Enteral Nutrition Lecture Notes

Overview

• Enteral Nutrition (EN): A treatment for malnutrition where nutrition is provided via a tube directly into the GI tract.
  • Applicable for individuals who are malnourished or unable to eat normally.
  • Also used to supplement regular food intake when necessary.

Indications for Enteral Nutrition

• Conditions requiring EN:
  • Anorexia or burns, needing extra nutrition.
  • Mental status issues (e.g., post-stroke or brain injury) leading to inability to swallow.
  • Critically ill patients (e.g., intubated patients).
  • Patients with head, face, or neck issues (e.g., oral cancer).
  • Obstruction or airway issues preventing safe swallowing.

Requirements for Enteral Nutrition

• Functioning GI Tract: Presence of bowel sounds is essential.
• Avoid EN in: Cases of ileus or bowel obstruction to prevent complications like pain, perforation, peritonitis.

Types of Feeding Methods

• Bolus Feeding:
  • Given over a short period using gravity-fed syringe.
  • Mimics regular meal patterns.
• Continuous Feeding:
  • Administered via a pump, common in acutely ill patients.
  • Pros and Cons:
    • May cause blood sugar elevation, stomach overload, diarrhea.
    • Viewed as PPI prophylaxis by some physicians.

Types of Feeding Tubes

• Nasogastric (NG) Tube:
  • Most common, inserted through the nose.
• Orogastric (OG) Tube:
  • Used in patients with a breathing tube.
• Dobhoff Tube:
  • Small bore, post-pyloric, goes into the duodenum.
• Percutaneous Endoscopic Gastrostomy (PEG) Tube:
  • Long-term tube inserted through endoscopy.
• Jejunostomy (J) Tube:
  • Inserted into the jejunum, bypasses stomach for high aspiration risk patients.

Maintenance and Safety

• Preventing Aspiration:
  • Assess tube for patency and correct placement before use.
  • Maintain positioning of 30-45 degrees during continuous feeding.
  • Use of tape, bridle, or securement devices to maintain placement.
• Checking Placement:
  • Initial verification via KUB x-ray.
  • Regular checks of tube markings.
  • Verification of bowel sounds before feeding.

Tube Patency

• Flushing:
  • Regularly flush the tube every 4 hours.
  • Flush before and after medication administration.
• Clearing Blockages:
  • Using soda or pancreatic enzymes can help break down blockages.

Potential Complications

• Skin Breakdown:
  • Monitor for pressure injuries around the tube.
• Gastric Residuals:
  • Check and manage according to hospital policy.
• Metabolic Issues:
  • Hyperglycemia and hypernatremia can occur.
  • Ensure appropriate free water flushes.
• Diarrhea:
  • Assess for feeding rate issues or expiration of feed.

Medication Administration

• Use Liquid Medications:
  • When possible, switch medications to liquid form.
  • No extended-release medications should be crushed.
• Crushing Pills:
  • Ensure pills are thoroughly crushed and diluted.
  • Avoid crushing medications labeled as extended or sustained release.

This summary captures the key points of the lecture on enteral nutrition, outlining its indications, types of feeding methods and tubes, and important maintenance and safety considerations.