main routes of tube feeding

1. What are the main routes of tube feeding used for
short duration?
•
Nasogastric (NG), the most common
•
Nasojejunal (NJ)
•
Nasoduodenal (ND)

2. •
Compare between the tube feeding routes used for short period and
those used for long duration (advantages and disadvantages

3. Advantages and disadvantages of various
feeding routes/ NG
3
1) Nasogastric (NG):
Shor-term
 Indications:
- For patients who are unable to consume oral intake
safely & adequately
 Advantages:
- Easy to place and remove tube
- Uses stomach as reservoir
- Can use intermittent feedings
- Dumping syndrome less than with NI feedings

4. Advantages and disadvantages of various feeding
routes/ NG
4
 Disadvantages:
- Contraindicated for patients at high risk for
aspiration
- Potentially irritating to the nose & esophagus
- May be removed by uncooperative or
confused patients
- Not appropriate for long-term use
- Unaesthetic for patient

5. Advantages and disadvantages of various feeding
routes/ Gastrostomy
2) Gastrostomy:
 Indications:
- For long-term use in patients with a functional gastrointestinal tract
- Frequently used for patients with impaired ability to swallow
 Advantages:
- Same as NG, but more comfortable and aesthetic for patients
- Confirmation of tube placement easier
- Cannot be misplaced into the trachea
 Disadvantages:
- Percutaneous endoscopic gastrostomy insertion contraindicated for patients
who cannot have endoscopy
- Risk of aspiration pneumonia in patients with GERD
- Stoma care required
- Danger of peritonitis
- Potential for tube dislodgment
5

6. •
What are the main differences between intermittent tube feeding
and continuous drip feeding method?

7. 7
2. Continuous Drip Method
- Given at a constant rate over a 12- to 24-hour period to
maximize tolerance & nutrient absorption.
- Used for feeding of critically ill clients because:
= it is associated with smaller residual volumes,
= lower risk for aspiration,
= decrease in the severity of diarrhea.
- It is preferred for feedings delivered into jejunum
- Should be interrupted every 4 hours so that water can be
infused into the line to clear the tubing and hydrate the
client

8. 8
Tube-Feeding Complications
- EN is generally considered safe.
- Aspiration is the most serious complication for
patients:
* with inhibited cough reflex,
* unconsciousness,
* with pulmonary complications.
* with delayed gastric emptying
* with gastroesophageal reflux
- Aspiration increases the risk of aspiration-related
pneumonia

9. •
Q2: Nutrition therapy is used in treating many digestive system
disorders. Among these disorders are gastroesophageal reflux
disease (GERD) and peptic ulcer disease. (5 marks)
•
Discuss these disorders and the nutrition therapy for each of them.

10. (2) Gastroesophageal Reflux Disease(GERD):
- GERD: is the backflow of gastric acid into the esophagus;
- It occurs when symptoms of reflux happen two or more times a week.
- Is caused by an abnormal reflux of gastric contents into the esophagus
related to an abnormal relaxation of the lower esophageal sphincter (LES)
- Factors that lower LES pressure and contribute to gastroesophageal reflux
are:
* Hiatal hernia,
* Obesity,
* Pregnancy,
* Smoking, and
* Certain medications (e.g., dopamine, morphine).
* Genetic factors.
10

11. 11
Nutrition Therapy:
- A three-pronged approach is used to treat GERD:
1. Lifestyle modification, including nutrition therapy;
2. Drug therapy; and
3. Surgical intervention, if necessary.
- Most available evidence shows a link between obesity, especially abdominal
obesity, and GERD and that weight loss improves symptoms.

