GENERAL DIETS

MELANIE SILVA-BANATICLA, RN,MAN

UPHSD-CALAMBA
 Adulthood
• Broadly divided into 3 periods
– Young ( 18-40 years old)
– Middle (40-65 years old)
– Late ( over 65 years old)
 YOUNG ADUTHOOD (18-40 years old)
• Time of excitement & exploration
• Individuals are alive with plans, desires, &
energy as they begin searching for & finding
their places in the mainstream of adult life.
• They appear to have boundless energy for
both social & professional activities.
• Often interested in exercise & may participate
in athletic events.
MIDDLE ADULTHOOD (40-65 YEARS OLD)
• Physical activities typically begin to decrease, resulting
in lowered caloric requirement for most individuals.
• During these years, people seldom have young children
to supervise, & the strenuous physical labor of some
occupations may be delegated to younger people.
• Tire more easily, therefore they may not get as much
exercise.
• Because appetite & food intake may not decrease,
there is common tendency toward weight gain during
this period.
 During young & middle adulthood
• Beginnings of osteoporosis may also be
evident
• a diet rich in calcium, vitamin D, & fluoride is
thought to help prevent osteoporosis.
• OSTEOPOROSIS – condition in which bones
become brittle because there have been
insufficient mineral deposits, especially
calcium.
Nutrient Requirement
- amount of specific nutrient
needed by the body.
> 19-50 years old – calcium
1,000mg & Vitamin D is 5 µg
- fat-free milk or foods
made from fat-free milk
Calorie requirements – number of
calories required daily to meet energy
needs.
> growth is usually complete by the
age 25, calorie requirements diminish
after the age of 25 as basal
metabolism rates decrease
 What are kilocalories?
• Energy can be measured using JOULES or
Calories. When large units are involved, such
as they are in diets, the term KILOCALORIE is
used.
• 1 kilocalorie= 1000 calories
 What is energy balance?
• Means taking in (Eating) and using (through
work, exercise etc) an equal number of
calories or kilocalories.
• We all have our own metabolism or rate of
using up energy- this is known our METABOLIC
RATE.
• That is why some people may eat less food but
actually put on weight, to be able to eat anything
without putting on a pound.

• MALES BETWEEN 15 AND 18 NEED ABOUT 2750

CALORIES A DAY.
• FEMALES BETWEEN 15 AND 18 NEED ABOUT
2100 CALORIES A DAY.
 Overweight
• ENERGY IMBALANCE – the most common
cause
– Eating either too much or too little for the amount
of energy expended.
 People who want to lose weight usually do so by
using one of three possible methods

• 1. Decreasing kilocalorie energy intake.

