NCM 116 Skills

• Components of a diet: carbohydrates, fats, protein, vitamins, and minerals
• Carbohydrates:

  • Prefer source of energy, promote normal fat metabolism, store protein, and enhance lower gastrointestinal function
  • Sources: milk, grains, fruits, vegetables
  • Inadequate intake affects metabolism
• Fats:

  • Provide concentrated source and stored form of energy
  • Protect body organs and maintain body temperature
  • Inadequate intake can lead to clinical manifestations such as colds, lesions, amenorrhea, and increased infection
• Protein:

  • Builds and repairs body tissue, regulates fluid balance
  • Maintains acid-base balance, produces antibodies
  • Provides energy, produces enzymes and hormones
  • Inadequate intake can lead to protein-energy malnutrition, severe wasting of fats and muscle tissue
• Vitamins:

  • Facilitate metabolism of proteins, fats, and carbohydrates
  • Promote life and growth processes, maintain and regulate body function
  • Fat-Soluble: ADEK, stored in the body
  • Water-Soluble: B, C, not stored in the body, can be excreted through urine
• Diet therapy is concerned with recovery from illness and disease prevention
• Therapeutic diets are planned modifications of a normal diet, prescribed by a doctor and planned by a dietician
• Purpose of therapeutic diets:

  • Regulate amount of food
  • Assist body organs in maintaining normal function
  • Aid in digestion
  • Improve specific health conditions
  • Increase or decrease body weight
  • Modify feeding intervals
• Significance of therapeutic diets:

  • Useful in managing diseases
  • Promote greater assistance
• Indications for therapeutic diets:

  • Kidney failure
  • Lower serum cholesterol
  • Control elevated blood sugar levels
  • Treat celiac disease (e.g., gluten-free diet)
• Types of therapeutic diets:

  • Regular diet
  • Liquid diet
  • Clear liquid diet
  • Low cholesterol diet
  • Low residue diet
  • Diabetic diet
  • Low calorie diet
  • High caloric diet
  • Fat-restricted/low-fat diet
  • Sodium-restricted diet
  • High protein diet
  • Low protein diet
  • Bland diet
  • Renal diet
  • Soft diet
  • Therapeutic diet for malnutrition
• Gastric decompression:

  • For patients with gastric distention receiving aggressive ventilator resuscitation measures prior to intubation
  • Involves removing stomach contents using a nasogastric tube
• Gastric distension:

  • Enlargement of the stomach due to various causes
  • Physiologic distension occurs during eating
  • Other causes include binge eating, tumors, diabetic neuropathy, scarring, and delayed gastric emptying
• Nasogastric tube:

  • Flexible tube passed through the nose into the stomach
  • Used for temporary removal or addition of substances
  • Types of nasogastric tubes: Levin tube, SUMP (Salem), Moss tube, Sengstaken-Blakemore, Minnesota tube, Nutriflex tube
• Benefits of gastrointestinal decompression:

  • Prevents and relieves gastrointestinal tract distention
  • Useful in intestinal obstruction and paralytic ileus
  • Should be part of surgical treatment for obstruction and peritonitis
  • Protects against complications like bronchial aspiration, wound dehiscence, and evisceration
• Gastrointestinal decompression is associated with control of distention and vomiting
• Decompression protects the patient against bronchial aspiration of gastric contents
• Decompression encourages the adequate and rapid healing of intestinal suture lines
• Decompression minimizes the incidence of abdominal wound dehiscence and evisceration
• Decompression decreases the incidence of postoperative adhesive obstruction
• To perform gastrointestinal decompression:

  • Place the patient in a high Fowler's position
  • Instruct the patient to swallow on command
  • Insert the tube into an unobstructed nostril and slowly advance it to a predetermined length
  • Check tube placement before evacuation by air insufflation into the stomach with a large syringe
• The Cantor Tube is used for gastrointestinal decompression

  • It is a 10-foot long, single-lumen tube used for intestinal decompression
  • The Cantor tube has a mercury-weighted rubber tab attached to its perforated tip to help carry the tube through the stomach and intestine
• When using a one lumen gastric tube to decompress the gastrointestinal tract, a regulator with an intermittent suction setting must be used

  • Set the initial level of suction within the “low range” (0 to 80mmHg), starting between 40-60 mmHg
  • The suction level should not exceed 80 mmHg
• Jejunostomy tube (J-tube) is a soft plastic feeding tube placed through the skin of the abdomen into the jejunum, bypassing the stomach entirely