12. - Lifestyle and nutrition therapy modifications for GERD:
** Most likely effective:
i. Engage in moderate physical activity regularly.
ii. Elevate the head of the bed during sleep.
iii. Lose weight if overweight
iv. Avoid
^ Large meals
^ Lying down for 3 hours after meals
^ Alcohol
^ Heavily spiced & Fatty food
v. Do not smoke
12

13. (1) Peptic Ulcer Disease (PUD)
- Erosion of the gastrointestinal mucosal layer caused by an excess secretion of, or
decreased mucosal resistance to, hydrochloric acid and pepsin
- The majority of peptic ulcers occur in the duodenum; other sites include the lower end of
the esophagus, the stomach, and jejunum.
- Causes of peptic ulcer:
1) Helicobacter pylori infection is implicated in an estimated 70% of
of
gastric ulcers and 92% of duodenal ulcers.
- Most people infected with H. pylori do not develop the disease, which suggests
other factors may be involved
- H. pylori appears to secrete an enzyme that depletes gastric mucus, making the
the
mucosal layer more susceptible to erosion.
13
DISORDERS OF THE STOMACH

14. * For these patients, destroying the bacteria—typically with a combination
of antibiotics and acid- suppressing drugs—generally cures the ulcer.
2) The second leading cause of peptic ulcers is the use of nonsteroidal anti-
inflammatory drugs (NSAIDs).
- Eating spicy food does not cause ulcers
- The most common symptom of ulcers:
a. epigastric pain
b. bloating,
c. early satiety
d. nausea.
- Pain related to duodenal ulcers typically occurs in the fasting state or during
the night and is usually relieved by food
- Chronic PUD may be asymptomatic, particularly when ulcers are caused by
NSAIDs
14

15. - The most common and severe complication of PUD is bleeding.
- Pain or early satiety may impair intake and lead to weight loss.
- Blood loss can lead to iron deficiency.
- Long-term use of medications to decrease gastric acid production may impair the absorption
of calcium, iron, and vitamin B12.
 There is no evidence that diet causes PUD or speeds ulcer healing.
 Patients may be told to avoid coffee, alcohol, and chocolate because these substances
stimulate gastric acid secretion.
 A high fiber diet, especially soluble fiber, may reduce the risk of duodenal ulcer.
 Nutrition intervention may play a supportive role in treatment by helping to control
symptoms.
 Any of the following strategies may help:
* Avoid eating 2 hours before bed.
* Avoid individual intolerances.
* Avoid items that stimulate gastric acid secretion as coffee (decaffeinated and regular),
alcohol, caffeine, and pepper.
15

16. •
Q3: Diabetes mellitus is a group of metabolic diseases characterized
by hyperglycemia related to inadequate insulin secretion,
diminished insulin effectiveness, or both. (10 marks)

17. •
What are the effects of insulin on glucose, protein, and fat?

18. Actions of Insulin and Effects of Its Insufficiency
Nutrient Action of Insulin Results of Insulin Insufficiency
Glucose
 Promotes uptake of glucose into cells
 Promotes formation of glycogen in
the liver and muscle
 Promotes conversion of excess
glucose to triglycerides for storage
•
Decreases uptake of glucose into muscle and adipose
•
Decreases glycogen formation in liver and muscle
•
Increases glycogen breakdown in liver and muscle
•
Increases gluconeogenesis
•
Hyperglycemia
Protein
Promotes uptake of amino acids into
tissue protein
 Decreases uptake of amino acids into muscle
 Decreases protein synthesis
 Increases protein breakdown
Fat
Promotes formation of adipose from
excess fat
 Increases production of ketones in the liver
 Decreases formation of triglycerides in adipose
 Increases triglyceride breakdown in adipose
 Increases serum triglyceride and fatty acid level

19. What are the main types of
diabetes mellitus (DM)? 1.5
Type 1 Diabetes.
Type 2 Diabetes.
Gestational Diabetes

20. What is the main goal of diabetes management? Mention other goals of diabetes
management. 3.5

The primary goal of diabetes management is to keep blood glucose levels
as near normal as possible.

Additional goals are to:
* Attain and maintain reasonable weight
* Attain and maintain control of blood lipid levels & blood pressure
* Prevent or delay development of acute and chronic complications
* Maintain the pleasure of eating without limiting any foods
* Meet the individual’s cultural and personal needs