• 2. Increase kilocalorie energy
expenditure.
• 3. Using a combination of both.
 Late Adulthood
• Currently in the US, the fastest-growing age
group (85 & older)
• Life expectancy women – 80.1 years, men 74.8
years
• 2030, 65 million people 80 years & older
• GERONTOLOGY – the study of aging
 Special considerations for the
chronically ill older adult
• GERIATRICS- the branch of medicine that is
involved with diseases of older adults.
– Osteoporosis
– Periodontal disease
– Arthritis
– Cancer
– DM
– Hypertension
– Heart disease
 Periodontal Disease
• Characterized by bone loss in the jaw, which can
lead to loosened teeth & infection in the gums.
ARTHRITIS – a disease that causes the joints to
become painful & stiff. It results in structural
changes in the cartilage of the joints. For
overweight, weight reduction program should be
instituted.
Regular use of ASPIRIN – may cause slight bleeding
in the stomach lining & subsequent anemia
- diet may require additional IRON
 Cancer
• Research about the role of nutrition in cancer
dev’t continues.
• The American cancer society has indicated that
diets consistently high in fat or low in fiber &
vitamin A may contribute to cancer.
DIABETES MELLITUS – chronic disease, it develops
when the body does not produce sufficient
amounts of insulin or does not use it effectively
for normal carbohydrate metabolism.
- Diet is very important in the treatment of DM.
 Hypertension
• High blood pressure can lead to strokes. It is
associated with diets high in salt or possibly
low in calcium.
 Regular diet?
• A regular diet is a meal plan that includes a variety of
foods from all of the food groups
• A healthy meal plan is low in unhealthy fats, salt, and
added sugar.
• A healthy meal plan may reduce your risk of heart
disease, osteoporosis (brittle bones), and some types
of cancer.
Healthy Eating Plate
High Fiber Diet
 High Fiber Diet
• Diets containing 30 grams or more of dietary
fiber
• Believed to help prevent diverticulosis,
constipation, hemorrhoids, & colon cancer.
• Also helpful in the treatment of DM &
atherosclerosis.
• It must introduce gradually to prevent the
formation of gas & discomfort that accompanies
it. 8 glasses of water must also be consumed.
 High-fiber diet sample menu
BREAKFAST DINNER LUNCH OR SUPPER
Stewed prunes Baked pork chops Fresh fruit cup
Bran cereal with milk & Baked potato Roast beef sandwich on
sugar Fresh corn Cracked wheat bread
Whole wheat toast with Green salad with oil Coleslaw
marmalade & vinegar dressing Carrot cake
coffee Whole-grain bread Fat-free milk
With margarine Coffee or tea
Fresh pineapple
Fat-free milk
tea
 Dietary Fiber
• Part of food that is not broken down by digestive
enzymes.
• Indigestible parts of plants; absorbs water in large
intestine, helping to create soft, bulky stools;
• some is believed to bind cholesterol in the colon,
helping to rid cholesterol from the body;
• some is believed to lower blood glucose levels.
 WHAT ARE DIETARY FIBERS
• Is a substance found in outer layers of grains
and plants.
• It is the part of the food which resist digestion
by secretions by the human alimentary tract.
• Also termed as non-starch polysaccharides.
 Two types of dietary fibers
• Soluble Fibers- consists of a group of
substances that are made of carbohydrates
and dissolves in water.
• Insoluble Fibers- obtained from plant cells
walls and does not dissolve in water.
 Example of food containing soluble
fiber
• Fruits
• Oats
• Barley
• Legumes (peas and beans)
 Example of food containing insoluble
fiber

• Wheat
• Rye
• Other grains
 HEALTH BENEFITS OF A HIGH FIBER
DIET
• Speeds the passage of foods through the
digestive system and facilitates regular
defecation.
• Adds bulk to the stool and alleviates the
problem of constipation and hemorrhoids.
 HEALTH BENEFITS
• Balances intestinal pH stimulates intestinal
fermentation production of short chain fatty
acids thereby reducing the risk of colorectal
cancer.
• Lowers the low density lipoprotein (LDL)
cholesterol level therefore reduces the risk of
cardiovascular disease.
• Regulates blood sugar level thereby reducing the
risk of Type II diabetes.
• Soluble fiber such as psyllium and oat products
reduces the risk of coronary artery disease and
stroke by 40-50 percent.
 Examples of dietary fiber in plants
• Outer shells of corn kernels
• Strings of celery
• Seeds of strawberries
• Connective tissues of citrus fruits