  • Jejunostomy tube may be placed laparoscopically or surgically
  • Only liquids may pass through the jejunostomy tube
• Jejunostomy tube can be put in place by:

  • Surgical method
  • Via a percutaneous endoscopic gastrostomy (PEG) tube
  • Radiologically
• To clean the skin around the jejunostomy tube:

  • Change the bandages once a day or more if the area becomes wet or dirty
  • Keep the skin clean and dry using warm soapy water, dry towel, plastic bag, ointment or hydrogen peroxide (if recommended), and Q-tips
• To replace the dressings around the jejunostomy tube:

  • Use gauze pads, dressings, or bandages and tape
  • Follow the nurse's instructions on how to place the new bandages or gauze around the tube and tape it securely to the abdomen
• Jejunostomy tube maintenance:

  • Ensure a thorough flushing regimen is in place with COOLED BOILED WATER and a new syringe used daily
  • Review all medications as bypassing the stomach can affect absorption
  • Ensure correct preparation of medications, i.e. liquid/soluble/dispersible
• Overgranulation of stoma site:

  • Excessive growth of tissue around the stoma site
  • Keep the stoma site clean and dry to minimize this problem
  • Call nutrition nurse/doctor if infection is suspected
• Tube blockage:

  • Could be due to inadequate flushing of the tube
  • Unblock the tube by using warm boiled water, soda water, or bicarbonate of soda/water solution
  • If unable to unblock the tube, go to the hospital
• Purpose of jejunostomy tube:

  • To provide hydration, nutrition, or medication via surgical opening into the stomach or jejunum when the oral route is contraindicated
• Considerations for jejunostomy tube:

  • Special formulas or blender-prepared nutrients may be administered at room temperature and should be discarded if not used within a 24-hour period
  • Possible side effects to consider are distention, vomiting, diarrhea, and constipation
  • Consultation with physician or registered dietician may be indicated
• Equipment needed for enteral feeding:

  • 60 mL syringe
  • Graduated container
  • Glass of water
  • Prepared formula
  • Clamp
  • Gloves
  • Protective sheet
  • Enteral feeding bag and tubing
  • Enteral feeding pump (optional)
• Procedure for enteral feeding:

  • Gather all equipment
  • Explain the procedure to the patient
  • Provide privacy
  • Perform hand hygiene and wear gloves
  • Prepare measured amount of formula or medication
  • Elevate the patient's bed
  • Connect enteral bag tubing to the jejunostomy tube
  • Flush tube with water after each feeding
  • Document in patient's record
• Colostomy irrigation is a way to regulate bowel movements by flushing and emptying the colon at a scheduled time

  • The process involves instilling water into the colon through the colostomy or stoma, which stimulates the colon to empty
• Reasons for colostomy creation:

  • Colon, rectal, or anal cancer
  • Traumatic injury
  • Intestinal blockage
  • Diverticulitis
  • Crohn’s disease
  • Incontinence or constipation
• Equipment needed for colostomy irrigation:

  • Colostomy tray
  • Asepto syringe
  • 4x4 sponges
  • Glass bowl
  • Sponge forceps
  • Prescribed amount of solution
  • Pail or bedpan
  • Bath blanket
  • Rubbersheet
  • Table protector
  • Bedpan cover
  • Foot stool
  • Colostomy bag
  • Treatment pad
  • KY jelly
  • Rectal tube
  • Kidney basin
• Steps for colostomy irrigation:

  • Check the order
  • Gather and prepare equipment
  • Explain the procedure to the patient
  • Provide privacy
  • Change top sheet with bath blanket
  • Let the patient lie on his side
  • Place rubber sheet and treatment pad under the colostomy site
  • Arrange equipment at the bedside
  • Remove colostomy bag
  • Wash hands and dry
  • Pour solution into the bowl
  • Introduce the rectal tube through the stoma
  • Slowly introduce the prescribed amount of solution
  • Catch the return flow in a kidney basin
  • Clean the area around the colostomy after the procedure
• Colostomy care:

  • Clean skin is important for colostomy care
  • Use oil/moisturizer free soap and a soft cloth to cleanse the stoma
  • Rinse the soap off the skin and pat dry for a good seal between the skin and wafer
  • Check skin for redness or irritation, should be level/smooth around the stoma
• How often to change the appliance:

  • Normally every 3-5 days
  • Can shower with pouch on, but can remove it to shower when due for a change
  • Select a time when the stoma is least active to change the appliance