Information about Tube Feeding by Dr Dhaval Mangukiya.
Details of tube feeding, gastric feeding, jejunal or duodenal feeding, continuous feeding, cyclic feeding, bolus feeding, present guidelines, GRV etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
this presentation is about what is enteral feeding and how it is being carried out etc., it also gives information about classification based on duration of feeding. there is an information about infusion techniques and the time required for it.
Enteral feeding is a narrow feeding tube is place through nose down it to stomach. This tube is used to give fluid, medication and liquid food complete with nutrients directly in to stomach.
#ppt on Enteral Feeding, #Enteral Feeding
this presentation is about what is enteral feeding and how it is being carried out etc., it also gives information about classification based on duration of feeding. there is an information about infusion techniques and the time required for it.
Enteral feeding is a narrow feeding tube is place through nose down it to stomach. This tube is used to give fluid, medication and liquid food complete with nutrients directly in to stomach.
#ppt on Enteral Feeding, #Enteral Feeding
Discuss essential components and purposes of nutritional assessment and nutritional screening.
Identify developmental nutritional considerations.
Identify factors influencing nutrition.
Identify anthropometric measures.
Identify risk factors and clinical signs of malnutrition.
Describe nursing interventions to promote optimal nutrition.
Plan, implement, and evaluate nursing care associated with nursing diagnoses related to nutritional problems.
Discuss essential components and purposes of nutritional assessment and nutritional screening.
Identify developmental nutritional considerations.
Identify factors influencing nutrition.
Identify anthropometric measures.
Identify risk factors and clinical signs of malnutrition.
Describe nursing interventions to promote optimal nutrition.
Plan, implement, and evaluate nursing care associated with nursing diagnoses related to nutritional problems.
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
Contents:- Introduction, Need for GRDDS, Criteria for selection of drug for GRDDS, Advantages and Disadvantages, Factor affecting gastric retention time of a drug.
التغذية لمرضي الجراحة
للزملاء المتقدمين لامتحانات اجنبية زي MRCS
و للزملاء اللي منتقلين حديثا للعمل بالمملكة المتحدة او بينوو العمل فيها
تابعونا علي الصفحة الجراح
https://www.facebook.com/algarra7/
عنوان الفيديوعلى اليوتيوب
https://youtu.be/PNe2e41pv_w
Treatment of Pancreatic Neuroendocrine NeoplasmsDhaval Mangukiya
Information about Treatment of Pancreatic Neuroendocrine Neoplasms in clinical practice guidelines, management and tumors, practice changing study, Gastric NETs etc. by Dr Dhaval Mangukiya.
Details of Low Anterior Resection(LAR), Arterial Supply, Venous Drainage, Ports, Position, Modified Lithotomy, Vessel Ligation, Lymph Nodes, Nerves Anatomy, Superior Hypogastric Plexus, Lateral Pelvic Nerves, Correct TME, Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Inflammatory bowel disease in history, different investigations and surgery and post op by Dr Dhaval Mangukiya.
Details of Low Anterior Resection(LAR), Arterial Supply, Venous Drainage, Ports, Position, Modified Lithotomy, Vessel Ligation, Lymph Nodes, Nerves Anatomy, Superior Hypogastric Plexus, Lateral Pelvic Nerves, Correct TME, Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Acute abdomen in covid by Dr Dhaval Mangukiya.
Details of Acute abdomen in covid, Liver Injury, Hypotheses, Gastrointestinal manifestations, Critically ill patients with COVID-19 etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about monitoring after therapies for hcc by Dr Dhaval Mangukiya.
Details of Monitoring after therapies for HCC, Staging, Management of Hepatocellluar Carcioma, Limitation, RECIST criteria, Assessment, Target lesion, Special recommendations etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about GIST by Dr Dhaval Mangukiya.
Details of Epidemiology, Classification and Molecular genesis, Prognostic factors, Diagnosis, Management, Followup.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Management of Appendicular Lump by Dr Dhaval Mangukiya.
Details of Appendicular Lump, Basic to Above the Basics, Incidence, Safe Approach Interval Laparoscopy, Early Surgery etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Low Anterior Resection by Dr Dhaval Mangukiya.
