FORMULA PREPARATION AND PATIENT EDUCATION

PREPARING FOR AN NG TUBE FEEDING

Before working with the NG tube:

 Clean your hands with soap and water each time you work with your feeding tube.
 Make sure that the type of formula is correct and check the expiration date. If
something is incorrect, call the Enteral Team and do not use the formula.

Flushing instructions:

 Flushing is the best way to keep your feeding tube working properly.
 You must flush or clear the feeding tube with warm water several times each day to
keep it from clogging.
 Always flush at least twice a day and before, between, and after giving medications
through the NG tube.
 Flush with 30 to 60 mL of warm tap water (use at least 20 to 30 mL between each
medication).
 For your continuous feeding, flush at least every 4 to 6 hours. If the pump can be set
to automatically flush, set it to flush every hour, unless instructed otherwise.

Follow the steps for your type of feeding:

 Bolus or syringe feeding

 Gravity bag feeding
 Continuous feeding

Steps for a bolus or syringe feeding:

 Position yourself comfortably for the feeding. When possible, sit upright. If
this is not possible, make sure your head is elevated on the bed during the
feeding.
 Flush the tube with 30 to 60 mL of warm water.
 Remove the plunger from the large syringe and attach the syringe to the end of
the feeding tube.
 Add formula to the syringe. Let the feeding run in by gravity by raising the
syringe above your stomach. Feeding takes about 15 to 20 minutes. If needed,
use the plunger to apply slight pressure to administer the feeds.
  When the feeding is complete, flush the tube with at least 30 to 60 mL of
warm water.

Steps for a gravity bag feeding:

 Position yourself comfortably for the feeding. When possible, sit upright. If
this is not possible, make sure your head is elevated on the bed during the
feeding.
 Flush the tube with 30 to 60 mL of warm water.
 Pour formula into the gravity bag, and prime the tubing with formula by
opening the roller clamp.
 Attach the gravity bag tubing to the NG tube.
 If there is a clamp on your feeding tube, unclamp it. Let the feeding run in by
gravity by raising the bag. The feeding rate may be adjusted by positioning the
roller clamp on the tubing. The feeding may take up to 1 hour.
 When the feeding is complete, flush the tube with 30 to 60 mL of water. Try
not to put extra air into your stomach.
 The feeding tube can be rinsed with warm water and used again for up to 24
hours.

Steps for a continuous feeding:

 Set up the feeding by following the directions for the pump (see
separate handout) and prime the tubing.
 Place an amount of formula in the bag according to hang time:
 12 hours for any ready-to-feed formula
 4 hours for any powdered formula
 2 hours for any homemade blended formula
 Flush the tube every 4 to 6 hours using at least 30 to 60 mL of warm
water.
 Flush feeding tube with 30 to 60 mL of warm water.
 Attach the feeding bag to the tube.
 Start the pump per the manufacturer’s directions.
 Change the feeding bag every 24 hours.
 Before adding fresh formula, pour out any remaining formula and rinse
the bag with warm water.
  Flush the feeding tube with 30 to 60 mL of warm water anytime the
pump is turned off (for example, if you get up in the night and
disconnect from the pump) and at the completion of the feeding.

Giving medication in feeding tube:

 Flush the tube with warm water before, between, and after
giving each medication.
 Speak with pharmacist if you are unsure which medications can
be given through feeding tube.
 Try to use liquid medication whenever possible. Use a small
amount of water to thin out thick medications.
 Crush tablets into a fine powder and then mix with 20 to 30 mL
of warm water. Let it dissolve as much as possible then draw
up the medication solution into the syringe.
 Flush with 20 to 30 mL of warm water.
 Attach the syringe and give the medication.
 Flush with 30 to 60 mL of warm water.
 Repeat with each medication.

HEALTH EDUCATION

Health education is a social science that draws from the biological, environmental,
psychological, physical and medical sciences to promote health and prevent disease,
disability and premature death through education driven voluntary behaviour change
activities.

NUTRITION EDUCATION

"According to WHO, the focus of health and nutrition education is on people and
action. In general, its aims are to persuade people to adopt and sustain improved desirable
nutrition and health practices and to take their own decisions, both individually and
collectively to improve their nutritional and health status, and environment."