• RESIDUE – is the solid part of feces

– Made up of all undigested & unabsorbed parts of food
(including fiber), connective tissue in animal foods,
dead cells, & intestinal bacteria & their products.
– Most of this residue is composed of fiber.
 Low Residue Diet
• 5-10 grams of dietary fiber a day is intended to reduce
the normal work of the intestines by restricting the
amount of dietary fiber & reducing food residue.
• This diet aims to decrease the amount of stool in the
large intestine, which may help prevent blockage.
• Increase stool volume or provide laxative effect
(examples are milk & prune juice)
• Low fiber or residue restricted diet used in cases of:
– Severe diarrhea, diverticulitis, ulcerative colitis, & intestinal
blockage & in preparation for & immediately after intestinal
surgery.
 Low-residue diet sample menu
Breakfast Dinner Lunch or supper
Strained orange juice Chicken broth Tomato juice
Cream of rice cereal Ground beef patty Macaroni & cheese
With milk & sugar
White toast with Boiled potato, no skin Green beans
Margarine & jelly
Coffee with cream Baked squash White bread & butter
And sugar
Gelatin dessert Lemon sherbet
milk Tea with milk & sugar
 Types of vegetarians
• Vegans- solely eat vegetables and avoid all animal
products and by- products such as eggs, honey
and other daily foods.
• Fruitarians- this diet is for people who eat fruits,
nuts, and seeds and other plant components.
• Lacto-vegetarians- eat dietary products except
eggs.
• Lacto-ovo vegetarians- eat eggs and dairy
products and this is the most common type of
vegetarian.
• Pesce- vegetarians- includes fish in their diet.
• Pollo- vegetarians- eats chicken and turkey
except red meat and pork.
• Flexitarians- vegetables- are their main food but
occasionally eats other food groups too.
 Therapeutic Diets
• Modifications of normal diet used to
improve specific health conditions
• Normally prescribed by doctor and
planned by dietician
• May change nutrients, caloric content
and/or texture
• May seem strange and even unpleasant to
the patient
• Patient’s appetite may be affected by
anorexia or loss of appetite, weakness,
illness, loneliness, self-pity and other factors
• Use patience and tact to convince patient to
eat food
• Understand purpose of diet and provide
simple explanations to patient
Therapeutic Diets Therapeutic diets
• Regular diet • Fat restricted (low-fat)
• Liquid diet diet
• Soft diet • Sodium restricted diet
• Diabetic diet • Protein diet
• Calorie controlled diet • Bland diet
• Low cholesterol diet • Low residue diet
 REGULAR DIET
• Balanced diet usually used for ambulatory
patients
• At times is has a slightly reduced caloric
content
• Foods such as rich desserts, cream
sauces, salad dressings and fried foods
may be decreased or omitted
Diets Modified in Consistency
 Modifications in Food Texture
& Consistency
• Modifications in food texture & consistency
may be helpful for people with difficulty
chewing or swallowing
• Modifications may also be necessary for
patients as they resume foods orally
• Diets can be altered as patient’s condition
changes
 Modifications in Food Texture
and Consistency
• Mechanically altered diets
– Routinely prescribed for individuals with chewing or
swallowing difficulties
– Pureed diet: contains foods pureed to pudding-like
consistency
– Mechanical soft diet: contains ground or minced foods or
moist, soft-textured foods
– Blenderized diet: includes foods from all food groups,
often with added liquid
 LIQUID DIETS
• Nutritionally inadequate and should only
