Nutrition in our daily life style . pptx

TERMINOLOGIES
•1. Dyspepsia: Indigestion, a feeling of
fullness, discomfort, nausea and anorexia
•2. Dysphasia: Difficulty in swallowing TUE
•3. Nausea: A sensation of sickness with
inclination to vomit.

•4. Nutrients: Constituents of food, e.g.
Carbohydrate, protein, fat minerals,
vitamins and water.
•5. Regurgitation: Back flow e.g., back flow
of partly digested food into the mouth from
the stomach.

•6. Vomiting: Expulsion of stomach contents
via the esophagus and the mouth.
•7. Anorexia: Lack of appetite
•8. Anorexia nervosa: A psychiatric disorde
characterized by intense fear of becoming
overweight even when emaciated

•9. Anosmia: The loss of sense of smell
•10. Appetite: The psychological stimulus to
eat that may be connected with and
triggered by emotional stimu
•11. Asphyxia: Suffocation. Occurs when the
tissues are unable to obtain adequate
amounts of oxygen

•12. Basal metabolic rate: The amount of
energy needed by the body for essential
processes when at complete rest but awake
•13. Body mass index: A figure derived from
a person’s height and weight that indicates
whether that weight is acceptable

•14. Bulimia nervosa: An eating disorder in
which binge eating is followed by
depression and guilt, self-induced vomiting
and purging
•15. Dysphagia: Painful or difficulty
swallowing; may result from local mouth or
throat disorders, anxiety, or certain central
nervous system disorders

•16. Halitosis: Bad breath
•17. Malabsorption: Inadequate or
disordered absorption of nutrients from the
intestinal canal

•18. Malnutrition: The state of being poorly
nourished. May be caused by inadequate
food or deficiency of hur some essential
nutrients, or by malabsorption due to a
metabolic defect that prevents the body
from utilizing nutrients properly
•19. Nutrition: The science related to the
food requirements of the body

•20. PEG: (Percutaneous A tube inserted into
the stomach through the abdominal
Endoscopic wall to feed clients. May be
temporary or permanent. Gastronomy)
•21. Turgor: Resistance of the skin to
deformation when pinched. Related mainly
to age, but can be a sign of dehydration.

NUTRITION - DEFINITION
•⚫ Nutrients are defined as the constituents
of food, which perform important functions
in our body. If these nutrients are not
present in our food in sufficient amount,
the result is ill health. Important nutrients
include carbohydrates, proteins lipids,
vitamins, minerals, and water.

•Food also contains many substances, which
are non nutrients e.g. Coloring and
flavoring substances in food. Dietetics: It is
the branch of science that deals with the
practical application of the principles of
nutrition in health which is required to the
human body.

•1.Carbohydrates, proteins and fats are the
basic fuels for cellular activity.
•2. Minerals are inorganic substances that
help to regulate body processes. Some work
with the enzymes, some act as catalysts and
some work within the buffer systems.

•3. Vitamins are organic nutrients that
function to regulate physiological processes
such as growth and metabolism.
•4. Water is an important nutrient with
many functions. It acts as a coolant, a
lubricant, a suspending medium and as a
reactant in chemical processes.

•Since the food we eat cannot be used for
fuel in its consumed form, it must be
broken down (digested) to the molecular
level. In molecular form, the chemicals can
be transported and absorbed through the
cell membranes for utilization by the body
cells. This process of digestion consists of
both mechanical and chemical breakdown.

•1. Mechanical digestion includes chewing,
swallowing, peristalsis and defecation.
•2. Chemical digestion is the enzymatic
breakdown of the food stuffs into
chemically simple molecules that can be
absorbed and utilized by the cells.

FACTORS AFFECTING NUTRITIONAL STATUS
•Development: People in rapid periods of
growth (in infancy, and adolescence) have
increased needs for nutrients
• Gender: Nutrient requirements are
different for men and women because of
body composition and reproductive
functions

• Beliefs about food: Beliefs about effects of
food on health and well being can affect food
choices. Many people acquire their beliefs
about food television, magazines, and other
media. Food fads that involve non-traditional
food practices are relatively common.eg honey
is healthier than sugar, organic foods are always
healthier than those exposed to pesticides

•Ethnicity and culture: Ethnicity often
determines food preferences Eg: rice for
Asians, curry for Indians
•Religious practices: Religious practice also
affect diet. Eg.: some Roman Catholics
avoid meat on certain days

•Personal preferences: People develop likes
and dislikes based on associations with a
typical food (A child who loves visit his
grandparents may love pickle made by
them) Individuals likes and dislikes can also
be related familiarity.(children often say
they dislike a food before they sample it)

•Lifestyle: Certain lifestyle are linked to food-
related behaviours. People who spend many
hours at home may take time to prepare more
meals. People who are always in a hurry
probably eat restaurant meals

•Economics: What, how much, and how often
a person eats frequently affected by
socioeconomic status. E.g.: people with
limited income may not be to afford meat
and fresh vegetables.

•Medications and therapy: The effects of
drugs on nutrition vary They may alter
appetite, disturb taste perception interfere
with nutrient absorption or excretion (eg:
Some antidepressants increases food intake)

•Health: A individual’s health status greatly
affects eating habits and nutritional status.
The lack of teeth, ill-fitting dentures makes
food difficult, Disease processes and
surgery of gastrointestinal tract can affect
digestion, absorption metabolism, and
excretion of essential nutrients.

•Advertising: Food producers try to persuade
people to from product they currently use
to the brand of producer.

•Psychological factors: Some people overeat
when stressed, depressed or lonely, others
eat very little under the same conditions.
Anorexia nervosa and bulimia are severe
psychophysiological condition seen most
frequently female adolescents

FACTORS AFFECTING NUTRITIONAL INTAKE
•A) Decreased food intake
•b) Anorexia- Psychosocial factors
•c) Impaired ability to smell and taste
•d) Can develop secondary effect to drug
therapy or medical treatments

•E) Swallowing difficulty
•f) Gl problems
•g) Surgery
•h) Poverty
•i) Consciousness.

NURSING RESPONSIBILITY FOR MEETING
NUTRITIONAL NEEDS OF PATIENTS
•1. Consider the patient’s food preferences
as much as possible.
•2. Encourage the patient to fill out the
selective menu, so that preferred foods will
be served.

•3. Provide the patient with assistance in
selecting the ap propriate foods from the
menu. The use of selective menus has
improved food acceptance in most
hospitals.
•4. Order and deliver the patient’s tray
promptly, when it has been delayed while
he was undergoing tests or pro cedures.

•5. Feed or assist the patient as necessary.
Even patients, who can feed themselves,
may need assistance in open ing milk
cartons, cutting meat and spreading butter
on bread.

•6. Discuss the advantages of the following
diet. Explain to the patient how he will feel
better and heal faster. For some diseases or
disorders, the patient may be required to
follow a special diet during the period of
illness or the remainder of his life.

•A. A high protein diet is essential to repair
tissues in any condition, which involves
healing such as recov ery from surgery or
burns.
•B. A person with diabetes must adhere to a
diet con trolled in calories, carbohydrates,
protein and fat.
•C. A person with hypertension may require
a diet restricted in sodium.

•7. Inform the dietitian or food service
specialist for any special needs the patient
may have.
•8. A patient who has lost his teeth and has
difficulty in chewing will need
modifications in the consistency of the food
he/she eats.

•9. Visit with the patient briefly when
serving the food tray.
•10. Encourage family members to visit
during meal time. If present, a family
member may want to feed the patient who
needs assistance. Be sure that this is
relaxing and safe for the patient.

•11. When conditions allow for it, encourage
the ambulatory patient to go to the dining
hall for meals or open curtains in a double
room so that patients may eat together.
•12. If the patient must eat alone, turn on
the television or radio.

NUTRITIONAL ASSESSMENT
•Nutritional anthropometry is concerned
with the measurements of the variations of
physical dimensions and body composition
at stages of life cycle and different planes
of nutrition. It is a field-oriented method,
which can be easily adopted and
interpreted.

•The basic measurements which should be
made on all age groups are weight in kg,
length/height and arm circumference in
cms. In young children it should be
supplemented by measurements of head
and chest circumference.

•Weight:
•Weight gain is an indicator of growth in
children. It is measured with the help of
the weighing scale. Body weight should be
determined after the first void and before
ingestion of food.

•Anthropometric indices (weight for age):
The Nutritional status can be interpreted
using Gomez Classification as follows:

•Weight: >90% weight for age. Normal.
•76-90% weight for age. Grade I
malnutrition.
•61 <75% weight for age. Grade II
malnutrition.
•<60% weight for age. Grade III
malnutrition..

•Linear measurements: Two types of linear
measurements are commonly used.
•Height or length of the whole body
Circumference of the head and the chest.

•Height: The height of the individual is the
sum of four components-leg, pelvis, spine
and skull. For infants and children
recumbent length (crown- heel length) is
measured.