Importance

Nutrition education reinforces knowledge and corrects faulty concepts about nutrition.

 It allows the individual to evaluate the nutrition information he or she receives.

  It promotes the best use of an individual's limited economic resources.
 It promotes the concept of health as a values community asset.

Components of Nutrition Education

Nutrition education programmes should have at least three components which should be
directed at the various social groups.

a) Increasing the nutrition knowledge and awareness of the public and of policy-makers- This
can be achieved by providing information on the relationship between diet and health; the
relationship between nutritional and health status and individual productivity and national
development; the nutritional needs of the population and of individuals; the importance of
ensuring the quality and safety of the food supply; the causes and consequences of nutritional
disorders; and the benefits of food labelling and legislation.

b) Promoting desirable food behaviour and nutritional practices- This can be achieved by
providing information on the nutritional value of foods; the components of an adequate diet;
making appropriate food choices and purchases from available resources; hygienic food
preparation and handling of food; storage, processing and preservation of food; and equitable
intra household food distribution according to the nutritional needs of family members.

c) Increasing the diversity and quantity of family food supplies- This can be achieved by
providing information on methods of improving food production; crop selection and
diversification; proper storage, preservation and processing; conservation of nutrients during
food preparation; and the prevention of food waste. Each of these components makes a
special contribution to nutritional improvement. All three are important and need to form part
of nutrition education and training programmes for personnel in agriculture, education and
health in African countries. At the community level the people affected by nutritional
problems should participate in determining which components should receive most emphasis
to bring about lasting improvements in local food and nutrition conditions

PRINCIPLES OF NUTRITION AND HEALTH EDUCATION

1. Credibility

 It is the degree to which the message to be communicated is perceived as trustworthy

by the receiver
  Good health education must be consistent and compatible with scientific knowledge
and also with the local culture, educational system and social goals

2. Interest

 Health teaching should be related to the interests of the people

 Health programme should be based on the ―FELT NEEDS‖, so that it becomes
―people ‘s programme
 Felt needs are the real health needs of the people, that is needs the people feel about
themselves

3. Participation

 A high degree of participation tends to create a sense of involvement, personal

acceptance and decision –making
 It provides maximum feedback
 The Alma- Ata Declaration states ―The people have a right and duty to participate
individually and collectively in the planning and implementation of their health care‖
 Health programmers are unlikely to succeed if community participation is not an
integral part

4. Motivation

 In every person, there is a fundamental desire to learn. Awakening this desire is called
motivation
 Two types of motives
 primary motives-are driving forces initiating people into action
 secondary motives –are created by outside forces or incentives
 Need for incentives is a first step in learning to change
 Incentives may be positive or negative
 Main aim of motivation is to change behaviour
 Motivation is contagious: one motivated person may spread motivation throughout a
group

5. Comprehension

 Health educator must know the level of understanding, education and literacy of
people to whom the teaching is directed
  Always communicate in the language people understand.
 Teaching should be within the mental capacity of the audience.

6. Reinforcement

Repetition of message at intervals is necessary

If the message is repeated in different ways, people are more likely to remember it.

7. Learning by doing

The importance of learning by doing can be best illustrated by the Chinese proverb ―if I
hear, I forget; if I see, I remember; if I do, I know‖

8. Known to unknown

We must proceed

 from the concrete to the abstract‖

 from the particular to the general‖
 from the simple to the more complicated‖
 from the easy to more difficult‖
 from the known to unknown‖
 Here health communicator uses the existing knowledge of the people as pegs on
which to hang new knowledge

9. Feedback

 The health educator can modify the elements of the system (e.g., message, channels)
in the light of feedback from his audience
 For effective communication, feedback is of paramount importance.

10. Leaders

 Leaders are agents of change and they can be made use of in health education work.
 The attributes of a leader are;
 He understands the needs and demands of the community
 Provides proper guidance, takes the initiative, is receptive to the views and
suggestions of the people;
 Identifies himself with the community;
 Selfless, honest, impartial, considerate and sincere;
 Easily accessible to the people;
 Able to control and compromise the various factors in the community;
 Possesses the requisite skill and knowledge of eliciting cooperation and achieving
coordination of the various official and non-official organizations.