Matthew Lillard
Enteral feedings...
What must you have to get one?
A functional GI tract!
Save me from malnutrition GI Joe!
Enteral feedings...
Nursing interventions
- elevate HOB 30-45 degrees during feeds and after feeds for 30-60 min
- assess for bowel sounds
- use liquid meds whenever possible
- check residuals Q4 hours and feed it to them
- flush tubes w/ 30-60ml filtered water
Too much gastric residuals indicates?
not effective
How often do you change TPN?
Q24 hours w/ a special filter
Your patient with a bowel obstruction keeps throwing up! What are we going to do now?
NG tube! Bowel rest girly pop
Enteral feedings...
What are the complications?
- Vomiting
- Dehydration
- Diarrhea
- Constipation
Enteral feedings...
When to call about gastric residuals
greater than 250, call hcp.
greater than 500, hold feedings and reassess tolerance in 1 hr.
What is the desired glucose for parenteral feeds?
A BG of 140
With TPN, be careful w/ these two things...
Glucose and Infection
How often do you check BG w/ TPN?
Q 6 hours
Enteral feedings...
How to prevent complications?
Vomiting comes from improper placement, so make sure it is placed right!
Dehydration is from poor fluid intake, so increase flushes and possibly decrease protein.
Diarrhea- feed should be room temp and not too fast
Constipation- stool softener and increase flushes
Enteral Feeds...
If surgically placed, when do you feed them?
Feeds are delayed to 24-48 hours after placement.
Where does TPN go through and why?
If there is no ostomy output, put them on...
If they are kept on it for a super long time, we will need to fix protein deficiency by putting them on ...
NPO
TPN
When to call about ostomy bag output?
no output or more than 2000ml
What is the difference between enteral and parenteral feeding?
Enteral is for a functioning GI tract and is NG.
Parenteral is for a nonfunctioning GI tract and is done through a central line.
Intussusception- what happens?
Proximal segment telescopes into more distal segment
Most common cause of intestinal obstruction in young children.
What is intussusception?
In intussusception, increased pressure=___=___ and ____
decreased blood flow= ischemia and necrosis
Intussusception S/Sx
sudden onset crampy abdominal pain
inconsolable crying
knees drawn up to chest
vomiting
lethargy
currant jelly stool
tender distended abdomen
palpable sausage shaped mass in URQ
Monitor for these things in intussusception
bowel sounds, fever, peritonitis, and bowel perforation
Diagnosis and treatment for intussusception
Dx by symptoms and ultrasound (mass w/ "bulls eye")
Tx enema (air or saline), or surgery if it doesn't work
What do you assess for in intussusception that may cause surgery to be cancelled?
red currant jelly stools may poof! Magically disappear
Bowel obstruction S/Sx
abdominal pain, N/V, decreased bowel sounds, distention
Most common cause of dehydration in children
Vomiting and diarrhea