•The desirable birth weight and length of an
infant is 3 kg and 50 cm respectively. By the
time the baby turns the first birth day, the
birth weight is doubled and an increment of
25 cm in length is reached.

•Head circumference:
•The measurement of head circumference is
a standard procedure to detect pathological
condition in children. Head circumference is
related mainly to brain size. At birth the
circumference of head is greater than that
of the chest.

•Chest circumference: The circumference of
the head and the chest are about the same
at six months of age. After this the skull
grows slowly and the chest more
rapidly.Therefore between the ages of six
months and five years the chest/head
circumference ratio of less than one may be
due to failure to develop or due to wasting
of muscle and fat of chest.

•In nutritional anthropometry the
chest/head circumference ratio is of value
in detecting under nutrition in early
childhood.

•Mid upper arm circumference (MUAC):
• Mid upper arm circumference at birth in a
healthy child is between 10 and 11 cm. Over
the first year the increment in MUAC is 3 to
4 cm as the muscles of the arms start to
develop.

•In the preschool age the increase in MUAC is
only one cm. Hence there is not much
difference between the MUAC of a 3 year
old from that of a 5 year old. So MUAC is an
age independent index. The field workers in
nutrition in our country have fixed the
desirable value for MUAC as 12 cm for
Indian preschool children

•The WHO has recommended 14 centimeter
as a desirable value for MUAC for preschool
children. Hence in screening malnourished
children in a community this method is used
with ease. When the value of MUAC is less
than 12 cm among 1-5 year old children,
they are designated as malnourished.

•In the field condition a bangle with a
diameter of 4 centimeter can be used as a
tool to detect malnutrition. When the
bangle moves smoothly over the mid-upper
arm of the child, it indicates malnutrition.
The bangle test can be conducted with ease
in field condition to screen malnourished
children.

CLINICAL METHODS OF ASSESSING
NUTRITIONAL STATUS
•As a frontline health worker providing
health services at community level, will
almost certainly encounter many people
with nutritional deficiency problems. In
addition to the anthropometric
assessments, you can also assess clinical
signs and symptoms that might indicate
potential specific nutrient deficiency.

•Clinical methods of assessing nutritional
status involve checking signs of deficiency
at specific places on the body or asking the
patient whether they have any symptoms
that might suggest nutrient deficiency from
the patient.

•Clinical signs of nutrient deficiency include:
pallor (on the palm of the hand or the
conjunctiva of the eye), Bitot’s spots on the
eyes, pitting oedema, goitre and severe
visible wasting (these signs are explained
below).

Checking for bilateral pitting oedema in a
child
•In order to determine the presence of
oedema, you should apply normal thumb
pressure on both feet for three seconds
(count the numbers 101, 102, 103 in order
to estimate three seconds without using a
watch). If a shallow print persists on both
feet, then the child has nutritional oedema
(pitting oedema).

GRADES OF OEDEMA
•Depending on the presence of oedema on
the different levels of the body it is graded
as follows. An increase in grades indicates
an increase in the severity of oedema.

0= no oedema
+= Below the ankle (pitting pedal oedema)
++= Pitting oedema below the knee
+++= Generalised oedema.

2. Bitot’s spots
•These are a sign of vitamin A deficiency.
Look at these spots are a creamy colour and
appear on the white of the eye

3. Goitre
•Goitre is a swelling on the neck and is the
only visible sign of iodine deficiency.

4. Visible severe wasting
•In order to determine the presence of
visible severe wasting for children younger
than six months, you will need to ask the
mother to remove all of the child’s clothing
so you can look at the arms, thighs and
buttocks for loss of muscle bulk. Sagging
skin and buttocks indicates visible severe
wasting.

Special Considerations.
•Older people(over the age 60)
•The energy requirement for older person
decreases in comparison with younger
adults as a result of less physical activity
and decreased basal metabolism.

•The requirements for micronutrients do not
decreases. Hence adequate diet for older
people must ensure that micronutrient
requirements are still met even with
reduced energy intake.
•Sufficient intake of fluids are required to
prevent dehydration and improve digestion.

•They need fewer calories than younger
people, but about the same amount of
protein and other nutrients.
•They may need soft food.

•Some older adults also need large amounts
of fibre to prevent constipation
•Some people may choke on thin fluids like
water. In this case, thick fluids are good.

PREGNANT AND LACTATING WOMEN
•Women’s nutritional need for energy,
protein, micronutrients significantly
increases
•Pregnant women require an additional 285
kcal/day and lactating women require an
500 kcal/day.

•Adequate intake of iron, folate, vitamin A,
iodine are particularly important for the
health of both women and their infants.

ADOLESCENTS
•They need at least 2 large mixed meals and
some snacks each day.
•They can eat bulky food.
•Boys need lots of calories.

•Girls need of iron.
•School aged children (6-12 years)
•They need at least 2 to 3 mixed meals and
snacks each day

INFANTS AND YOUNG CHILDREN
•Malnutrition during the early years of life
has a negative impact on cognitive, motor,
skill, physical, social, and emotional
development
•Children(1-5 years old)

•They need breast milk until they are at
least 2 years old.
•They need at least 3 mixed meals and 2
snacks day.
•They cannot eat large bulky meals

•It is especially important for the meals to
be and not to contain parasites or
microorganisms that could cause diarrhoea
or other infection

Babies (6-12 months)
•Need breast milk 8 to 10 times or more
each day.
• They need small meals which are not
bulky,3 to 5 times a day
•Babies under 6 months old They need only
breast milk at least 8 to 10 times each day

ENTERAL NUTRITION
•Enteral nutrition (EN) also referred to as
total enteral nutrition(TEN) is provided
when the client is unable to ingest foods or
the upper GI tract is impaired and the
transport of food to the small intestine is
interrupted.

•Enteral feedings are administered through
nasogastric, nasoduodenal, nasojejunal
feeding tubes, or through gastrostomy or
jejunostomy tubes. Enteral feeding also
known as enteral tube feeding.

INDICATIONS FOR ENTERAL NUTRITION
•Cancer
•Head and neck.
•Upper GI
•Critical illness/trauma

•Neurological and muscular disorders
•Brain neoplasm Cerebrovascular accident
•Dementia
•Myopathy
•Parkinson’s disease.

•Respiratory failure with prolonged
intubation.
•Gastrointestinal disorders Enterocutaneous
fistula
•Inflammatory bowel disease
•Mild pancreatitis

•Inadequate oral intake.
•Anorexia nervosa
•Difficulty chewing
•swallowing Severe depression

ENTERAL FEEDINGS
•Enteral feeding refers to intake of food via
the gastrointestinal (GI) tract. The GI tract
is composed of the mouth, esophagus,
stomach, and intestines.

•Enteral feeding may mean nutrition taken
through the mouth or through a tube that
goes directly to the stomach or small
intestine. In the medical setting, the term
enteral feeding is most often used to mean
tube feeding.

•A person on enteral feeds usually has a
condition or injury. That prevents eating a
regular diet by mouth, but their GI tract is
still able to function.

•Being fed through a tube allows them to
receive nutrition and keep their GI tract
working. Enteral feeding may make up their
entire caloric intake or may be used as a
supplement.
•A. The type and frequency of feeding and
amounts to be administered are ordered by
the primary care provider.

•B. A standard formula provides 1 Kcal per
mL of solution with protein, fat,
carbohydrate, minerals, and vitamins in
specified proportions.
•C. Enteral feedings are administered to
clients through open or closed systems.

•D. Open systems use an open-top container
or a syringe for administration
•e. Closed systems consist of a prefilled
container that is spiked with enteral tubing
and attached to the central access device.
•F. Enteral feedings can be given
intermittently or continuously

•Intermittent feedings are the
administration of 300 to 500 mL of enteral
formula several times per day. Bolus
intermittent feedings are those that use a
syringe to deliver the formula into the
stomach

•Continuous feedings are generally
administered over a 24-hour period using an
infusion pump(often referred to as a
kangaroo pump) that guarantees a constant
flow rate. Cyclic feedings are continuous
feedings that are administered in less than
24 hours(eg: 12 to 16 hours)

TYPES OF ENTERAL FEEDING
•According to the American College of
Gastroenterology, there are six main types
of feeding tubes. These tubes may have
further subtypes depending on exactly
where they end in the stomach or
intestines.

•The placement of the tube will be chosen
by a doctor based on what size tube is
needed, how long enteral feeds will be
required, and your digestive abilities.

THE MAIN TYPES OF ENTERAL FEEDING TUBES
INCLUDE:
•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 (subtypes include
nasojejunal and nasoduodenal tubes).
•Oroenteric tube starts in the mouth and
ends in the intestines.

•Gastrostomy tube is placed through the skin
of the abdomen straight to the stomach
(subtypes include PEG (Percutaneous
Endoscopic Gastrostomy), PRG
(Percutaneous Radiologic Gastrostomy), and
button tubes).

