which nursing action promotes safety of a patient who is prescribed continuous enteral feeding? This is a topic that many people are looking for. cfiva.org is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, cfiva.org would like to introduce to you Nurses Guide to Minimizing Tube Feeding Intolerance. Following along are instructions in the video below:
Name is alison. I work at a level. One trauma center that takes care of of a diverse group of patients.
Ive been there almost 16 years. Our objectives are threefold. We will discuss benefits of early feeding in the icu.
We will review barriers. Which may impede nutrient delivery. And finally we will identify strategies that you can put into place that will minimize tube feeding and tolerance.
I would like to introduce you to mr p. A 48 year old male status post motor vehicle accident that arrived in the emergency room with diagnosis of blunt force trauma to the chest and multiple fractures. He was intubated and sedated and route to the hospital.
He came to our icu from the emergency department in critical condition during our icu nurse cleanup and assessment phase. We focused on mr piece physical injuries. We place lines.
We started medications that would control his blood pressure pain and provide sedation while on the ventilator. However one type of injury would may have overlooked a nutritional injury. We may not have been aware of mr p.
Possibly having nutritional deficits or an urgent need of nutritional intervention in order to appropriately address mr ps nutrition injury. We have to fully volume resuscitate him and make sure his gi tract is capable of receiving a neural nutrition. We heard positive bowel sounds mr p is stable on pressors and is ready for initiation of internal feeding keeping the gut npo may have a significant impact on the ability to fight infection.
The gi tract is the largest immune organ in the body. It contains 70 to 80 percent of the total body immune tissues that provide a barrier against microorganisms and toxins feeding early not only delivers required nutrients. It also protects and facilitates the immune response.
When compared to other forms of nutrition such as parenteral enteral nutrition proves to be less invasive less expensive and much easier to manage from a fluid and electrolyte standpoint. There are multiple reasons that early enteral nutrition is beneficial in the icu patient. It maintains gut barrier and immune function.
It provides a valuable energy and protein source to preserve lean. Body. Mass and support the metabolic demands of critical illness.
Early enteral nutrition. Is associated with reduced incidence of infection early enteral. Feeding reduces days on mechanical ventilation link the stay in the icu and significantly reduces mortality issues that may cause a delay in feeding or inadequate delivery of feeding include hemodynamic instability.
Mechanical obstruction for feeding tube issues such as clogging mis placement or inadvertent removal of feeding tubes. However the most prevalent issue. Preventing adequate early enteral nutrition is intolerance feeding intolerance is defined as one or more of the following elevated gastric residual volume increased abdominal girth or abdominal distension vomiting subjective discomfort diarrhea intolerance is experienced by 30 to 60 of icu patients and accounts for one third of all inner aleut rishon cessation.
The highest rate of intolerance is seen in cardiovascular gi and septic patients. We want to prevent intolerance by minimizing contamination. Hand washing is fundamental to safe patient care gloves should be changed.
Frequently. We should change our gloves after checking gastric residual volume so that bacteria is not transferred. When we are reconnecting tube feedings.
Proper placement and removal of personal protective equipment is essential for preventing transfer of microorganisms to the nurse for other patients cleaning the work environments high touch surface areas. Before you begin your patient care will decrease bacterial load on monitors. Pumps and bed rails minimize feeding tube contamination through the following measures clean.
The feeding tube hub with alcohol wipes. Before each connection as it may have become colonized with bacteria do not store and reuse syringes. As they are an excellent growth medium for microorganisms keep the feeding tube insertion sites.
Clean and dry patient. Positioning is an important component of successful feeding the upper respiratory and upper intestinal tracts of patients are frequently colonized by intestinal flora chlorhexidine oral care. Bi d.
Can decrease. The bacterial load associated with regurgitation typically protocols recommend the head of the bed be elevated 30 to 45 degrees. While feeding patients may not tolerate.
This position. If thats the case place them in reverse trendelenburg tube placement can also interfere with tolerance. If gastric emptying is slowed small bowel feeding may be indicated on the other hand.
If the patient has a shortened bowel gastric feeding may be indicated for maximal absorption. The american association of critical care nurses suggests that sedation slows. Gastric emptying.
And therefore. Sedation levels. Should be minimized to reduce aspiration risk.
Medication. Containing ingredients such as sorbitol may also contribute to diarrhea and intolerance. Sterile water.
Is recommended for immunocompromised and pediatric patients adherence to the recommended hang times for formulas can help to minimize the risk of formula contamination. There are a number of methods that promote increased feeding tolerance. Approximately one third of patients receive a prokinetic agent at some time during their icu stay to promote gastric emptying.
Small bowel placement of feeding tubes. Is also used to bypass the stomach allow an increased provision of formula protocols such as pep up protocol utilized. Numerous safe start tactics to preemptively promote tolerance early on rather than waiting for intolerance issues elements of the pep up protocol include the use of prokinetic agents volume based feedings and semi elemental formula components of the formula such as peptide percentage protein source and fat blend can affect tolerance.
Formula selection is an important tactic and promoting tolerance use of small peptide high medium chain. Triglyceride formulas. Such as peppermint has been associated with improvement in diarrhea vomiting and abdominal pain.
And a rapid progression to go feeding in addition small peptide 100. Whey formulas have been associated with superior protein. Repletion weight gain growth and overall improvement with nutritional status peppermint is the initial formula ordered in the pep up protocol.
Because it promotes tolerance in the critical care setting returning to our case study. We are going to call a code brown in mr. Keys room.
He has had three watery stools during the shift what are some tips to cleaning up this mess without causing undue harm to the nurse and how can the nurse intervene to minimize diarrhea or feeding intolerance. I see you nurses are exposed to rare exotic and exciting. Aromas.
You are a true icu nurse. When you can identify your patients. Diagnosis by sense of smell.
This nurse is code brown survival. Kit. Includes cinnamon or mentholated candy.
A mask with shaving cream on the outside or 2mass with toothpaste smeared between them these tips promote nursing survival. When cleaning up a code brown diarrhea has commonly recognized as three to four watery stools or fecal output of greater than 250 mls per day the etiology of diarrhea varies from medical conditions such as inflammatory bowel disease. Or infectious manifestations of bacterial overgrowth in addition medications can lead to loose stools.
Particularly liquid medications. Containing sorbitol. Formula selection is important in managing diarrhea and minimizing its occurrence.
The use of peptide based. Diets high end medium chain. Triglycerides with the addition of soluble fiber.
May be indicated for the patient who experiences diarrhea at university of tennessee in knoxville they found that the provision of a specialty formula providing small protein fragments called peptides made a difference in their high risk patients. This was a retrospective study of surgical icu patients that demonstrated that formulas with a greater percentage of small peptides were better tolerated. These patients had three times less diarrhea and three times less use of rectal tubes in summary right patient right time.
We need to be proactive in taking care of all patients. Including addressing their nutritional injuries early during hospitalization. Identify those patients who will benefit from early in iran.
Nutrition right route. When the gut works use it right position. Make.
Sure. The head of the bed is elevated 30 to 45 degrees. As tolerated right protocol.
Encouraged multidisciplinary involvement to implement tube feeding protocols in your icu right formula. If tolerance is an issue use a specialty formula that addresses those issues dont accept inadequate feeding and intolerance in your icu become a nutrition champion. Promoting early enteral nutrition recognize signs and symptoms of intolerance and address these issues share your expertise with physicians and dietitians in your facility in order to improve your patient outcomes.
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