Details of GOAL of LAR, Margins, Reconstructions, Anal Anastomosis, End to Side Colorectal Anastomosis, Stapler Vs Hand Sewn, Intersphincteric Resection, Colonic J pouch Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Lap vs Open Colorectal Resection by Dr Dhaval Mangukiya.
Details of Factors compared, COST Trial, CLASSIC Trial, COLOR Trial, COREAN Trial, ALCCS Trial, Summary, SAGES Guidelines,
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Inflammatory Bowel Disease by Dr Dhaval Mangukiya.
Details of brief overview of the talk, Surgery in crohn's disease, Scenarios, Localised ileal or ileocaecal disease, Coincidental ileitis, Localised or multifocal colonic disease, Concomitant abscess, Surgical considerations, Anastomotic technique, Laparoscopy etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Hydatid Cyst Biliary Fistula by Dr Dhaval Mangukiya.
Details of Hydatid Cyst Biliary Fistula, USG criteria for intrabiliary rupture, Surgical Options, Post operative bile leak, Treatment and also Algorithm
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Approach to the patients of GI malignancy by Dr Dhaval Mangukiya.
Details of GI malignancy, HPB malignancy, Liver, Pancreas, Biliary,
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
GERD is most common gastric problem in community affecting large number of people. Diagnosis and management is very simple with understanding.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Gerd surgical management by Dr Dhaval Mangukiya.
Details of both sides of Gerd, Introduction, Surgical Anatomy, Hiatus Hernia, Esophageal dearance, Investigation etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Gej leak by Dr Dhaval Mangukiya.
Details of GE Junction Leak, Case 1, Case 2 etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Diverticular disease by Dr Dhaval Mangukiya.
Details of Diverticular disease, Differential Diagnosis, CT Scan Protocol, Point to look in CT, Options, Indications for Elective Surgery, Exploraion, Primary Resection, Opinion, Management etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Acute pancreatitis by Dr Dhaval Mangukiya.
Details of Acute Pancreatitis Multidisciplinary Approach, Case Scenario, CT, Post Operative Course,
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about acute abdomen in pregnancy.
Gastrointestinal surgery in pregnancy.
Presentation on acute abdomen in pregnancy, physiology of pregnancy, upper abdominal pain, lower abdomen pain, diffuse abdominal pain, lonizing radiation etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Abdominal sepsis and peritonitis final by Dr Dhaval Mangukiya.
Details of Anatomy, intra abdominal infections, physiology, peritonitis, risks for failure of source control, management of critical issues.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
4. • Short Term Access: Anticipated need for
enteral feeding < 6-8 weeks
– Nasogastric
– Nasojejunal
• Long Term Access (anticipated need for
enteral feeding > 6-8 weeks)
– Percutaneous Gastrostomy Tubes (PEG)
– Open Gastrostomy
– Transgastric Jejunostomy
– Surgical Jejunostomy
6. Gastric Feeding
• Start at a rate of 40 to 50cc/hr
• If tolerated advanced by 25cc/hr every 4-8
hours
(Range 10 to 50 cc/hr)
• Maximum 250 ml/hr
• Elemental formulas should start at full
strength at 25cc/hr for the first 12 hours then
advance by 25cc/hr every 6-12 hours until
reaching goal rate
7. Jejunal or duodenal feeding
• Standard or elemental feedings at full strength
at 25 cc/hr for the first 12 hours then advance
by 25cc/hr every 6-12 hrs until reaching goal
rate.
• Do not use bolus feeding method
• Max 100 to 120 ml/hr
9. Continuous feeding
• Feeding for 24 hours continuously either by
gravity drip or feeding pump
• Preferred method of use if the patient has
rapid intestinal transit and may be more
suitable for critically ill patients than other
regimens
• Postpyloric feeding is required, continuous
feeding is often tolerated better than
intermittent
10. Advantages:
• Allows the lowest possible hourly feed rate to meet
nutrient requirements
• Better gastrointestinal tolerance due to the lower feed
rate
• Better control of blood glucose levels due to continuous
carbohydrate input
Disadvantages:
• Physical attachment to the feeding apparatus (may
affect quality of life)
• Expense of equipment (pump and giving sets)
11. Cyclic / intermittent feeding
• Enteral nutrition is stopped for a 4-16 hour
period either during the day or at night.