•Jejunostomy tube is placed through the skin
of the abdomen straight into the intestines
(subtypes include PEJ (Percutaneous
Endoscopic Jejunostomy) and
PRJ(Percutaneous Radiologic Gastrostomy)
tubes.

POSSIBLE COMPLICATIONS OF ENTERAL
FEEDING
•Aspiration, which is food going into the
lungs
•Refeeding syndrome, dangerous electrolyte
Imbalances that may occur in people who
are very malnourished and start receiving
enteral feeds

•Infection of the tube or insertion site
•Nausea and vomiting that may result from
feeds that are too large or fast, or from
slowed emptying of the stomach
•Skin irritation at the tube insertion site

•Diarrhea due to a liquid diet or possibly
medications
•Tube dislodgement
•Tube blockage, which may occur if not
flushed properly
•There are not typically long-term
complications of enteral feeding.

TUBE FEEDING (GASTRIC GAVAGE,
NASOGASTRIC TUBE FEEDING)
•Gavage (gastric) feeding is an artificial
method of giving fluids and nutrients
through a tube, that has passed into the
oesophagus and stomach through the nose,
mouth or through the opening made on the
abdominal wall, when oral intake is
inadequate or impossible.

INDICATIONS FOR TUBE FEEDING
• A. When the patient is unable to take food by
mouth.eg: unconscious, semiconscious patients.
• B. For a patient who refuses food.eg: patient
with psychosis.
• C. When conditions of mouth or oesophagus
make the swallowing difficult or impossible.eg:
fracture of the jaw, surgery of the mouth,
throat, and oesophagus etc.

•D. When the patient is too weak to swallow
food or when the conditions make it
difficult to take a large amount of food
orally.eg: acute and chronic infections,
severe burns, malnutrition etc.
•E. When the patient is unable to retain the
food.eg: vomiting

ADVANTAGES OF TUBE FEEDING
•1) An adequate amount of all types of
nutrients including distasteful foods and
medications can be supplied.
•2) Large amount of fluids can be given with
safety.
•3) The dangers of parenteral feeding are
avoided.

•4) Tube feeding may be continued for weeks
without any danger to the patient.
•5) The stomach may be aspirated at any
time if desired.
•6) Overloading of the stomach can be
prevented by a drip method

PRINCIPLES
•Tube feeding is a process of giving liquid
nutrients or medications through a tube
into stomach when the oral intake is
inadequate or impossible
•A thorough knowledge of the anatomy and
physiology of digestive tract and respiratory
tract ensures safe induction of the tube

•Microorganisms enter the body through
food and drink.
•Introduction of the tube into the mouth or
nostrils is a frightening situation and the
client will resist every attempt. Mental and
physical preparation of the client
facilitates introduction of the tube.

•Systematic ways of working adds to the
comfort and safety of the client and help in
the economy of material time, and energy

FEEDING THE HELPLESS PATIENT
•It is assisting a dependent patient to take
food and fluids.

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

GENERAL INSTRUCTIONS
•The diet is prescribed by doctor planned by
dietitian and sewed by nurse.
•Food should be sewed 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 served in an attractive
manner so that the sight and smell of
should increase his appetite.

•Food should not be too hot or too cold.
Meals should be sewed 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 hands and make him brush
his teeth after meals.

PRELIMINARY ASSESSMENT
•Check
•Doctors order for any specific precautions.
•Patients likes and dislikes and
socioeconomic status.
•Find out the food habits of the patient.

•General condition and the ability for self-
care,
•Patients ability tom follows instructions.
•Ensure that the ordered diet is prepared
properly and safety.
•The articles available in the patients unit.

PREPARATION OF THE PATIENT AND THE
ENVIRONMENT
•Create a pleasant environment for the
patient by well ventilated, free from noise,
odor and unpleasant sight.
•Send the visitors away tactfully.
•Give bed pan or urinal to patient if
required before meals.

•If patient can sit help him to have fowler’s
position with cardiac table or over bed
table.
•Provide hand washing facilities to patient
and if necessary help him, so that he will
feel fresh.
•Place the towel over the chest and under
the chin to protect clothing.

EQUIPMENT
•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
•The required amount of feed in a mug at
the right temperature
•Kidney tray.

PROCEDURE
•Wash hands thoroughly. Make sure that
patient is not starving for any procedure.
•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, to rinse
mouth and spit into K-basin.
•Complete feed and wipe mouth.
•Record the procedure in the nurse record
sheet and intake output chart.

AFTERCARE
•Help the patient to wash his mouth and
hands. 0 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.

NASOGASTIC TUBE INSERTION
• Nasogastric (NG) intubation is a procedure
in which a thin, plastic tube is inserted into
the nostril, toward the esophagus, and
down into the stomach.

•Once an NG tube is properly placed and
secured, healthcare providers such as the
nurses can deliver food and medicine
directly to the stomach or obtain
substances from it.

•The technique is often used to deliver food
and medicine to a patient when they are
unable to eat or swallow.
•NG tubes are usually short and are used
mostly for suctioning stomach contents and
secretions.

RYLE'S TUBE
•Ryle’s Tube popularly referred to as
‘Nasogastric tube’ or NG tube is a long and
narrow bore tube, made out of silicone or
polyurethane, prominently used to gain
access to a patient’s stomach and its
contents.

•The Nasogastric tube is mainly used for the
treatment of stroke patients with dysphagia
and on patients on ventilators.

PURPOSE OF NASOGASTRIC TUBE:
•The Nasogastric tube is inserted primarily
for two purposes;
•1. For Nasogastric Aspirations-Nasogastric
Aspiration is the process of emptying the
upper gastrointestinal tract of
gastrointestinal secretion and swallowed
air.

•Nasogastric aspiration is also used in cases
of poisoning to drain the ingested toxic
liquid and to extract gastric liquid samples
for analysis.
•2. For feeding and administering medicines
and other oral agents like activated
charcoal.

TYPES OF TUBES
•Tubes that pass from the nostrils into the
duodenum or jejunum are called
nasoenteric tubes. The length of these
tubes can either be medium (used for
feeding) or long (used for decompression,
aspiration).

•Levin tube.
•It is a single-lumen multipurpose plastic
tube that is commonly used in NG
intubation. Levin tube is a single lumen
rubber or plastic tube mainly used for the
administration of medication and or
nutrition

•Salem sump tube.
•A double-lumen tube with a “pigtail” used
for intermittent or continuous suction. The
Salem sump tube is a large bore tube with
double lumen. One lumen is meant for
suction and drainage, while the other
smaller lumen is used for ventilation.

•Moss Tube: The Moss tube is a triple lumen
tube with radiopaque tip. The first lumen is
positioned and inflated in the cardia, the
second lumen serves as oesophageal
aspiration port and the third lumen is used
as duodenal feeding port

INDICATIONS:
•By inserting a nasogastric tube, you are
gaining access to the stomach and its
contents.
•This enables you to drain gastric contents,
decompress the stomach, obtain a specimen
of the gastric contents, or introduce a
passage into the GI tract.

•This will allow you to treat gastric
immobility, and bowel obstruction. It will
also allow for drainage and/or lavage in
drug over dosage or poisoning.
•In trauma settings, NG tubes can be used to
aid in the prevention of vomiting and
aspiration, as well as for assessment of GI
bleeding, NG tubes can also be used for
enteral feeding initially.

Gastric decompression.
•The nasogastric tube is connected to suction
to facilitate decompression by removing
stomach contents. Gastric decompression is
indicated for bowel obstruction and
paralytic ileus and when surgery is
performed on the stomach intestine.

Aspiration
•Aspiration of gastric fluid content. Either
for lavage or obtaining a specimen for
analysis. It will also allow for drainage or
lavage in drug over dosage or poisoning.

Feeding and administration of medication
•Introducing a passage into the GI tract will
enable a feeding and administration of
various medications NG tubes can also be
used for enteral feeding initially

Prevention of vomiting and aspiration.
•In trauma settings, NG tubes can be used to
aid in the prevention of vomiting and
aspiration, as well as for assessment of GI
bleeding.

PURPOSE
•To feed patient with fluids when oral intake
is not possible.
•To dilute and remove consumed position.
•To instill ice cold solution to control gastric
bleeding.

•To prevent stress on operated site by
decompressing
•To relieve vomiting and distention.
•To collect gastric juice for diagnostic
purposes.

EQUIPMENT
•1.Nasogastric tube in appropriate size
•2. Syringe 10ml (1)
•3. Lubricant
•4. Cotton balls
•5. Kidney tray (1)
•6. Adhesive tape

•7. Stethoscope (1)
•8. Clamp (1)
•9. Marker pen (1) 10.
•Steel Tray (1)
•11. Disposable gloves 1 pair

•ChecK
•Doctors order for any specific instruction.
Patients ability to follow instructions.
•General condition of the patient.
•Articles available in the unit.