be used for short periods of time
• Uses:
– After surgery or a heart attack
– Patients with acute infections or digestive
problems
– To replace fluids lost by vomiting or diarrhea
– Before some Xrays of digestive tract
 LIQUID DIETS
• 2 types
– Clear liquid diet (also called, non-residue diet)
• Water, apple or grape juice, fat-free broths, plain gelatin,
popsicles, ginger ale, tea, coffee
Use should be limited to 24 to 48 hours since it is nutritionally
inadequate.
• Otherwise, parental feeding is recommended
– Full liquid diet
• Everything on clear liquid diet plus strained soups and
cereals, fruit and vegetable juices, yogurt, hot cocoa, custard,
ice cream, pudding, sherbet, and eggnog
is allowance of foods which are liquid or which readily become
liquid at body temperature.
When carefully planned, the diet may be adequate in energy value
and protein and can therefore be used for several days.
 Soft diet
• Similar to regular diet but foods must require little
chewing and be easy to digest
• Avoid meat and shellfish with tough connective
tissue, coarse cereals, spicy foods, rich desserts,
fried foods, raw fruits and veggies, nuts, and
coconuts
• Mechanical Soft Diet
 the diet is also called dental soft or geriatric soft diet
 It follows the pattern of the regular diet.
 It consists of foods that require minimum chewing.
 Hard and large pieces of food are chopped, ground,
pureed, sieved or reduced to small pieces by other
mechanical means
 Soft Diet
• Uses:
– After surgery
– Patients with infections
– Digestive disorders or chewing problems
 Soft Bland Diet
Also called Bland IV
This diet is similar to the soft diet but with
additional restrictions on: hot spices like bell
pepper, and mustard; caffeine containing
beverages like coffee, tea cola drinks and
alcohol
Food is given in small frequent feedings.
Used for patients with hyperacidity and peptic
ulcer when a full bland diet cannot be
tolerated.
 Bland Diet
• Consists of easily digested foods that do
not irritate the digestive tract
• Used for patients with ulcers and other
digestive diseases
• Avoid coarse foods, fried foods, highly
seasoned foods, pastries, raw fruits and
veggies, alcohol, carbonated beverages,
nuts, coffee, tea, smoked and salted
meats and fish.
 Low Fiber Foods
What is a low fiber diet?
• A low fiber diet means you eat foods that do not
have a lot of fiber.
• in order to rest your bowels (or intestines).
• A low fiber diet reduces the amount of
undigested food moving through your bowel, so
that your body makes a smaller amount of stool.
• A low-fiber diet may be suggested if you have
diarrhea, cramping, trouble digesting food, or
after some types of surgery
 Therapeutic Diets
• PEPTIC ULCERS – treated with drugs, & diet
therapy generally involves only the avoidance of
alcohol & caffeine.
• DIVERTICULOSIS – maybe treated with high-fiber
diet
• DIVERTICULITIS – treated with gradual
progression from clear liquid to the high-fiber
diet
• ULCERATIVE COLITIS- may require low-residue
diet combined with high protein & high calories
 Therapeutic Diets
• CIRRHOSIS – requires substantial, balanced diet
with occasional restrictions of fat, protein, salt, or
fluids
• HEPATITIS – full well-balanced diet, although
protein may be restricted, depending upon the
client’s condition
• CHOLECYSTITIC & CHOLELITHIASIS – fat-restricted
diet, in cases of overweight, calorie restricted diet
as well.
• PANCREATITIS – ranges from TPN to an
individualized diet as tolerated.
Diets Modified in Composition
 DIETS MODIFIED IN COMPOSITION

