems at all. Used when the digestive
system isn't functioning at all or when there's a
gastrointestinal disease that requires it to have
complete rest.

*TYPES OF
PARENTERAL
NUTRITION
* Parenteral nutrition can also be classified by the type of
vein that is used to deliver the nutrition i.e
1. Central parenteral nutrition (CPN) – delivered through
a central vein usually superior vena cava. Used for TPN
since the vein allows a larger catheter to deliver a
higher concentration of nutrients with a higher calories
2. Peripheral parenteral nutrition(PPN) – delivered
through a smaller/ peripheral vein usually at the neck
or limb. Used for partial parenteral nutrition’

*CONT…
* Can be used to feed; minerals, proteins, water,
carbohydrates, fats and vitamins.

* Parenteral nutrition can replace mouth feeding

for as long as required even for life.
I. Abdominal surgery
II. Chemotherapy
III. Intestinal ischemia
IV. Small/ large intestinal obstructions
V. Intestinal pseudo-obstructions
VI. Prolonged ileus
VII.Gastrointestinal bleeding
VIII.Radiation enteritis
IX. Extremely premature birth
X. Prolonged diarrhea
XI. Inflammatory bowel etc

*CONDITIONS THAT
MAY REQUIRE TPN
* External/ tunneled catheter – tunnels under
the skin and out a separate exit point.
* Fully implanted catheter – remains completely
under the skin with a needle insertion port
attached at the end.
* Peripherally inserted central catheter (PICC) –
inserted into the vein at the upper arm and
threaded into the superior vena cava.
( how is the parenteral nutrition IV installed?)

*TYPES OF CATHETERS
* In cases of an external catheter, the external
end of another tube that connects the IV bag
with the nutrition solution is attached. In cases
of an internal catheter the IV tube is attached
to a tube connected to a special needle ( Huber
needle)
* Parenteral nutrition can be offered in hospital,
long term care facility or at home. However
high care is taken to avoid risk of contamination

*HOW IS THE
PARENTERAL
NUTRITION
* The fluid intake and output are periodically weighed and
measured. Some of the things monitored include:
1. Electrolyte and blood urea nitrogen/creatinine – to
prevent dehydration/ overdehydration
2. Blood glucose - to prevent hperglycemia or
hypoglycemia.
3. Mineral levels – to screen for deficiencies
4. Liver function indicators – including aminotransferases
and bilirubin

*MONITORING DURING
PARENTERAL
NUTRITION
* Primary advantage is to give the
gastrointestinal system a chance to heal from
severe illness or surgery.
* It can also give important boosting to help
bodies manage difficulties
* It can be life saving in situations where the
digestive system is impaired

*BENEFITS OF
PARENTERAL
NUTRITION
1. Infection – bacteria from IV catheter can infect the bloodstream and
if it spreads throughout the body it can lead to sepsis
2. Blood clots – can form at the site where the catheter meets the vein
3. GI atrophy – can begin to occur after about two weeks
4. Glucose imbalances – ( hyperglycemia/ hypoglycemia) are common.
Treated with insulin and dextrose adjustments.
5. Transient liver reactions – managed by adjusting the nutritional
formula.
6. Parenteral nutrition-associated liver diseases (PNALD) – its due to
long-term parenteral nutritional. In infants it may be due the liver
which hasn’t fully developed and in adults it may be due diminished
gut bacteria that develops when the gut isn't being used.

*RISKS AND
COMPLICATIONS OF
PARENTERAL
* Gallbladder problems – can result when the
lack of stimulation from the digestive system
causes bile to accumulate without being
released normally into the small intestine.
* Bone demineralization – ( osteoporosis/
osteomalacia) can develop in people who
receive long-term parenteral nutrition possibly
due to vitamin and mineral deficiencies
( calcium, magnesium and vitamin D)

*CONT…
* Injury during insertion of the catheter
* Fluid overload
* Reactions to lipid emulsions in the formula due
to food allergies
* Hunger pangs

*OTHER POSSIBLE
COMPLICATIONS