PREPARATION OF THE PATIENT AND UNIT
•Explain the sequence of procedure.
•Arrange the articles at the bedside.
•Provide privacy.
•Place the Mackintosh and towel across the
chest.
•Provide comfortable position.

•Remove the dentures, if any and place it in
a bowel of clean water.
•Give mouthwash and help him to clean the
teeth.
•Clean the nostrils, if there are secretions or
crust formation, using swab stick dipped in
saline.

PROCEDURE
•Check the Doctor’s order for insertion of
Nasal gastric tube.
•Explain the procedure to the client.
•Gather the equipments.
•Assess client’s abdomen

•Perform hand hygiene. Wear disposable
gloves if available.
•Assist the client to high Fowler’s position,
or 45 degrees, if unable to maintain upright
position.

•Checking the nostril:
•Check the nares for patency by asking client
to occlude one nostril and breathe the
normally through the other.
•Clean the nares by using cotton balls
• Select the nostril through which air passes
more easily.

•Measure the distance to insert the tube by
placing:
•Place the tip of tube at client’s nostril
extending to tip of earlobe
•Extend it to the tip of xiphoid process.
•Mark tube with a marker pen or a piece of
tape

•Lubricant the tip of the tube (at least 1-2
inches) With a water soluble lubricant.
•Inserting the tube:
•1. Insert the tube into the nostril while
directing the tube downward and backward.
2. The client may gag when the tube
reaches the pharynx.

•3. Instruct the client to touch his chin to his
chest.
•4. Encourage him/her to swallow even if no
fluids are permitted.
•5. Advance the tube in a downward and
backward direction when the client
swallows.

•6. Stop when the client breathes
•7. If gagging and coughing persist, check
placement of tube with a tongue depressor
and flashlight if necessary.
•8. Keep advancing the tube until the
marking or the tape marking is reached.

•Nursing Alert
•Do not use force. Rotate the tube if it
meets resistance.
•Discontinue the procedure and remove the
tube if there are signs of distress, such as
gasping, coughing, cyanosis, and the
inability to speak or hum.

METHODS TO CONFIRM NG TUBE IN THE
STOMACH
•Aspirate: Attach the syringe to the end of
NG tube and aspirate small amount of
gastric contents.

•Immerse distal end of tube: Into bowel of
water and check for air bubbles. If the tube
is in the trachea, air bubbles will coincide
with the expiration of each breath.

•Auscultate: Attach syringe to free end of
NG tube, place diaphragm of stethoscope
over left hypochondrium.Inject 10 mL of air
and auscultate abdomen for gushing sound.

•Secure the tube with tape to the client’s
nose. Nursing Alert: Be careful not to pull
the tube too tightly against the nose.
•Clamp the end of nasal-gastric tube while
you bend the tube by fingers not to open
Put off and dispose the gloves, Perform
hand hygiene.

•Replace and properly dispose of equipment.
•Record the date and time, the size of the
nasal gastric tube, the amount and color of
drainage aspirated and relevant client
reactions. Sign the chart
•Report to the senior staff.

CONTRAINDICATIONS:
•Nasogastric tubes are contraindicated in the
presence of severe facial trauma
(cribriform plate disruption), due to the
possibility of inserting the tube
intracranially. In this instance, an orogastric
tube may be inserted.

NURSING CONSIDERATIONS
•Provide oral and skin care. Give mouth
rinses and apply lubricant to the patient’s
lips and nostril. Using a water-soluble
lubricant, lubricate the catheter until
where it touches the nostrils because the
client’s nose may become irritated and dry.

•Verify NG tube placement. Always verify if
the NG tube placed is in the stomach by
aspirating a small amount of stomach
contents. An X-ray study is the best way to
verify placement.

•Wear gloves. Gloves must always be worn
while starting an NG because potential
contact with the patient’s blood or body
fluids increases especially with
inexperienced operator.

•Face and eye protection. On the other
hand, face and eye protection may also be
considered if the risk for vomiting is high.
Trauma protocol calls for all team members
to wear gloves, face and eye protection and
gowns.

COMPLICATIONS
•The main complications of NG tube
insertion include aspiration and tissue
trauma. Placement of the catheter can
induce gagging or vomiting, therefore
suction should always be ready to use in the
case of this happening.

GASTRIC GAVAGE
•Gastric gavage or nasogastric tube feeding
is given through tube which is inserted
through patient’s nose into stomach, when
patient is unable to take food orally.
•It is the administration of fluid food by
means of tube passed into the stomach it is
also called gastric gavage.

PURPOSES
•To provide adequate nutrition.
•To give large amounts of fluids for
therapeutic purpose.
•To provide alternative manner to some
specific clients who has potential or
acquired swallowing difficulties.

•To introduce food into stomach when the
patient is not able to take food in the usual
manner.
•When the condition of mouth or esophagus
makes swallowing difficult.

INDICATION FOR TUBE FEEDING
•Unconscious patient or semiconscious.
•After certain surgeries of the mouth and
throat. Patients unable to swallow.
•Premature babies.
•When the patient is unable to retain the
food, e.g.Anorexia nervosa and vomiting.

•Give mouthwash frequently to avoid
complications of a neglected mouth.
•Maintain accurate intake and output chart.
•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 to the stomach completely.
• 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.

ADVANTAGES OF TUBE FEEDING
•An adequate amount of all types of
nutrients including distasteful foods and
medication can be supplied.
•Large amount of fluids can be given safely.
•The danger of pererial feeding are avoided,
e.g. Venous thrombosis.

•Tube feeding may be continued for weeks
without any danger to the patient.
•The stomach may be aspirated at any time
is desired.
•Overloading of the stomach can be
prevented by a drip method.

PRINCIPLES INVOLVED IN GASTRIC GAVAGE
•A thorough knowledge of the anatomy and
physiology of the digestive tract and
respiratory tract, ensures safe induction of
the tube (avoid misplacement of the tube).
•Tube feed is a process of giving liquid
nutrients or medications through a tube
into the stomach when the oral intake is
inadequate or impossible.

• Microorganism enters the body through food
and drink.
• Introduction of the tube into the mouth or
nostrils is a frightening situation and the
preparation of the patient facilitates
introduction of the tube.
• Systematic ways of working adds to the comfort
and safety of the patient and help in the
economy of material, time and energy.

•Identify the correct patient. Check the
doctor’s order for any specific precautions.
•Check the level of consciousness of the
patient. Check whether the feed is ready at
hand.

PREPARATION OF THE PATIENT AND
ENVIRONMENT
• Explain the sequence of the procedure
• Provide adequate privacy.
•Position the patient in sitting or semi
fowlers

•Place the Mackintosh and towel around the
neck.
•Arrange the articles at the bedside locker.
•Clean the mouth by providing mouthwash.

EQUIPMENT
•1.Disposable gloves (1)
•2. Feeding solution as prescribed
•3. Feeding bag with tubing (1)
•4Water in jug
•5. Large catheter tip syringe (30ml or larger
than it) (1)

•6. Measuring cup (1)
•7. Clamp if available (1)
•8. Paper towel as required
•9. Dr’s prescription
•10. Stethoscope

PROCEDURE
•Assemble all equipments and supplies after
checking the Dr.’s prescription for tube
feeding.
•Prepare formula:
•a. In the type of can: Shake the can
thoroughly. Check expiration date

•B. In the type of powder: Mix according to
the instructions on the package, prepare
enough for 24 hours only and refrigerate
unused formula. Label and date the
container. Allow formula to reach room
temperature before using.

•C. In the type of liquid which prepare by
hospital or family at a time: Make formula
at a time and allow formula to reach room
temperature before using.

•Explain the procedure to the client
•Perform hand hygiene and put on disposable
gloves if available
•Position the client with the head of the
bed. Elevated at least 30 degree angle to 45
degree angle

•Determine placement of feeding tube by:
• a. Aspiration of stomach secretions.
•Attach the syringe to the end of feeding
tube
•Gently pull back on plunger Measure
amount of residual fluid
•Return residual fluid to stomach via tube
and proceed to feeding

•B. Injecting 10- 20mLof air into tube:
•Attach syringe filled with air to tube. Inject
air while listening with stethoscope over
left upper quadrant

•C. Bowl with water
•Pinches the end of the NG tube and keeps
the tip in the water and checks for presence
of bubbles

•Intermittent or Bolus feeding
•Using a feeding bag: Feeding the following
•1. Hang the feeding bag set-up 12 to 18
inches above the stomach. Clamp the
tubing.

•2. Fill the bag with prescribed formula and
prepare the tubing by opening the clamp.
Allow the feeding to flow through the
tubing. Reclamp the tube.
•3. Attach the end of the set-up to the
gastric tube. Open the clamp and adjust
flow according to the Dr.’s order.

