Review of CVDDM

1
Test Review

• Review of CVD/DM
• Review of Test
• Guest Speaker on PKU after lecture

2
Chapter 20 Enteral Formulas

• Enteral formulas
• Liquid diets delivered via the GI Tract
• Given orally or via tube
• For people who cant meet nutritional needs po

3
Enteral Nutrition

• Enteral Feeding
• Preferred to Parenteral
• If the gut works, use it!
• Maintains normal gut functioning
• Less risk
• Less cost
• Oral feedings preferred to tubeless stress and
  complications

4
Enteral Formulas

• Formula selected following assessment of
  nutritional needs
• Characteristics Examples of
• Complete Formulas
• Standard or Intact Formulas
• Hydrolyzed Formulas
• Modular Formulas

5
Enteral Formulas, cntd.

• Complete Formulas
• Designed to supply 100 of nutrient needs
• Supplies all nutrients client needscan also
  supplement table foods
• Standard or Intact Formulas
• Contains complete protein molecules
• Client must be able to digest and absorb
  nutrients without any difficulty

6
Enteral Formulas, cntd.

• Hydrolyzed Formulas
• Fragments of proteins or partially digested into
  amino acids so more easily absorbed
• Lower in fat because more difficult to digest and
  absorb
• Suitable for clients who are not able to digest
  or absorb nutrients well

7
Enteral Formulas, cntd.

• Modular Formula
• Provides a single nutrient instead of all
  nutrients
• More closely tailored to meet specific nutrient
  needs of clients
• Increases cost of formula
• Other Formula Variables
• Energy or Kcalories may vary
• Sources of Protein
• Length of EFALCT or MCT
• Vitamin and Mineral Content

8
Variables in Formulas

• Residue or Fiber Content
• Fiber and residue may be restricted to minimize
  gas, fecal output /or abdominal distention
• Fiber-containing formulas may be necessary to
  prevent constipation or diarrhea

9

• OsmolalityNumber of particles in solution
• Isotonicformulas that approximate blood serum of
  300 mOsm/kg
• Hypertonichigher osmolality than blood serum
• Can develop problems, e.g. diarrhea if delivered
  too rapidly
• More expensive than isotonic

10
Selecting Enteral Formulas

• Oral supplements
• Can provide additional kcalories/protein
• Variety of flavorstry a variety
• Serve cold
• Avoid serving at meals
• Tube Feedings
• Physical problems (chewing swallowing)
• Malnourishedlow appetite or high nutrient needs
• Obstructions, coma, intestinal surgery, need
  hydrolyzed formula

11
Tube Placement

• Identify major locations for tube placement
• Tube placements Determined by medical problems
  and estimated length of time feeding is required
• Expected to be on tube feedings less than about
  four weeks
• Nasogastric
• Nasoduodenal or nasojejunal

12
Tube Feedings Formulas

• Tube feedings longer than four weeks or if
  obstruction in upper GI
• Gastrostomy into the stomach (PEG)
• Jejunostomy (DEJ) or (PEJ)

13
Formula Selection

• Guidelines for formula selection
• General Requirement The formula which meets the
  clients medical and nutrient needs with the
  lowest risk of complications and at the lowest
  cost
• Formula Selection Factors
• Ability to digest nutrients
• Nutritional requirements
• Residue or fiber modifications
• Individual tolerances
• Size of the inner lumen of the feeding tube
• RD consult

14
Delivery of Formulas

• Appropriate techniques to use in order to prevent
  contamination
• Open feeding systemFormula transferred from
  original package to a feeding container
• Closed feeding systemFormula comes prepackaged
  ready to hangminimizes risk of contamination
• Closed system preferred by the State

15
Delivery of Formulas, cntd.

• Safe Handling of Formula
• Reducing risk of contamination
• At nursing station
• At bedside
• Formula Delivery techniques
• Minimize risk of aspirationelevate client 30-45
  degrees during and 30 min. following formula
  delivery

16
Delivery of Formulas, cntd.

• Different ways formulas can be administered to
  clients
• Intermittent Feedings
• Delivery into stomach in 30 or more min.
• Mimic usual eating patterns less costly more
  freedom between meals.
• Continuous Feedings
• Delivery constant over 8-24 hr. period
• Intestinal feedings
• Infusion pump required

17
Delivery of Formulas, cntd.

• Start 15-30 mL full strength w/u gradually
  15-30 mL as tolerated q shift to goal rate
• Monitor residuals
• Need for water
• Minimizing clogging risks
• Thirst
• Weight changes
• Urine output

18
Medications and Tube Feedings

• Guidelines for delivering medications through
  drugs
• Prevent interactions between medications meds
  and formula and clogged feeding tubes
• Give meds by mouth if possible
• Use liquid form when possible
• Use injectable or intravenous
• Crush tablets to fine powder mix with water
• Avoid mixing meds together or with formula
• Flush with water before after administering

19
Formula Schedules

• Plan a tube feeding schedule based on volume of
  formula needed and method of administration p.
  506
• Transitioning guidelines from tube to oral
  feedings
• Gradual shift from tube to oral feedings
• Accurate Calorie Counts
• Meeting 2/3 or nutrient needs orally before
  discontinuing tube feedings.
• Drinking formula and then more food

20
Enteral Formulas Summary

• Increasing variety of formulas marketed every
  year
• Formulas Delivery must be tailored to the needs
  of the individual
• On-going assessment and intervention r/t formula
  tolerence
• Cost vs. benefit the overall GOAL of the tube
  feeding must be considered.

21
Clinical Application

• Imagine that you need a transnasal tube feeding.
  How might you react to the news that you need the
  feeding tube and to the insertion procedure?
• What might you miss about eating table foods?
• What might a nurse do to help you deal with these
  feelings?