• Low calorie
• High calorie
• High protein
• Low protein
• Low fat
• Low cholesterol
• Low carbohydrate
• Low salt/Sodium restricted
• Low potassium
• Low purine/Purine restricted
 Calorie Controlled Diet
Low-Calorie Diet
• Used for patients who are overweight
• is a diet with low calorie consumption per day.
• contain the recommended daily requirements for
vitamins, minerals, trace elements, fatty acids and
protein.
• Carbohydrate may be entirely absent, or
substituted for a portion of the protein; this choice
has important metabolic effect.
• Avoid or limit high calories foods such as:
– Butter, cream, whole milk, cream soups or gravies,
sweet soft drinks, alcoholic beverages, salad
dressings, fatty meats, candy and rich desserts
 HIGH CALORIE & HIGH PROTEIN
A high protein and high calorie diet is made up
of foods that are high in both protein
and calories.
• Some of these health conditions include
cancer, HIV, and AIDS.
• Other conditions that increase calorie and
protein needs include wounds (such as
ulcers), trauma, burns, weight loss, and
malnutrition.
• to gain weight and get stronger after a
surgery or illness.
 High-protein diet
Examples of high-protein foods are tofu, dairy
products, fish, and meat.
• A high-protein diet is often recommended by body
builders and nutritionists to help efforts to build
muscle and lose fat.
• Used for children and adolescents who need
additional growth, pregnant or lactating women,
before and/or after surgery, pts suffering from
burns, fevers, or infections
 Low Protein Diet
• is used by persons with abnormal kidney or
liver function to prevent worsening of their
disease.
• Regular diet with limited or decreased
protein rich foods
 Fat Restricted or Low-Fat Diet
• Used for patients with gallbladder and liver
disease, obesity, and certain heart
diseases
• Avoid cream, whole milk, cheese, fats,
fatty meats, rich desserts, chocolate, fried
foods, salad dressings, nuts, and coconut
Foods high in fat:
-Dairy foods (whole milk, ice cream, creams)
-Fatty red meats
-Butter is not only high in fat, but saturated fat as well
-Oils are fat, although some may have lower saturated
fat.
-Egg yolks, which are particularly high in cholesterol.
-Cheese (sorry, there are some that are better than others,
though)
-Processed meats (sausage, salami, hot dogs, bologna)
Foods low in fat:
-Fruits
-Vegetables
-Fish and shellfish
-Cereals, rice
-Pasta
-Nuts and seeds
-Vegetable oils are preferable to butter (see below)
 Low Cholesterol Diet
• Restricts foods containing cholesterol
• Used for patients with atherosclerosis and
heart disease
• Limit foods high in saturated fats such as
beef, liver, pork, lamb, egg yolk, cream,
cheese, natural cheeses, shellfish, whole
milk, and coconut and palm oil products
 LOW-CARB DIET
• A low-carb diet limits carbohydrates such as bread, grains,
rice, starchy vegetables and fruit —and emphasizes sources
of protein and fat.
• A low-carb diet is generally used to lose weight.
 In general, a low-carb diet focuses on meat, poultry, fish,
eggs and some nonstarchy vegetables.
 A low-carb diet excludes or limits most grains, beans, fruits,
breads, sweets, pastas and starchy vegetables.
 Some low-carb diet plans allow fruits, vegetables and whole
grains.
 A daily limit of 50 to 150 grams of carbohydrates is typical.
 Sodium Restricted Diet
(Low Sodium or Low Salt Diet