•4. Add 30-60 mL of water to the feeding bag
as feeding is completed. Allow the flow into
basin.
•5. Clamp the tube and disconnect the
feeding set-up.

•Using the syringe: Feeding the following
•1. Clamp the tube. Insert the tip of the
large syringe with plunger, or bulb removed
into the gastric tube.
•2. Pour feeding into the syringe

•3. Raise the syringe 12 to 18 inches above
the stomach. Open the clamp.
•4. Allow feeding to flow slowly into the
stomach. Raise and lower the syringe to
control the rate of flow.
•5. Add additional formula to the syringe as
it empties until feeding is complete

•Termination feeding:
•1. Terminate feeding when completed.
•2. Instill prescribed amount of water for 20
•3. Keep the client’s head elevated
30minutes.

•Mouth care:
•1. Provide mouth care by brushing teeth
•2. Offer mouthwash
•3. Keep the lips moist

•Clean and replace equipments to proper
place
•Remove gloves and perform hand hygiene
•Document date, time, amount of residual,
amount of feeding, and client’s reaction to
feeding. Sign the chart

GASTROJEJUNOSTOMY FEEDING
•Gastrojejunostomy feeding is defined as
enteral nutrition is the of a liquid food
preparation directly into the stomach or
small intestine via a tube. It is a ideal
method of providing nutrition for the
person who as unable to swallow food and
drink normally but has intact
gastrointestinal function.

•It is the introduction of liquid food through
a tube or catheter which the surgeon has
already introduced into the stomach
through the abdominal wall.

INDICATIONS
•Tumors or operations on the upper
gastrointestinal tract.
•Cancer of the esophagus.
•Stricture of the esophagus caused by
poisoning in case of fistula.

•It is essential that the area of the skin
around the tube be kept clean and dry.
•A water proof ointment such as zinc oxide
may be applied around the tube to protect
the skin from the irritation of the
hydrochloric acid.

•Foods given through the gastostomy tube
are some as those given by nasogastric tube
and the same amounts are given at the
same intervals.

METHODS OF ADMINISTRATION
•Intermittent feeding: Given four to six
times a day continuously is delivered as a
bolus through a longer lumen tube. Volume
for formula usually 250 mL to 450 mL is
placed in a large syringe and inserted into
the proximal end of the tube.

•Intermittent gravity drip: Administration
delivers a similar volume 250 to 450 mL of
feeding over 20 to 30 ml a minute, four to
six times a day.

•Continuous administration: Delivers fluid
through a small lumen tube at a constant
rate via orogastric and nasogastric routes.
The rate of flow is carefully regulated. The
nurse should calculate the amount of fluid
to be Procedu infused during an hour and
regulates the infusion pump accordingly.

•Check
•The doctors order for any specific
instruction.
•Level of consciousness of the patient.
•Self-care ability of the patient.
•Mental status to follow instructions.

OPERATION OF THE PATIENT AND
ENVIRONMENT
•Explain the sequence of the procedure.
•Provide privacy.
•Arrange the articles at the bedside.

•Place the patient in a comfortable position.
•Keep the environment clean and tidy.
•Keep ready with feed to be given.

EQUIPMENT
•A clean tray containing:
•A funnel, rubber tubing, glass connection
screw and clamp.
•A glass of drinking water.
•Required amount of feed, temperature
100° F.

•Sterile lubricant to protect surrounding
area.
•Sterile dressing and forceps in a dressing
tray.
•Medicine as per order.
•Kidney tray.

•Many tailed binder if required.
•Mackintosh and towel.
•Stethoscope.
•Syringe

PROCEDURE
•Wash hands thoroughly.
•Place the mackintosh or towel; clean the
surrounding area of the opening.
•Cover the wound with sterile piece of
gauze.

•Unscrew the clamp from the gastrostomy
tube and attach the funnel and rubber
tubing; keep the tube pinched to prevent
air from setting in.
•Aspirate the gastric contents by attaching a
syringe.

•Pour some clean water into the funnel and
lower a little to let our air.
•Then pour the feed before the funnel is
empty. If any medicines are ordered, these
are given after feed

•Give water after giving medicines.
Disconnect the tabbing and funnel.
•Clean and apply sterile instrument aroun
Dress it with sterile dressing and apply.

AFTERCARE
•Remove the mackintosh and towel.
•Position the patient comfortable.
•Secure the tube with plaster.

•Replace the articles to utility room.
•Hand wash
•Record the procedure in nurse record sheet.

SKIN CARE
•It is very important to keep the skin site
clean and dry so it does not get red and
irritated. The skin around the G tube
should be cleaned once a day with a bath or
shower. To clean:
•Gently remove any tape and gauze. A small
amount of clear or tan drainage is normal. .
Gently clean the skin around the GJ tube
with soap and water. Rinse and pat dry.

•After the skin is dry, you may put a clean 2x2 gauze
around the GJ tube, under the disc..
•Make sure the disc on the outside fits against the
skin so that the tube does not move in or out
easily. Cut four 3-inch pieces of tape.
•Tape the disc and gauze dressing to the skin.

TOTAL PARENTERAL NUTRITION
•Parenteral nutrition, also known as
intravenous feeding, is a method of getting
nutrition into the body through the veins.
While it is most commonly referred to as
total parenteral nutrition (TPN), some
patients need to get only certain types of
nutrients intravenously.

•Parenteral nutrition is often used for
patients with Crohn’s disease, cancer, short
bowel syndrome, and ischemic bowel
disease.

DEFINITION:
•Parenteral nutrition (PN) is sterile
intravenous solution of protein, dextrose
and fat in combination with electrolytes,
vitamins, trace elements and water. PN is
used to treat children who cannot be
adequately fed by the oral or enteral route.

•TPN bypasses the normal way the body
digests food in the stomach. It supplies the
fuels the body needs directly into the blood
stream through a central IV line. The body
needs three kinds of fuel-carbohydrates,
protein and fat.

•Carbohydrates provide calories to the body.
They supply most of the energy or fuel the
body needs to run. The main energy source
in TPN is dextrose (sugar).

•Protein is made up of amino acids, which
are the “building blocks” of life. The body
uses protein to build muscle, repair tissue,
fight infections and carry nutrients through
the body.

•Fat or lipids are another source of calories
and energy. Fat also helps carry vitamins in
the blood stream. Fat supports and protects
some of your organs and insulates your body
against heat loss. Fat is white in color.
•TPN also contains other nutrients, such as
vitamins and minerals, electrolytes and
water.

•Vitamins added to the TPN provide the
needed daily amounts of vitamins A, B, C,
D, E and K. It is the vitamins that are added
to the TPN mixture that turns it yellow. The
body also needs minerals. These minerals
are zinc, copper, chromium, manganese and
selenium. The vitamins and minerals in the
TPN are needed for the body’s growth and
good health.

•Electrolytes are important for bone, nerve,
organ and muscle function. Electrolytes,
such as calcium, potassium, phosphorus,
magnesium, sodium, chloride and acetate,
are also added to the TPN mixture.

•Water is a vital part of TPN. It prevents
patients from becoming dehydrated (too
little fluid). The amount of water in the
TPN is based on your child’s height and
weight.

ROLES OF PROFESSIONALS IN TPN
•Medical: Assess patient, assess fluid
balance, contact dietician to assess
nutritional status, refer to nutrition
support team to develop nutrition plan,
complete ordering and prescribing of PN
(ordering prior to 1200), ensure monitoring
in place, reassess patient (ongoing).

•Nursing: Assess patient, fluid balance
recording, daily weight of patient, check PN
prescription, ensuring specific PN solution
written (g/L protein and g/L glucose), check
PN solution, line care and connection/
running of intravenous PN infusions.

•Dietetics: Assess patient, provide energy
and protein requirements, and assessment
of enteral intake.
•Pharmacy: Check ordering PN,
manufacturing, checking and dispensing PN.

•Clinical nutrition team (nurse coordinators,
dietician, medical staff, pharmacy): Assess
a) patient, b) fluid balance charts, c)
dietician advice, d) PN ordering and
prescribing and e) special circumstances and
provide an overarching nutritional plan and
consultation based advice.

INITIAL PREPARATION
•Document patient’s weight and weight loss
•Complete consult form for Clinical
Nutrition Program and page Nutrition
Support Nurse Coordinator

•Organize dietician review of nutritional
state and estimated nutritional
requirements (energy, protein and specific
nutrient) or use equations to calculate
basal metabolic rate and adjustments.

•Consider access type (CVC or peripheral)
and duration it will be needed. Only day 1
(10% dextrose) solutions can be run through
a peripheral line. In general the smallest
caliber single lumen central line is
preferable.

•Perform baseline bloods (creatinine, urea
and electrolytes, calcium magnesium and
phosphate, liver function tests, full blood
count, triglycerides, blood sugar, venous
blood gas) and correct electrolyte
abnormalities before starting PN.

