a nursing procedure about how to feed an unconcious patient

1. Feeding of the patient
BY
Aminu Muhammad Hussain

2. • Patients admitted to hospital generally have nutritional needs that
must be met by the nurses. They often have higher energy needs or
small appetites than healthy people and many patients entering
hospital have already lost weight due to their illness.

3. Purpose
• To assist the patient to eat meal
• To meet the nutritional need
• To promote health
• To prevent dehydration
• To improve appetite

4. Indications
Head and neck cancer.
Dysphagia
Inflammatory bowel disease
Trauma
Psychotic illness
Elderly
Pediatric (malnourished)

5. TYPES OF FEEDING
Enteral
The term, enteral, refers to nutrition administered via the gastrointestinal
tract. It may be administered orally or via tube feeding.
Oral
Oral nutritional supplements (ONS) are nutrition support products that
provide an effective and non-invasive way for people to meet their nutrition
needs or increase their nutritional intake.
Tube Feeding
If a person has a condition or illness which limits or impairs oral intake,
enteral nutrition (EN) therapy can be administered directly into the
gastrointestinal tract as a tube feeding. Enteral nutrition via tube feeding
provides life sustaining nutrients

6. CONT.
Parenteral
Parenteral nutrition (PN) is the intravenous administration (feeding into a
vein) of nutrients directly into the systemic circulation, bypassing the
gastrointestinal tract. It is a special liquid mixture containing protein,
carbohydrates, fats, vitamins, minerals, and other nutrients needed to live.
PN represents an alternative or additional approach for nutrition intervention
when nutrition needs cannot be met from the oral or enteral routes alone, or
are contraindicated.

7. Requirement
• A tray containing:
• A glass of water to give at the end of the meal
• Napkin to wipe the face in between
• Mackintosh and towel
• Feeding cup or spoon and fork
• The required amount of feed in a mug at the right temperature
• Kidney tray

8. Principles
• The diet is prescribed by doctor planned by dietician and prepared by nurse
• Food should be prepared at correct time in a pleasant manner and in a
pleasant atmosphere
• Small and frequent meals are preferable for a sick person
• Maintain a chart for intake of food and fluids for seriously ill patients. The
patient should be free from pain and other discomfort during meal time
• Food should be prepared in an attractive manner so that the sight and
smell of should increase his appetite
• Food should not be too hot or too cold

9. Cont.
• Ensure privacy
• Meals should be prepared in clean and covered vessels
• Give enough time for the patient to enjoy his food
• Encourage the patient to develop a taste to his therapeutic regimen
of diet
• Be careful not to spill food. Wipe the patient’s mouth and chin
whenever necessary
• Wash patient’s hand and make him brush his teeth after meals

10. Procedure
• Wash hands thoroughly
• Make sure that patient is not starving
• Explain procedure to patient
• Make sure that therapeutic restriction are considered
• Cover patient below chin with face towel
• Feed the patient either by using spoon or fingers
• Offer water as required
• After meal, give water to rinse mouth and spit into basin or bowl
• Complete feed and wipe mouth
• Record the procedure in the nurse record sheet and intake output chart

11. After the procedure
• Help the patient to wash his mouth and hands
• Remove towel around the neck
• Make the patient comfortable
• Take all the articles to utility room discard the waste, clean the
articles and replace it
• Record the procedure in the nurse’s record sheet and intake output
chart

12. TUBE FEEDING
Ryle's tube feeding refers to giving of feed to a patient through a tube
inserted into the stomach through nose or mouth. The purpose is to feed the
patient who cannot take oral feed such as patient in unconscious state,
following surgery on mouth, throat and esophagus (food pipe).

13. Types of tube /feeding
Nasogastric tube (NGT) starts in the nose and ends in the
stomach.
Orogastric tube (OGT) starts in the mouth and ends in the
stomach.
Nasoenteric tube starts in the nose and ends in the intestines
.
Gastrostomy tube is placed through the skin of the abdomen
straight to the stomach.
Jejunostomy tube is placed through the skin of the abdomen
straight into the intestines.

14. INDICATION
Unconscious patient or semiconscious (stroke, which may impair ability to swallow)
After certain surgeries of the mouth and throat
Patient’s unable to swallow
Premature babies, failure to thrive or inability to eat in young children or infants
When the patient is unable to retain the food, e.g. anorexia nervosa
Cancer, which may cause fatigue, nausea, and vomiting that make it difficult to eat
Critical illness or injury, which reduces energy or ability to eat enough nutrients
Neurological or movement disorders that increase caloric requirements while making it
more difficult to eat
GI dysfunction or disease, although this may require intravenous (IV) nutrition instead

15. REQUIREMENT
Swab sticks and a small bowel with water - to clean the nostrils.
• Mackintosh with cover - to prevent soiling of patient's linen.
• Kidney tray and paper bag to collect soiled swabs and gastric content.
• Liquid paraffin in small container.
• Feed in a container kept in warm water.
• 20 to 50 rnl syringe.
• Container with feed and glass.
• Drinking water

16. PRINCIPLES / GUIDELINES
Give mouthwash frequently to avoid complications of a neglected mouth
Maintain intake and output chart accurately
Measure and drain the feed (fluid) to avoid blockage in the tube
Avoid introducing air into the stomach during each feed. Pinch the tube before the
fluid run into the stomach completely from the tube
Feeding may be given at intervals of 2, 3 or 4 hours and the amount is not
exceeding 150 to 300 ml per feed
Observe for complications such as nausea, vomiting, distension, diarrhea,
aspiration pneumonia, asphyxia, fever, and water and electrolyte imbalance

17. Procedure
Wash hands thoroughly
Place towels around neck in such a way that patients clothing and bed linen
are protected
Make sure the tube is in stomach before giving feeds
Remove spigot. Pinch the tube to prevent air entry. Remove plunger from
syringe and connect to tube
Keep syringe about 12 inches above patients head. Start feed with small
measured amount of water and allow feed to follow slowly and steadily
through tube in such a way, that air does not enter tube
Do not force fluid, allow to flow by gravity
At the end of feed flush tube by pouring small measured amount of water.
Remove syringe and replace spigot

18. PROCEDURE
Explain the procedure to the patient.
• Bring the collected articles to bedside.
• Put the patient in fowler's position or sitting position.
• Spread mackintosh and towel over the patient's chest.
• Clean the nostrils with wet swab sticks.
• Wash hands with soap and water and put on gloves.
• Take Out the gastric content with syringe, discard it in kidney tray.
• Remove the piston by pinching tube near the point of attachment of syringe so that air
does not enter into the tube.
• Pour the feed into the barrel of syringe, let it flow freely, refill the syringes before it gets
empty.

19. AFTER THE PROCEDURE
Remove the Mackintosh and towel
Place the patient in comfortable position
Replace the articles to utility room, clean it and replace it
Record the procedure in nurse’s record sheet and intake and output chart

20. QUESTIONS
1. What are the indications for feeding a patient
2. How many types of feeding method do you know
3. What are the requirement of feeding a patient
4. What guidelines need to be observed when feeding a patient
5. Differentiate types of tube feeding