• Used for patients with cardiovascular

diseases such as hypertension or congestive
heart disease, kidney disease, and edema
• Avoid or limit addition of salt to any food,
smoked meats or fish, processed foods,
pickles, sauerkraut, olives, and processed
cheeses
 LOW POTASSIUM
• Potassium is a crucial component in our blood stream, and in
order to avoid unwanted side-effects, a low potassium diet
should be eaten when levels need to be specifically regulated
because levels are too high, and a diet rich in potassium
should be followed when levels are too low.
• Potassium is a mineral found in significant levels in the body's
blood stream. This mineral helps regulate levels of the mineral
sodium which is significant for controlling hydration of the
body. Potassium is crucial to cleansing unwanted toxins from
the cells of the body.
• It is also essential for:
-Maintaining a correct blood pH
-Stimulating the production of insulin
-Maintaining digestive enzyme efficiency
-Ensuring optimal nerve and muscle functions
• FOODS HIGH IN POTASSIUM
• Asparagus
• Avocado
• Broccoli
• Brussels sprouts
• Cauliflower
• Celery
• Mushrooms
• Spinach
• Sweet potatoes
The second group is fruits:
• Bananas
• Cantaloupe melon
• Dried apricots
• Grapefruit
• Kiwifruit
• Oranges
• Strawberries
And thirdly non-specific foods which have been identified as rich in
potassium:
• Halibut
• Cod
• Pinto beans
• Soy beans
• Kidney beans
• Natural yogurt
 PURINE RESTRICTION
• Purines are natural substances found in a
variety of different foods.
• Your body breaks purines down into a waste
product called uric acid.
• Because uric acid is a waste product, your body
does not use it and your kidneys remove it.
• In healthy individuals, the kidneys remove uric
acid without a problem.
• In some people, such as those with gout, the
kidneys cannot remove uric acid properly so
they must follow a low-purine diet.
 Low purine Foods
When following a purine restricted diet, you may eat as
many low purine foods and beverages as you wish while
staying within your calorie range to maintain a healthy
weight.
Examples of low purine foods include refined breads and
cereals, fat-free or low-fat milk, white pasta, fat-free or low-
fat cheeses, potatoes, beans and most fruits and vegetables.
You may also consume eggs, but should only have 3 to 4 per
week. You can also consume peanuts and peanut butter, but
if you need to lose weight, you should limit your intake
because nuts are high in calories and fat.
Some low purine beverages include coffee, fruit juice and
water.
• MEDIUM PURINE FOODS
When following a purine-restricted diet, you
can consume medium purine foods in
moderation.
Examples of medium purine foods include beef,
lamb, pork, poultry, fish, shellfish, asparagus,
spinach, cauliflower, mushrooms, oats,
oatmeal, dried beans and peas, whole grains
and broth-based soups.
A serving of meat is defined as 2 to 3 oz.
cooked. A vegetable serving is 1/2 cup and a
liquid serving is 1 cup.
 High Purine Foods
When following a purine restricted diet, you
should completely eliminate high purine foods
from your diet.
Examples of high purine foods include anchovies,
mussels, scallops, sardines, herring mackerel and
organ meats such as liver, kidney and heart.
Game meats are also considered high purine foods.
You should also avoid fatty foods, like creamy salad
dressings, fried food, ice cream and sugary sodas.
• Considerations
It is important to lower your fat intake when following a
purine restricted diet. Fat retains uric acid in your kidneys
and can increase uric acid accumulation. When following a
purine restricted diet, try to limit your fat intake to less than
30 percent of your daily calories. If you consume 2,000
calories per day, your fat intake should be less than 67 g of
fat per day. Additionally, it's important to drink 8 to 12 cups
of fluid per day. Fluids help your kidneys flush out excess uric
acid, as well as keeping you hydrated. While you may enjoy
some low-purine beverages, water should make up most of
your fluid intake.
ENTERAL FEEDING
 What is Enteral Feeding
• Enteral feeding is done for patients unable to
orally ingest foods.
• Enteral, or tube feeding, gives nutrition and
hydration to patients.
 Types of Enteral Feeding
• Nasogastric Feeding –
– uses a tube that is inserted into the stomach via the
nose.
– In rare cases, a nasogastric tube is used for long-term
care.
– Medications or liquid food can go directly to the