•See drug doses for potassium, phosphate,
and magnesium corrections. Corrections can
often be given by the enteral route (e.g.
Potassium, phosphate) if the child is
receiving other medications by this route.

FLUID CALCULATIONS
•Calculate total fluid volume requirement
(mL/hr and total volume over 24 hours)
•Consider losses (upper GIT, lower GIT,
drains, urine) Consider other fluids being
given to the patient over 24 hrs
(antibiotics, other infusions, blood or
albumin)

•Determine the volume available for PN
(total fluid volume requirement minus the
volume required for other infusions).

•Note: sometimes the volume available may
not be enough to provide adequate
nutrition, especially in patients who are
fluid restricted – other infusion volumes
should be minimal volume, liaise with
clinical nutrition team to ensure the
patient is receiving adequate nutrition

•Calculate mL/kg/day= volume available for
PN/weight Lipid is not usually included in
volume calculations
•Calculate mL/hr volume available for
PN/24.
•Note PN may be run over a shorter time in
which case the denominator will change.

• In children with significant refeeding risk,
PN may be started at lower volumes (giving
a lower % of their EER and reducing the risk
of refeeding)

•Side effects of TPN: The most common side
effects of parenteral nutrition are mouth
sores, poor night vision, and skin changes.
Patients should speak with their doctors if
these conditions do not go away. Other, less
common side effects include.

•Changes in heartbeat
•Confusion
•Convulsions or seizures
•Difficulty breathing
•Fast weight gain or weight loss

•Fatigue
•Fever or chills
•Increased urination
•Jumpy reflexes
•Memory loss
•Muscle twitching, weakness, or cramps

•Stomach pain
•Swelling of the hands, feet, or legs
•Thirst
•Tingling in the hands or feet Vomiting.

GASTRIC ANALYSIS
• The gastric analysis test examines the acidity of
the gastric secretions in the basal state
(without stimulation) and the maximal
secretory ability (with stimulation, i.e. With
histamine phosphate, betazole hydrochloride
(histalog) indicate a peptic ulcer (stomach or
duodenal), and an absence of free HCl
(achlorhydria) could indicate gastric atrophy
(possibly caused by gastric malignancy) or
pernicious anemia.

•In addition, gastric contents can be
collected for cytological examinations.
Gastric analysis by tube (basal and
stimulation) and tube less gastric analysis
(urine examination after a resin dye and
stimulant are administered) are the
methods used for evaluating gastric
secretions.

MAJOR CONSTITUENTS OF GASTRIC
SECRETIONS
•HCI (acid)
•Source-Parietal cells
•Function-Kills microbes, dissolves food
particles, activates pepsinogen into pepsin
and provides optimum pH for pepsin

•Pepsinogens (pepsin)
•Source-Chief cells
•Function-Begins initial hydrolysis of
proteins (optimum pH 2-4)

•Rennin (only in infants)
•Source-Stomach
•Function-Causes milk clotting and promote
its digestion by preventing rapid passage
from the stomach.

•Gastric lipase
•Source-Chief and mucous cells
•Function-An acid stable lipase that digest
short chain fatty acid

•Gastrin
•Source- G cells
•Function-Stimulates acid secretion by
stomach

•Mucous
•Source- Mucous cells
•Function-Protects stomach, moistens food

BASAL GASTRIC ANALYSIS (TUBE)
•Gastric secretions are aspirated through a
nasogastric tube after a period of fasting.
Specimens are obtained to evaluate the
basal acidity of the gastric content first and
the gastrie stimulation test follows.

STIMULATION GASTRIC ANALYSIS (TUBE)
•The stimulation test is usually a
continuation of the basal gastric analysis.
After samples of gastric secretions are
obtained, a gastric stimulant (i.e. Histalog
or pentagastrin is administered, and gastric
contents are aspirated every 15 to 20
minutes until several samples are obtained.

TUBELESS GASTRIC ANALYSIS
•This test is for screening purpose to detect
the presence of absence of HCl; however, it
will not indicate the amount of the free
acid in the stomach. A gastric stimulant
(caffeine, histalog) is given, and an hour
later a resin dye (azuresin, diagnex blue) is
taken orally by the client.

•The free HCI releases the dye from the
resin base; the dye is absorbed by the
gastrointestinal tract and is excreted in the
urine. Absence of the dye in the urine 2
hours later is indicative of gastric
achlorhydria. This test method saves the
client the discomfort of being intubated
with nasogastric tub; however, it does lack
accuracy.

NORMAL FINDINGS
•Fasting: 1.0 to 5.0 mEq/L/h
•Stimulation: 10 to 25 mEq/L/h
•Tubeless: Detectable dyes in the urine.

PURPOSES
•To evaluate gastric secretions.
•To detect an increase or decrease of free
HCI.

CLINICAL PROBLEMS
•Decreased Level
•Pernicious anemia.
•Gastric malignancy (atrophy).
•Atrophic gastritis.

•Elevated Level
•Peptic ulcer (duodenal).
•Zolliner-Ellison syndrome.

CLIENT PREPARATION
•Explain the purpose and procedure of the
tube or tubeless gastric analysis test to the
client. Check with the health care providers
before you give your explanation to find
out whether he or she will perform both
basal and stimulation gastric analysis. List
the steps of the test on paper for the
client, if needed.

•Tell the client how the nasogastric tube is
inserted (i.e. The tube is lubricated and
passes through the nosethe mouth) and that
he or she will be asked to swallow or will
be given sips of water as the tube is passed
into the stomach. The end of the tube may
be attached to low intermittent suction.

• Notify the health care provider, if the client is
receiving the following categories of drugs:
antacids, antispasmodics, anticholinergics,
adrenergic blocker, cholinergics and steroids.
Drugs from the above groups and a few others
should be withheld for 24 to 48 hours before
the gastric analysis. Drugs that cannot be
withheld should be listed on the request slip.

•Monitor vital signs. Observe for possible
side-effects for use of stimulants (i.e.
Dizziness, flushing, tachycardia, headache
and a lower systolic blood pressure).
•Label the specimens (gastric or urine) with
the client’s name, the date, the time and
the specimen’s number.

•Be supportive of the client. Encourage the
client to express his or her concerns or fear.
Answer questions or her refer them to
appropriate health professions.

PROCEDURE
•The client should be NPO for 8 hours to 12
hours prior to the test. Smoking should be
restricted for hours.
•Certain groups (i.e. Anticholinergics,
cholinergics,adrenergic blockers, antacid,
and steroids) and alcohol and coffee should
be restricted for at least 24 hours before
the test. It should be noted on the request
slip, if the drugs cannot be withheld.

•Baseline vital signs should be recorded.
•Loose dentures should be removed.
• A lubricated nasogastric tube is inserted
through the nose or mouth.

•A residual gastric specimen and four
additional specimens taken 15 minutes
apart should be aspirated and labeled with
the client’s name, the time, and a specimen
number. The nastrogastric tube may be
attached to low intermittent suction.

STIMULATION TEST:
•A continuation of the basal gastric analysis.
•A gastric stimulant is administered (i.e.
Betazole hydrochloride (histalog) or
histamine phosphate intramuscularly,
pentagastrin subcutenously).

•Several gastric specimens are obtained over
a period of 1 to 2 hours (histamine four 15
minute specimens in 1 hour and histalog
eight 15-minute specimens in 2 hours).
Specimens should be labeled with the
client’s name, the date, the time, and
specimen numbers.

•Vital signs should be monitored. Emergency
drugs such as epinephrine (adrenalin)
should be available.
•The test usually takes 2 and half hours for
both parts (basal and stimulation).

TUBELESS GASTRIC ANALYSIS
•The client should be NPO for 8 to 12 hours
before the test.
•The morning urine specimen is discarded.
Certain drugs are withheld for 48 hours
before the test (i.e. Antacids, quinine, iron,
vitamin B complex), with
•the health care providers permission.

•Give the client caffeine sodium benzoate
500 mg in a glass of water.
•Collected a urine specimen 1 hour later.
This is control urine specimen.

•Give the client the resin dye agent
(azuresin or diagnex blue) in a glass of
water.
•Collect a urine specimen 2 hours later. The
urine may be colored blue or blue green for
several days. Absence of color in the urine
usually absence of HCI in the stomach.

FACTORS AFFECTING DIAGNOSTIC RESULTS
•Incorrect labeling of specimens could affect
test results.
• Drugs antacids, anticholinergics, and
histamine blockers (cimetidine, ranitidine)
could decrease HCI levels; antacids,
electrolyte and iron preparations, vitamin B
complex, and quinidine could fastly elevate
the diagnex blue level.

•Stress, smoking and sensory stimulation
could increase HCI secretions.

DIET THERAPY
• It is the treatment of a disorder with a special
diet. Dietary prescription includes the written
order regarding the foods or liquids to be given
to the patient. A basic knowledge of nutrition
and diet therapy contributes to the nurse’s
ability to effectively answer the patient’s
questions about the diet and nutrition. A
dietary prescription may be for nothing by
mouth, a standard diet or special diet.