• The shorter the period of feeding
• the higher the rate may need to be in order to
meet the patient’s requirements.
• Suitable for pump and gravity drip.
12. Advantages:
• Allows greater patient mobility (may improve quality of life)
• Allows breaks for physical activity, for administration of medications that are
incompatible with feeds, and to encourage oral intake if applicable.
• Useful in the transition from continuous to bolus feeding, or from tube feeding to oral
intake.
• Daytime feeds may reduce aspiration risk if it is difficult to maintain a 30° elevation
overnight
• Feeding during daytime only is more physiological and may therefore have benefits
such as helping to re-establish the diurnal cycle; promoting normal gastrointestinal
motility and promoting re-acidification of the stomach (which protects against
bacteria).There is no evidence for a benefit of ‘gut rest’, however.
Disadvantages:
• Compared with continuous feeding, a higher infusion rate is required to provide the
same volume of feed. This may be less well-tolerated, with a higher risk of problems
such as reflux, aspiration, abdominal distension, diarrhoea and nausea
13. Bolus feeding
• Defined as rapid administration of a bolus feed /water by
syringe (usually by gravity, without the plunger).
• Bolus feeding is usually into the stomach, which has the
reservoir capacity to tolerate a large volume of feed.
• A prescribed volume of feed is given (such as 100-400ml)
• over 15-60 minutes at regular intervals.
• The patient must have a competent oesophageal sphincter
and be able to protect his/her airway adequately to
minimise aspiration risk, as this risk is higher with larger
feed volumes and administration rates.
14. Advantages:
• Physiologically similar to a typical eating pattern
• Allows greater patient mobility
• Convenient for gastrostomy feeding
• Can be used to supplement oral intake
• Can be flexible to suit the patient’s lifestyle and
improve quality of life
• May facilitate transition to oral intake
15. Disadvantages:
• Large boluses may be poorly tolerated,
especially in small bowel feeding
• Requires more nursing time compared with
pump-controlled feeding
• Highest risk of aspiration, reflux, abdominal
distension, diarrhoea and nausea
16. Present Guidelines
SCCM & A.S.P.E.N Guidelines, McClave et al 2009
• Immune modulating enteral formulations for surgical
ICU patients – Grade A
• Patients with ARDS should be placed on an enteral
formulation characterized by anti inflammatory lipid
profile (Omega 3 fish oil) and anti oxidants – Grade A
• Combination of anti oxidant vitamins (E &C) and trace
minerals (selenium) to be provided to all critically ill
patients receiving NS – Grade B
• Additional of enternal glutamine should be considered
in Burn, Trauma and mixed ICU patients – Grade B
17.
18.
19.
20. • Evaluate all enterally fed patients for risk of
aspiration. (A)
• Assure that the feeding tube is in the proper
position before initiating feedings. (A)
• After enteral feeding goal rate is achieved and/or
the sump tube is replaced with a soft, smallbore
feeding tube, gastric residual monitoring may be
decreased to every 6-8 hours in noncritically ill
patients. (C)
• However, every-4- hour measurements are
prudent in critically ill patients. (B)
21. Monitoring Gastric Residual Volume
(GRV)
• When possible, use a large-bore sump tube for the first 1-2 days of
enteral feeding and evaluate gastric residuals using at least a 60 mL
syringe. (A)
• Check gastric residuals every 4 hours during the first 48 hours for
gastrically fed patients.
• If the GRV is > 250 mL after a second gastric residual check, a
promotility agent should be considered in adult patients. (A)
• A GRV >500 mL should result in holding EN and reassessing patient
tolerance by use of an established algorithm including physical
assessment, GI assessment, evaluation of glycemic control,
minimization of sedation, and consideration of promotility agent
use, if not already prescribed. (B)
• Consideration of a feeding tube placed below the ligament of Treitz
when GRVs are consistently measured at > 500 mL. (B)
22. • Flush feeding tubes with 30 mL of water every
4 hours during continuous feeding or before
and after intermittent feedings in an adult
patient.(A)
23. • Elevate the backrest to a minimum of 30º, and
preferably to 45º, for all patients receiving EN
unless a medical contraindication exists. (A)