Aim for a healthy weight'

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-- 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.
DG 2000- Public Comment Period
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Enteral Nutrition
What, Why, When, and How?
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!
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Formula Types
Standard, Intact, Blenderized
For Pt able to digest/ Absorb nutrients
May contain pureed foods!!!!!
Hydrolyzed-- Protein delivered as small
peptides/ AA for those with compromised digestive
function.
Modular Contain a single nutrient
(pro, CHO, lipid) Combined to meet unique
needs of each pt Used least often,
Often low in fat
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Nutrient Content of Enteral
Formulas Caloric
Density (kcal per ml
or cc)
0.5 1.0 1.5
2.0
Normal formula Energy Needs Met in
Smaller
Volume Kcal needs high Low
appetite Volume Restricted
For pts with damaged or atrophied GI
tract. Dilute formulas allow for recovery of GI
function.
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Important Considerations Physical
Properties Formula Osmolality ( of osmotic
particles per Kg of solvent) Hypotonic
Isotonic Hypertonic 280-320
mmol/kg May cause Osmolality of
human gastric
plasma retention Example 0.85
sodium chloride in duodenum, or
normal saline may cause fluid
shift, 5 glucose solution diarrhea, ( 5
g per 100 ml) dehydration
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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
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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
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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
addt feeding.
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Methods of Delivery Due to
risk of aspiration-- Elevate upper body
gt30 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