NOTHING BY MOUTH
•Nil per oral (NPO) status includes diet
modification as well as fluid restriction. It
is prescribed before surgery or certain
diagnostic procedures.

STANDARD DIETS
•Regular Diet
•Regular diets are planned to meet the
nutritional needs of adolescents, adults and
geriatric phases of the life span.
•The regular diet includes the basic food
groups and a variety of foods.

•The basic food groups include meat, milk,
vegetables, fruits, bread and cereal, fats
and sweets. The regular diet is designed to
provide exceptionally generous amounts of
all recognized nutrients and meets or
exceeds the RDA for all nutrients tabulated.

•Soft diet
•It includes the foods that are easy to chew
and swallow, thus promoting mechanical
digestion of food. Nuts, seeds (tomatoor)
and fried food is avoided.

•Clear liquid diet
•It is also called surgical liquid diet, is
ordered as prepared for diagnostic tests or
as first meal or two after surgery. Liquids
included are water, tea, lemon-lime soda,
carbonated drinks, clear and strained fruit
juices.

•Full Liquid Diet
•It includes all foods that are liquid to room
temperature. In addition to the liquids on a
clear liquid diet milk drinks,cream soups,
cooked cereals, ice-cream puddings or all
fruits and vegetables.

•Mechanical soft diet
•It consists of food fixed for a person who
has no teeth or has difficulty in chewing.
The food is either ground or chopped into
very small pieces and cooked very soft to
ease the chewing.

SPECIFIC DIET
•Liberal bland diet
•This diet is indicated for any medical
condition requiring treatment for the
reduction of gastric secretion, such as gas
tric or duodenal ulcers, gastritis,
esophagitis or hiatus hernia.

•The diet consists of any variety of regular
foods and beverages, which are prepared or
consumed without black pepper, chilli
powder or chilli pepper. Chocolate, coffee,
tea, caffeine-containing products and
decaffeinated coffee are not included in
the diet.

•The diet should be as liberal as possible and
individualized to meet the needs of the
patient. Foods, which cause the patient
discomfort, should be avoided. Small,
frequent feedings may be prescribed to
lower the acidity of the gastric content and
for the physical comfort of the patient.

•Low fat diet
•Fat restricted diets may be indicated in
diseases of the liver, gallbladder or
pancreas in which disturbances of the diges
tion and absorption of fat may occur
(pancreatitis, post gas trointestinal surgery,
cholelithiasis and cystic fibrosis). Fats are
digested with the help of bile.

•In diseases affecting the liver, bile is not
produced in sufficient quantity. Also in gall
bladder disease the bile may not reach the
duodenum. Therefore, in liver and gall
bladder diseases, a low fat or fat free diet
may be ordered.

•Skimmed milk is allowed. Glucose, sugar or
jaggery, rice, bread, dal, green vegetables
and fruits are allowed, provided that no fat
is used in cooking.

•High protein diet
•This is ordered for patients with burns,
protein deficiency disease, pre eclampsia,
anemia and in chronic kidney dis ease.

•About one litre of milk should be taken
each day and extra protein can be supplied
by adding skimmed milk pow der or egg to
the milk.

•Mixed protein rich foods like groundnuts,
grams and dal may be ground and cooked
with the stable cereal. Non veg etarians
may have fish and meat.

•Low protein diet
•This is ordered for patients with acute nephritis.
It is contin ued as long as there is too much urea
in the blood. Easily digested carbohydrate foods
with a little ghee or butter and boiled sweets
may be allowed. At first the diet may be only
fruit juice with glucose. A little milk may be
allowed later.

•Low residual diet
•This is a diet without roughage or anything
that stimulates the bowel. This is ordered
in cases such as colitis, colostomy and may
be ordered for a few days after perineal
suturing.

•Arrowroot, milk and eggs, tea, toast,
strained fruit juice is allowed. Vegetables
and fruits are softened and filtered through
a sieve. Avoid rough cereals, green
vegetables, dal, peas and beans.

•Sodium restriction diet
•The purpose of the sodium restricted diet is
to promote loss of body fluids for patients
who are unable to excrete the element
normally because of a pathological
condition.

• The diet is indicated for the prevention, control
and elimination of edema in congestive heart
failure; cirrhosis of the liver with ascites; renal
disease complicated by either edema or
hypertension; when administration of
adrenocorticotrophic hormone (ACTH) or
steroids are prescribed, for certain endocrine
disorders such as Cushing’s disease and hypo
thyroidism.

•The sodium-restricted diets provide a
specific sodium level or a range of sodium.
The diet order must indicate the specific
sodium level or range desired either in
milligrams (mg) or milli equivalent (mEq).
Terms such as “salt free” and “low sodium”
are not sufficient.

RESPONSIBILITIES OF THE NURSE IN
RELATION TO DIET THERAPY
•1. The nurse should be familiar with the
diet prescription and its therapeutic
purpose.
•2. Although individual trays are carefully
checked before leaving the Nutrition Care
Division, mistakes can hap pen.

•3. Examine each tray with the patient’s
specific diet in mind. You should be able to
recognize each type of diet.
•4. You should relate the diet to body function
and the con dition being treated. For
example, a low fat diet is usu ally the first
step in treating patients with elevated blood
lipids (hyperlipidemia).

•5. Be able to explain the general principles
of the diet to the patient and obtain the
patient’s cooperation.
•A. For example, teach a diabetic patient
the relationship between his insulin and the
amount of food consumed.

•B. Observe the patient’s reaction to the
diet. If the patient understands the
relationship between his condition and his
diet is shown that he can continue to enjoy
most of his favorite foods, he is more likely
to remain on the. diet

• 6. Help to plan for the patient’s continued care.
A. Most patients are e hospitalized only during
the acute and early convalescent phases of their
illness so it may be necessary to continue a
special diet at home
b. Chronic conditions, such as diabetes or
hypertension, require permanent dietary
alterations.

•C.Be aware of the patient home situation
And the problems that the diet may cause
the patient and their family will have to
adjust their meal plans.
•D. Request a consultation for the patient
with the dietician early in the
hospitalization to allow for instructions and
follow-up care.

THERAPEUTIC DIET
•Therapeutic diet is used for the therapeutic
purposes in form of dietary supplements. It
is a diet that is formulated usually by
nutritionists, dietitians and medical doctors
to aid in the healing of the body from
certain types of injuries and dis eases.

ADVANTAGES
•Nutritional support is fundamental,
whether the patient has an acute illness or
faces chronic disease and its treatment.
Frequently, it is the primary therapy in
itself. The registered dietitian, along with
the physician, carries the major respon
sibility for the patient’s nutritional care.

•The nurse and other primary care
practitioners provide essential support.
Nutritional care must be planned on
identified personal needs and goals of the
individual patient. We should not lose sight
of the reasons for therapeutic diets.

TO IMPROVE OR MAINTAIN NUTRITIONAL
STATUS
•Widespread societal changes include an
increase in the num ber of women in the
work force and families who rely on food
items and cooking methods that save time,
space and labor. The “snack” is clearly a
significant component of foods consumed. A
therapeutic diet may be planned to pro
mote foods that contribute to nutritional
adequacy.

TO IMPROVE NUTRITIONAL DEFICIENCIES
•Dietary surveys have shown that
approximately one third of the population
lives on diets with less than the optimal
amounts of various nutrients. Such
nutritionally deficient persons are limited
in physical work capacity, immune sys tem
function and mental activity.

•They lack the nutritinal eserves to meet
any added physiologic or metabolic de
mands from injury or illness or to sustain
fetal development during pregnancy.

TO MAINTAIN, INCREASE OR DECREASE
BODY WEIGHT
•Despite the growing interest in physical
fitness, one out of every four persons is on
a weight reduction diet. Only 5 percent of
these dieters manage to maintain their
weight at the new lower level after such a
diet.

TO ALLEVIATE STRESS TO CERTAIN ORGANS
OR TO THE WHOLE BODY
•1. When loss of teeth or dental problems
make chewing difficult, a dental soft diet
may be used. All foods are soft cooked,
meats are ground and sometimes mixed
with gravy or sauces.

•2. Peptic ulcer is the general term given to
an eroded mucosal lesion in the central
portion of the gastrointes tinal tract.
Positive individual needs and a flexible pro
gram of a regular diet, including good food
sources of dietary fiber, milk and other
protein foods prevail today.

• 3. General functional disorders of the intestine
may be caused by irritation of the mucous
membrane. Symp toms vary between
constipation and diarrhea. Dietary measures are
designed to provide optimal nutrition and
regulate bowel motility. There should be
additional amounts of fruits, vegetables and
whole grains. The fi ber content may need to be
decreased during periods of diarrhea or
excessive flatulence.

