ENTERAL ENTERAL NUTRITIONNUTRITION

MAHENDRA JANGIRMAHENDRA JANGIR

DEFINATION & GOALDEFINATION & GOAL

• ENTERAL NUTRITION IS DEFINED AS NUTRITION PROVIDED THROUGH A TUBE DIRECTLY TO GI TRACT.

• THE GOAL OF NUTRITION INTERVENTION IS TO SUPPLY ADEQUATE NUTRIENTS TO MEET THE PATIENT’S NUTRITIONAL NEEDS BY THE MOST PHYSOLOGIC,SAFEST AND COST-EFFECTIVE ROUTE.

INDICATION FOR ENINDICATION FOR EN

• POOR NUTRIENT RETENTION

• PROLONGED NPO STATUS

• INSUFFICIENT INTAKE

INDICATION FOR ENINDICATION FOR EN

GASTROINTESTINAL DISEASES -SHORT BOWEL SYNDROME -INFLAMMATORY BOWEL

DISEASES -INTRACTABLE DIRRHOEA OF INFANCY -EXTRAHEPATIC BILIARY ATRESIA -INTESTINAL PSEUDO-OBSTRUCTION -CHRONIC LIVER DISEASE -GLYCOGEN LIVER DISEASE

INDICATION FOR ENINDICATION FOR EN

NEUROLOGICAL

-STATIC ENCEPHALOPATHY

-DYSPHAGIA

-CNS TUMOR

CARDIORESPIRATORY -CYSTIC FIBROSIS

-BRONCHOPULMONARY DYSPLASIA

-CONGENITAL HEART DISEASE

INDICATION FOR ENINDICATION FOR EN

MALIGNANCY -POOR

INTAKE:RADIATION/CHEMOTHERAPY -TERMINAL SUPPORTHYPERMETABOLIC STATES -BURNS -TRAUMA / HEAD INJURYOTHER -ANOREXIA NERVOSA -CHRONIC RENAL DISEASE

CONTRAINDICATION FOR ENCONTRAINDICATION FOR EN

PERITONITISOBSTRUCTIONILEUSVOMITINGENTERIC FISTULAPANCEATITIS

ROUTES OF EN ROUTES OF EN ADMINISTRATIONADMINISTRATION

NASOENTERAL -NASOGASTRIC

-NASODUODENAL

-NASOJEJUNAL

ROUTES OF EN ROUTES OF EN ADMINISTRATIONADMINISTRATION

TUBE ENTEROSTOMY

-GASTROSTOMY

-JEJUNOSTOMY

TRANSPYLORIC ENTRANSPYLORIC EN

INDICATIONS

-GASTROESOPHAGEAL REFLUX

-ALTERED MENTAL STATUS

-INTRACTABLE EMESIS

-DELAYED GASTRIC EMPTYING

-ABNORMAL SWALLOWING

INITIATION OF ENINITIATION OF EN

APROACHES

-BOLUS Vs CONTINOUS FEEDS

-FULL FEEDS Vs GRADED REGIMENS

ASSESSMENT OF CLINICAL ASSESSMENT OF CLINICAL RESPONSERESPONSE

ANTHROPOMETRIC MEASUREMENTS

FEEDING TELERANCE

COMPLICATIONCOMPLICATION

GASTROINTESTINALMECHANICALMETABOLICFORMULA RELATED

GI COMPLICATIONSGI COMPLICATIONS

VOMITINGDIARRHEACONSTIPATIONABDOMINAL PAIN / BLOATINGGASTRIC IRRITATIONASPIRATION

MECHANICAL COMPLICATIONSMECHANICAL COMPLICATIONS

TUBE OCCLUSIONNASOPHARYNGEAL EFFECTSTUBE FRACTUESLEAKAGEDISLODGEMENTIRRITATION

METABOLIC COMPLICATIONSMETABOLIC COMPLICATIONS

HYPOVOLEMIAHYPERKALEMIAHYPOPHOSPHATEMIAHYPERTONIC DEHYDRATIONFLUID OVERLOAD

FORMULA COMPLICATIONSFORMULA COMPLICATIONS

INCOMPATIBILITY WITH MEDICINESHYPEROSMOLALITYCONTAMINATION

NURSING MANAGEMENTNURSING MANAGEMENT

NAUSEA AND VOMITING: ALWAYS KEEP THE HEAD 30-45 DEGREES

ELVATED FOR FEEDING. POSITION Pt. ON RIGHT SIDE TO FACILITATE

PASSAGE OF GASTRIC CONTENT THROUGH PYLORUS.

DECREASE TOTAL VOLUME OF FEED. TO OVERCOME DELAYED GASTRIC

EMPTYING STOP FEED FOR 2 HOURS AND CHECK RESIDUAL

NURSING MANAGEMENTNURSING MANAGEMENT

• CONT… TO OVERCOME DELAYED GASTRIC

EMPTYING ADMINISTER PROKINETIC AGENTS(METOCLOPROMIDE,CISAPRIDE).

TO RELIEVE CONSIPATION PROVIDE FREE WATER, USE HIGH FIBER FORMULA.

STOP FEEDING IN CASE OF GI OBSTRUCTION.

NURSING MANAGEMENTNURSING MANAGEMENT

• CONT… FLUSH FEEDING TUBE 3-4 HRLY TO

PREVENT OBSTRUCTION. TO OVERCOME METABOLIC

COMPLICATIONS FREQUENTLY CHECK ELECTROLYTES AND BLOOD SUGAR.

TO STIMULATE ORAL GRATIFICATION PROVIDE ICE CHIPS,SUGAR FREE CANDIES.

PROVIDE ORAL CARE 4-6 HRLY.

CONCLUSIONCONCLUSION

EN IS THE PREFERRED METHOD OF NUTRITIONAL SUPPORT

SAFE AND EFFICACIOUSWELL TOLERATEDSAFER, CHEAPER, SIMPLER AND

MORE EFFECTIVE THAN PARENTERAL NUTRITION

•