patient's stomach in order to provide the nutrition
necessary for developmental growth.
– In some instances, nasogastric tubing is used as a
supplementary way of caloric intake, which means the
patient can eat solid foods as well
• Gastrostomy Feeding - is inserted into the
abdomen to deliver nutrition into the stomach.
• A gastronomy tube can be used for long-term
care.
• With a G-tube, two types of feedings are done:
bolus and continuous feeding.
• A bolus feeding is similar to regular feeding
patterns, with feedings lasting up to 30 minutes.
• Continuous feeding lasts longer and is usually
done overnight.
• Jejunal Feeding - uses a tube placed into the
jejunum, which is the middle part of the small
intestine.
– Jejunal feeding is necessary when the patient is
unable to use his gastrointestinal tract.
– In most instances, jejunal feeding is done for
patients with a high risk of inhaling foods into the
lungs.
– The jejunal tube bypasses the stomach, going
directly into the intestine, which decreases the
risk of aspiration.
 INDICATIONS AND
CONTRAINDICATIONS FOR TUBE
FEEDING
• The majority of patients require nutritional support for
around one month or less. If patients are unable to
take supplemental sip feeds safely then enteral tube
feeding is required
• Enteral nutrition is contraindicated in a patient with
significant hemodynamic compromise.
• Among the recognized contraindications to a semi
recumbent position for enteral feeding are an unstable
spine, hemodynamic instability, prone positioning, and
certain medical procedures (such as a central venous
catheter insertion).
 Complications of Enteral Feeding
• Tube blockage can occur with crushed
medication, inadequate flushing (particularly with
nasojejunal tubes, which tend to be longer and of
a finer bore), and with precipitation of protein in
the feed Ideally tubes should be regularly
flushed, every six hours in the case of nasojejunal
tubes, and flushed before and after use.
• Tubes can generally be unblocked with water,
although fizzy drinks, pancreatic enzymes, and
commercial preparations
• (for example, Clog Zapper; Corpak MedSystems)
have been tried with varying success
• Physical complications are related to the size,
material and pliability of the tube, with
polyurethane tubes being softer and so less
traumatic than polyvinylchloride
• Nasopharyngeal discomfort due to the
physical presence of the tube in the throat is
common. There may be a deficiency in saliva
production due to mouth breathing and no
chewing. Sore mouth, dysphagia, sensation of
thirst, and dry mucous membranes are
recognized complications.
• Intracranial insertion of tubes is a small,
although documented, risk.
• More pliable, soft tubes and more careful
insertion may reduce this, although modern
tubes with internal wires may increase the risk
of this potentially fatal complication.
• It is well known, and included in all product
literature that reinsertion of guide wires with
feeding tubes in situ should not be attempted
due to the risk of the wire passing either
through an outflow port, or perforating the
tube and then perforating the viscus.
• Gastro-oesophageal reflux may occur more
frequently when a nasoenteric tube is used in the
supine position.
• This may be in part due to lack of gravitational
effect keeping gastric contents in the stomach,
and exacerbated by the presence of the feeding
tube impeding the effectiveness of the gastro-
oesophageal sphincter, and larger bore tubes
seem to affect the cardio-oesophageal junction
most.
• Whatever the diameter of tubes it is probably
preferable not to feed patients lying flat.
• Prokinetics, sucralfate, or proton pump
inhibitors could be used to treat oesophagitis.
• Tracheo-oesophageal fistula may develop when
large bore nasoenteric tubes are used with a
nasotracheal or tracheostomy tube in place.
The fistula develops from pressure necrosis of
the oesophagus and trachea.
• Endobronchial placement is most common in those
with altered swallowing or a reduced gag reflex.
• Intrapulmonary infusion of enteral diet can be fatal if
not recognized. Other complications which can arise
from misplacement of tubes include pneumothorax,
intrapleural infusion of enteral diet, and oesophageal
perforation.
• Patients most at risk from misplacement of tubes
include:
– those on ventilators,
– with altered level of consciousness or
– with neuromuscular abnormalities, such as reduced gag,
swallow, and cough reflexes.