•4. Organic diseases of the intestine fall into
three general groups: anatomic changes,
malabsorption syndromes and inflammatory
bowel disease with infectious mucosal
changes.

•A. Diverticulosis is an example of anatomic
changes. Current studies and clinical
practice have demon strated that
diverticular disease is better managed with
a high fiber diet than with restricted
amounts of fiber used in former practices.

•B. Celiac disease is an example of
malabsorption syn drome. Since the
discovery that the gliadin fraction in gluten
(a protein found mainly in wheat) is the
causative factor, a low gluten, gliadin-free
diet has resulted in marked remission of
symptoms.

•C. Inflammatory bowel disease is a term
applied to both ulcerative colitis and
crohn’s disease. These two diseases have
similar clinical and pathological features.
They are particularly prevalent in industri
alized areas of the world, suggesting that
the envi ronment plays a significant role.

•The two goals of a therapeutic diet are to
support the tissue healing process and
prevent nutritional deficiency. The diet
must supply about 100 grams of protein per
day through elemental formulas or protein
supplements with food as tolerated.

TO ELIMINATE FOOD SUBSTANCES TO
WHICH THE PATIENT MAY BE ALLERGIC
•There are three basic approaches to the
diagnosis and treatment of food allergies:
clinical assessment, laboratory tests and
dietary manipulation. Diet therapy is
individualized.

TO ADJUST DIET COMPOSITION
•A therapeutic diet may be ordered to aid
digestion, metabo lism or excretion of
certain nutrients or substances.

FEEDING HELPLESS PATIENT ORALLY
•Preparing the Patient for Meals
•As a nurse, your duties may include serving
the diet trays at mealtime. For many
patients, mealtime is the high point of the
day.

•The patients are more apt to have a better
appe tite, eat more and enjoy their food
more if you prepare them for their meals
before the trays arrive.

•1. Provide for elimination by offering the
bedpan or urinal or assisting the patient to
the bathroom.
•2. Assist the patient to wash hands and face
as needed.
•3. Create an attractive and pleasant
environment for eating.

•4. Remove distracting articles such as an
emesis basin or a urinal and use a
deodorizer to remove unpleasant odors in
the room.
•5. See that the room is well lighted and at
a comfortable temperature.

•6. Position the patient for the meal. If
allowed, elevate the head of the bed or
assist the patient to sit up in a chair.
•7. Clear the overbed table to make room
for the diet tray.
•8. Avoid treatments such as enemas,
dressings and injec tions immediately
before and after meals.

•9. Meals should be accurately prepared,
according to the requirements of the
individual, patient and his disease.
•10. Great care should be taken and be kept
away from the patient to avoid spilling.

•11. Meals should be attractively served. The
plate should be clean on both surfaces. A
nicely prepared, well cooked food improves
appetite.

ARTICLES REQUIRED
•1. Mackintosh and towel
•2. Feeding cup or straw
•3. A glass of water
•4. Full plate, quarter plate
•5. Cup and saucer

•6. Jug
•7. Spoon, fork, knife
•8. Napkin
•9. Kidney tray

•1. Wash hands.
•2. Sit by the bedside.
•3. The position should be convenient for the
nurse and patient.

•4. A towel must be placed around his neck
so that it gives maximum protection to the
patient and bedclothes.
•5. Feed the patient slowly in small
amounts, allowing him to chew the food
and swallow it adequately.

•6. Place the spoon properly in patient’s
mouth.
•7. Give dry foods in patient’s hands to hold
and eat.
•8. Give the foods in order in which they are
normally eaten by the patient.

•9. Do not force the food.
•10. Encourage the patient to take all types
of foods.
•11. When the patient has stopped eating,
offer a glass of water.

SPOON FEEDING
•1. This is often used for the feeding of
children and patients who cannot feed
themselves. The spoon should be of suitable
size and time should be allowed for the
mastica tion.

•2. The nurse should appear unhurried. It is
usual for the nurse to stand on the right
side of the patient but excep tions occur.
•3. Help the patient to take their feeds who
are unable to feed themselves and
everything possible must be done to
alleviate the feeling of helplessness.

• 4. Children with cleft lip and cleft palate are
mostly spoon fed; sometimes a special spoon is
used and after operation, a sterile spoon is
used.
• 5. The child should be well supported and the
spoon placed well to the back of the mouth.
After operations for cleft lip or cleft palate,
great care should be taken to prevent the spoon
from touching the suture lines.

FEEDING WITH A FEEDING CUP
•1. The feeder (feeding cup) must be
perfectly clean, espe cially the spout and
under the over hanging half-lid. It should
be placed on a saucer with a spoon and
carried to the bedside on a tray which is
covered with a tray cloth.

•2. Spread a towel around the patient’s
neck. The feed should not be too hot. The
nurse’s left arm should be placed under the
pillow to raise the patient’s head and the
spout of the feeder placed between his lips.

•3. The patient should be taught to place his
tongue over the spout tip when requiring a
rest or to make a sign to the nurse.
•4. In some instances, feeding is made more
easy if a piece of rubber tubing is attached
to the spout of the feeder, this should be
carefully washed and boiled at least once
daily.

•5. In some cases, both feeder and rubber
spout are boiled before and after each
feed. A special brush is provided for the
cleaning of spouted feeders.
•6. At the end of the meal, the patient’s
mouth should be dried, in some cases the
mouth may require cleaning before and
after the meal.

•After Care
•1. Help the patient to wash his mouth, face
and hands.
•2. Dry the face and hands.
•3. Make the patient comfortable.

•4. Tidy up the bed.
•5. Take all articles to the utility room.
Discard the waste.
•6. Wash hands.
•7. Record the amount and type of food
taken.

INTAKE AND OUTPUT RECORD
•Intake and output is the recording of all
fluid intake and output during a 24-hour
period provides important data about the
client’s fluid and electrolyte balance.

PURPOSE
•To maintain an accurate record of fluid
intake and output when ordered or when
this information is important as a basis for
therapeutic planning for the patient.

NECESSARY EQUIPMENT
•1. Intake and output work sheet
•2. Measurement glass
•3. Pint measure for measuring urine,
drainage, etc.
•4. Patient’s chart

INSTRUCTIONS
•1. Intake and output will be recorded in
milliliters and to talled at 8-00 a.m. Totals
are transferred to the appro priate columns
in the patient’s chart.

•2. The work sheet for intake and output
will be kept at the bedside affixed on the
bedside chart back.
•
•3. The nurse incharge of the patient will be
responsible for maintaining the record.
However, the patient and his attendant if
capable can be taught to do so.

MEASURING INTAKE
•1. Fluid intake refers to all fluid entering the
patient’s body. It also includes foods that are
liquid at room tempera ture, such as ice chips,
ice-cream and certain beverages.
•2. Measure any fluids offered to the patient and
make a note of how much the patient drinks and
the time of the day at which it is drunk.

•3. If the patient is drinking from a jug, obtain
the total in take by subtracting the fluid
remaining in the jug at the end of the day plus
any fluid added.
•4. You can also pre-measure the drinking glasses
or bowls most commonly used by the patient.
So, when the patient tells you that he had “one
glass of water”, you will know the amount.

•5. Measure ice chips by multiplying the
volume by 0.5; when melted, the volume of
ice is approximately half its previous
volume.
•6. For yogurt, ice cream, gelatin, packed or
canned drinks, measure the amount printed
on the labels.

•7. Measure the amount of feeds through
nasogastric tube by noting the volume of
the bag at the beginning of the feeding and
then subtracting the amount left at the end
of the feeding. Remember to include any
feeding that is added during the day.

•8. Intravenous intake (drips) can also be
measured using the above method.
•9. If water is used to flush the nasogastric
tube, record the amount used for irrigation
in the intake and output chart.

MEASURING OUTPUT
•1. Fluid output refers to all fluids that
leave the patient’s body. This includes
urine, loose stools, vomitus, aspi rated
fluid, excessive perspiration and drainage
from surgical drains, nasogastric tubes and
chest tubes.

•2. Use a container marked with milliliters
(mL) to collect fluid output. Be sure to
label the container “FOR MEA SURING
OUTPUT ONLY” to prevent confusion with
intake container.

•3. Always wear gloves when handling body
fluids.
•4. Any amount not measured due to any
reasons such as patient passed urine while
in the toilet should be docu mented,
otherwise the chart becomes inaccurate and
misleading.

•5. In cases such as vomits or diarrhea,
record the number of time it was passed.
For such cases, check with your doctor in
advance if it is necessary to measure the
exact amount.
•6. It is also important to make a note of the
fact if the pa tient is sweating.

• 7. If the patient has drainage, record the
amount of the drainage. It is important to
document the source of the drainage especially
if he has more than one drainage site.
• 8. If patient is on intermittent or continuous
irrigation, cal culate the true output by
measuring the total output and subtracting the
total irrigation infused.

Nutrition in our daily life style . pptx

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