Transcript Lecture One

-- Aim for a healthy weight.
-- Become physically active each day.
-- Let the (Food Guide) Pyramid guide your food choices.
-- Eat a variety of grains daily, especially whole grains.
-- Eat a variety of fruits and vegetables daily.
-- Keep food safe to eat.
-- Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.
-- Choose beverages and foods that limit your intake of sugars.
-- Choose and prepare foods with less salt.
-- If you drink alcoholic beverages, do so in moderation.
Definition:
liquid formulated foods designed to be used
to supplement oral intakes or provide complete
nutrition. Typically used in hospitalized pts,
often in tube feedings.
ENTERAL FEEDINGS SHOULD BE USED WHENEVER
A CLIENT CAN DIGEST OR ABSORB NUTRIENTS VIA
THE GI TRACT!!
“IF THE GUT WORKS, USE IT!”
Formula Types
Standard, Intact, Blenderized
For Pt able to digest/
Absorb nutrients
May contain pureed foods!!!!! Hydrolyzed-- $$
$
Protein delivered as
small peptides/ AA for
Modular
those with compromised
digestive function.
Contain a single nutrient
(pro, CHO, lipid)
Often low in fat
Combined to meet unique
needs of each pt
Used least often, $$$$$
Nutrient Content of Enteral Formulas
Caloric Density
(kcal per ml or cc)
0.5
1.0
1.5
2.0
Normal formula
For pts with damaged or
atrophied GI tract.
Dilute formulas allow for
recovery of GI function.
Energy Needs Met in
Smaller Volume:
• Kcal needs high
• Low appetite
• Volume Restricted
Important Considerations: Physical Properties
Formula Osmolality (# of osmotic particles per Kg of solvent)
Hypotonic
Isotonic
280-320 mmol/kg
Osmolality of human
plasma
Example:
0.85 % sodium chloride
or “normal saline”
5% glucose solution
( 5 g per 100 ml)
Hypertonic
May cause
gastric
retention;
in duodenum,
may cause
fluid shift,
diarrhea,
dehydration
Other Important Physical Properties
Renal Solute Load (RSL)
Remember: Hyperosmolar solutions require increased
water intake in order for renal excretion,
particularly in the pediatric patient.
Dehydration is a great risk-- hypernatremia
azotemia (high serum N)
oliguria
fever
weight loss
Tube Feeding protocols
Frequency/ amount
Bolus*= large volume delivered intermittently
ex: 400 ml q 4 h (2,400 ml per 24 hours)
Continuous= given over 16 to 24 hours
ex: 75 ml per h for 24 hrs (1,800 ml per 24 hrs.)
(final rate)
Intermittent*= gravity drip using smaller
volumes than bolus; more often
*Often poorly tolerated; n/v/d, aspiration
Volume and Rate of Delivery
Standard Procedure: use full-strength formula
but control flow rate!
Nasogastric Feedings:
start slow: 25-50 ml/ hour
increase 10-25 ml per 8-24 hrs.
Measuring Residuals: withdrawing formula left in stomach
using a syringe
if 100-150 ml remain, no add’t feeding.
Methods of Delivery
Due to risk of aspiration--
Elevate upper body >30˚;
remain at least 30 min.
after feeding.
Supplemental Water can be provided in the
feeding tube. Functions to:
• flush tube to prevent clogging
• meet daily fluid requirements