Nutrition Review

Chapter 25 26
Dysphasia
Enteral Tube Feeding
Page 366
Fruits versus the Vegetables….
Nutrition review………..
 Which group is?
 Is a starch more likely to be
 Pasta a grain or a dairy?
 Carrots  Is protein more likely to be in
 Eggs fruit or meat?
 Tofu
 Which is higher in calories
an egg, or an apple?
 Pureed Lentils
 Which group represents high
 Pumpkin
carbs?
 Rice  What 2 types of food contain
 Cereal the most calories?
L=LIMIT M= More often
 High fat foods like pizza
 Salt
 Lean meats
 Multi grain breads
 Variety of colors
 Fibre
 Alcohol
Dysphagia
 Definition: The loss or impairment of the
ability to chew or swallow or both.

 Think about the process. Eat a cookie.

 If we were to break the process into 4 stages,
What happens?
Normal Swallowing Phases
 #1 Oral Preparation

 Chew and prepare the

mouthful ( BOLUS) to
an appropriate size and
consistency for
swallowing.
 # 2 Oral Phase

 Propelling the BOLUS

to the back of the throat.
 # 3 Pharyngeal Phase

 Passing the BOLUS

through the pharynx
past the airway
opening.
 #4 Esophageal phase

 The BOLUS progresses

through the esophagus
towards the stomach
Enteral Feeding Defined
Enteral feeding is the term used when nourishment is
put directly into the stomach or intestines by a
method other than chewing or swallowing.
 When to Use Enteral Feeding

 If no weight gain for 3 months ( less for infants and young

children)
 Indicators of fat or muscle mass has decreased or are below
5th percentile
 Oral feeds providing less than 80% of required calories or not
meeting fluid needs
 Caregiver spending more than 4-6 hrs a day feeding
 Oral-motor skills prevent adequate intake
 Risk of aspiration
When to use ……………..
 A.I.D.S.
 Burns
 Cancer
 Oro-motor anomalies
 Anorexia nervousa
 Many short term uses
Types of Enteral Feeding
 Nasogastric NG Tube

 short term use

 advantage- no surgery required
 disadvantages discomfort,
 in infants can decrease the
suck/swallow reflex
 must be positioned correctly
 Very seldom used for our
clients
Gastronomy Tube Sites
G-Tube Feeds
 Well suited for long-term Enteral
feeding.
 More comfortable, do not irritate
nasal passage, esophagus or
trachea, cause facial skin
irritation or interfere with
breathing.
 Stable more physiologic,
allowing some continued oral
eating.
G-Tube Disadvantages
 Disadvantages include:
 the surgery required to place the
tube
 possible skin irritation or infection
around the site
 slight risk of intra-abdominal
leakage resulting in peritonitis.
 Of special concern is the child with
poor gastric emptying and or severe
reflux or intractable vomiting.
G-Tubes
 Button G tubes are at skin level
and easily hidden under a
child's clothing.
 They require less daily care and
interfere less with a child's
movement .
 G tubes generally use a large-
bore tube which allows a more
viscous feeding and decreased
risk of tube occlusion.
Jejunal Tube feeding
 Tube feeding directly into the
jejunum ( middle section of the
small intestine)
 Used for children who cannot
use their upper gastrointestinal
tract due to congenital
anomalies.
 Used for severe gastric reflux or
a high risk of aspiration. The
jejunal tube bypasses the
stomach decreasing the risk of
gastric reflux and aspiration
J-Tube Feeds
Disadvantages:
 Difficult to position, and may
dislodge or relocate
 Must be checked often by ex-ray
 Require continuous drip and slower
feeding time.
 Grater risk of formula intolerance
and nausea, diarrhea
 Formulas more expensive
Continuous Drip
Gravity Drip Infusion Pump
 less expensive than  provides consistent,
pump uniform amount of
formula
Administration of Nourishment
 Bolus Feeding
 delivered 4-8 x a day directly
into stomach
 each feed lasts 15 minutes
 more convenient
 less expensive
 not always easily tolerated or
digested
 allows for supplemental feeds in
the event of undernourished
 Continuous Drip
 By gravity or Infusion Pump
 feeding may be delivered
without interruption for an
unlimited period of time each
day
 Commonly used for 8-10 hours
during the night with bolus
supplements during the day
 good for extremely
malnourished
Continuous Drip Pump
 Several types of pumps
exist, some have back
packs and battery packs
and are more easily
transported.
 Kangaroo Brand
Kangaroo Pump
Formula
 Disease - Specific TRADE NAMES
 have fibre  NutriSource
 milk -based  Pediasure
 blends  Enercal
 contain electrolytes  Ensure
 Suplena
 Resource
Complications Common
 Gas, bloating, pain and  Inappropriate Mixes
discomfort can cause dehydration or
electrolyte imbalances
 Aspiration reflux  clogged tubes
 Inability to tolerate  Leakage of gastric contents
particular formula  Bleeding around the stoma
 Nausea , Vomiting  Infection of stoma
Diarrhea  Scar tissue build up
 Constipation
 child pulls tube out
When The Tube needs changing
or if Johnny pulls it out!
 Don’t panic!
 1.Have extra sets on
hand for this purpose
and one at school.
 2. Make sure balloon in
new set works by
injecting sterile saline
into the port .
Changing a g tube………....
 3. Draw out saline from
existing tube, Drain it
completely.
 4.Hold the button area
down.
 5. Put sterile gauze
around the area
keeping child flat and
tummy muscles loose.
Changing the G tube
 6. Begin pulling gently on the
tube, lifting it out of place.
No rush.
 7. If you meet with
resistance, try withdrawing
more saline from balloon.
Sometimes air and or blood
come out with the tube.
Changing continued…….
 8. With sterile Gauze
wipe the area, dab the
actual hole, remove
excess blood or fluid.
 9. Gently insert the new
G-Tube into the
opening.
 10. Fill the balloon
slowly with saline.
Finished!!
 Make sure to double
check the syringe and
that the saline has not
gone back into the
syringe...
Summary Enteral Feeding
 For under or malnourished individuals
 Can be inserted into stomach or jejunum
 Formula is either a supplement to the diet or the only
form of nutrition the person receives.
 Each system is person specific. A strict protocol is
followed - know your client!
 Eating is essential for all of us!!!!!!!!