NUTRITION and diet therapy

1. It is a therapy where a feeding tube
supplies nutrients to people who
cannot get enough nutrition through
eating. A flexible tube is inserted
through the nose or belly area to
provide nutrients by delivering liquid
nutrition directly into the stomach or
small intestines.

2. Providing nutrition
Providing fluids
Providing medication
Decompressing the stomach
Removing stomach contents

3. It is a way of providing nutrition for patients
who are unable to consume an adequate
oral intake but have at least a partially
functional gastrointestinal (GI) tract that is
accessible and safe to use.

4. It dependes on the patient’s medical
status and the anticipated length of
time of tube feeding will be used.
There are two types of feeding route:
The Transnasal Route and Ostomy

5.  Transnasal Route
- it includes nasogastric (NG),
nasoduodenal (ND), and nasojejunal (NJ).
- feeding routes that extend from the
nose to either the stomach or the small
intestine
 Ostomy
- a surgically created opening on the
stomach that made to deliver feedings
directly into the stomach or intestines

6. 1. Gastric tube
(GT) offers direct
access to the
stomach through a
surgical cut in the
left upper side of
your abdomen.

7. 2. Gastrojejunal
(GJ) tube is a
feeding tube that
goes into both the
stomach and small
intestines.

8. 3. Jejunostomy tube
(J tube), like the G
tube, it is placed
through an incision
in the abdomen but
this cut os lower
than the G tube.

9. 4. Nasogastric Tube
(NGT) is inserted
into the nose and
down through the
throat. It is threaded
into the esophagus
and rests in the
stomach.

10. 5. Nasojejunal and
Nasoduodenal (NJ)
and (ND) tubes are
similar to NGT but
extend past the
stomach into the
jejunum or
duodenum of the
small intestine.

11. 6. Orogastric Tube
(OGT) is similar to
NGT but is it inserted
into the mouth
instead. Itthe follows
the same pathway
through the throat and
esophagus and into
the stomach.

12. 7. Percutaneous
Endoscopic
Gastrostomy (PEG)
it uses a lighted
instrument called an
edoscope to place
the G tube through a
surgical hole in the
stomach.

13.  Comatose patients on mechanical ventilation or with a
severe head injury
 A neuromuscular disorder affecting swallowing reflex
 Severe anorexia from chemotherapy, HIV, sepsis
 Upper GI obstruction esophageal stricture or tumor
 Conditions associated with increased metabolic and
nutritional demands include
 Mental illness like dementia

14. Hemodynamic instability with poor end-
organ perfusion.
Active GI bleeding
Small or large bowel obstruction
Paralytic ileus secondary to electrolyte
abnormalities, peritonitis

15. Moderate to severe malabsorption
Diverticular disease
Fistula in the small bowel
Short bowel disease in the early stages.

16. Aspiration
Diarrhea
Nausea
Distention and Bloating
Dehydration
Fluid overload
Constipation
Gatric rupture
Clogged Tube
Anxiety
Dry mouth

17.  Daily weight to defect fluid shifts
 Daily intake and output
 Gastric residuals every 4-6 hrs in critically ill
patients
 Character and frequency of bowel
movements
 Signs and symptoms of intolerance
 Daily electrolyte levels, BUN and creatinine
 External length of the tube, to check for
displacement
 Tube site for infection

18. Formula Function Food sources
Intact Formula Also called polymeric formulas, contain
unaltered molecules of proteins,
carbohydrates, and fats. They are best
for people who can digest and absorb
nutrients without difficulty.
Carbohydrates
Protein
Hydrolyze Also known as Monomeric formulas are
"predigested" and are a good choice for
patients who lack the ability to digest or
have a small absorptive area.
Cornstarch, honey, dried fruits and fruit
juices
Modular It provides different forms of individual
nutrients to supplement existing
formulas.
Dairy, fruits, grains, legumes, and
starchy vegetables

19. It is an intravenous administration of
nutrition, which may include protein,
carbohydrate, fat, minerals and
electrolytes, vitamins and other trace
elements for patients who cannot eat or
absorb enough food through tube feeding
formula or by mouth to maintain good
nutrition status.

20. Total parenteral nutrition (TPN): The only
source of nutrition is the IV administered
nutrition. TPN is given through central
venous access. Total parenteral nutrition is
not administered through a peripheral
intravenous catheter because it has high
osmolarity. High osmolarity irritates
peripheral veins.

21. Peripherical parenteral nutrition (PPN):
PPN is used to provide additional nutrition
to patients with functional gut and enteral
feedings. It is the delivery of nutrients via a
peripheral vein (veins located in arms or
legs, outside the superior vena cava). The
PPN bag may contain insulin to prevent
excessively high blood sugars.

22.  Gastrointestinal surgery
 Intolerance to enteral nutrition
 Enterocutaneous fistula
 Pancreatitis
 Gastrointestinal obstruction
 Malabsorption

23.  •Functioning GI tract
 •No safe venous access
 •Hemodynamically unstable
 •Patient not desiring aggressive support
 •Anticipated treatment with TPN <5 days in
patients without severe malnutrition

24. Mechanical and Septic Complications
Hyperglycemia
Hepatobiliary Disease
Biliary Complications
Manganese Toxicity
Bone Disease
Calcium Deficiency
Refeeding syndrome
Infection
Dehydration and Electrolyte Imbalances

25. ENTERAL NUTRITION
Food getting into the lungs (aspiration)
Infection of the tube or insertion site
Nausea and vomiting
Diarrhea
Skin irritation
Tube blockage
Tube dislodgement

26. PARENTERAL NUTRITION
 Catheter infections
 Blood clots
 Liver disease
 Bone disease
 Fatigue
 Memory loss
 Increased urination