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 Continuous Drip
delivered 4-8 x a day directly By gravity or Infusion Pump
into stomach feeding may be delivered
each feed lasts 15 minutes without interruption for an
more convenient unlimited period of time each
day
less expensive
Commonly used for 8-10 hours
not always easily tolerated or
during the night with bolus
digested
supplements during the day
allows for supplemental feeds in good for extremely
the event of undernourished
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!!!!!!!!