– In this group of patients it is important to confirm the

position of tubes radiologically.
Nursing management of enteral tube
feedings.
• Checking the flow rate of enteral feeding: Flow
rates were checked between 1 to 4 hours
• Flushing the enteral tube
• Method of unclogging obstructed tubes
• Checking residuals
• Administering medications
ENTERAL FORMULAS
 Enteral Nutrition
• A way to provide food through a tube placed in
the nose, the stomach, or the small intestine.
• A tube in the nose is called a nasogastric tube
or nasoenteral tube.
• A tube that goes through the skin into the stomach
is called a gastrostomy or percutaneous
endoscopic gastrostomy(PEG).
• A tube into the small intestine is called a
jejunostomy or percutaneous endoscopic
jejunostomy (PEJ) tube.
• Enteral nutrition is often called tube feeding
 Feeding Tube
• is a medical device used to provide nutrition to
patients who cannot obtain nutrition by
swallowing.
• The state of being fed by a feeding tube is called
enteral feeding or tube feeding.
• Placement may be temporary for the treatment of
acute conditions or lifelong in the case of chronic
disabilities.
• A variety of feeding tubes are used in medical
practice. They are usually made of polyurethane
or silicone.
 Intact Formulas
• Intact formulas, also called polymeric formulas,
contain unaltered molecules of proteins,
carbohydrates, and fats. They are best for people
who can digest and absorb nutrients without
difficulty.
• Polymeric formulas are available as standard
formulations containing protein isolate with one
or more sources of carbohydrate and fat; or as
blenderized whole food formulations.
• Blenderized formulas, which are used
infrequently, are more likely to clog feeding tubes
since they have a high viscosity. There is a greater
risk of food-borne illness with blenderized
formulas.
 Hydrolyzed Formulas
• Hydrolyzed formulas, also called monomeric
formulas, contain predigested proteins and
simple carbohydrates, plus a small amount of oil
or a blend of medium chain triglycerides (MCTs)
and oil.
• Monomeric formulas are "predigested" and are a
good choice for patients who lack the ability to
digest or have a small absorptive area. Patients
with feeding tubes in the lower GI tract may also
benefit from these formulas.
– Monomeric formulas contain very little residue and are
appropriate for patients that require bowel rest.
 Modular Formulas
• A modular formula is an incomplete liquid
supplement that contains specific nutrients,
usually a single macronutrient (carbohydrate,
protein or fat).
• Different modules can be combined to result in
a nutritionally complete diet. Modular diets
can be tailored to an individual's needs but are
generally complex to design, and may fail to
meet all of the patient's nutritional needs.
• Made by combining specific nutrients.
FEEDING ADMINISTRATION
 Feeding Administration
• Parenteral feeding involves infusing nutrition
directly into the bloodstream.
• This is only done if the digestive tract is unable to
absorb nutrients from enteral feeds.
• This method of feeding requires a central
intravenous line.
– A central line is a surgically placed, long lasting IV line
that passes through a central vein (close to the heart).
– Hence, it bypasses the digestive system entirely.
– Due to the delicate nature of this type of feeding,
cleanliness and other precautions are essential.
 Methods to administer tube feedings
• Continuous Drip Feeding
The continuous drip method is most commonly used. Continuous
drip is administered via gravity or a pump and is usually tolerated
better than bolus feedings.
• Bolus Feedings
Bolus feedings allow for more mobility than continuous drip
feedings because there are breaks in the feedings, allowing the
patient to be free from the TF apparatus for activities such as
physical therapy.
• Combination
A combination of continuous drip (at night) and bolus feedings
(during the day) can be used.
 Tube Feeding Administration
Continuous Drip vs. Bolus Feedings
The rate of the continuous drip administration can be
controlled with a pump, and the initial rate should be
slow to allow for adaption to a hyperosmolar formula
and to monitor for tolerance.

Bolus feedings should consist of 250 - 300 mL given

over 15 minutes, followed by 25-60 mL water which
helps prevent dehydration and clogging of the tube. At
least 3 hours should elapse between each bolus
feeding.
Tube Feeding Administration
 RESIDUAL VOLUME
Checking "Residuals"
Before each bolus feeding, gastric contents should be
suctioned out and returned to the stomach before a
new feeding is administered to ensure that minimal
residue remains from the previous feeding.

Residual volume should be checked every 3-5 hours

when feeding is by continuous drip. Excess residual
volume (>100 -150 mL) may indicate an obstruction or
some other problem that must be corrected before
feeding can be continued.
 Hypoalbuminemia
• Hypoalbuminemia is commonly implicated in the
development of diarrhea among TF patients. If the
albumin value is less than 3.5g/dl it is best to dilute
the formula. If the albumin value is less than 2.5g/dl
enteral feeding may not be tolorated at all.
• If the patient is not tolerating the formula, the rate
should be slowed and/or concentration should be
diluted until tolerance is achieved. Signs of
intolerance include diarrhea, nausea, vomiting,
dehydration and cramping.
 Tube Feeding Administration
• Careful administration of TF helps prevent
bacterial contamination. Blenderized formulas
should be prepared under sanitary conditions
and should be used within 24 hours to reduce
the risk of bacterial infection.
• Unopened cans of formula can be stored at
room temperature, but must be refrigerated once
opened and used within 24 hours.
• Fresh formula should never be added to formula
remaining in the feeding bag. The feeding bag
and tubing (except tubing connected to the
patient) should be changed every 12 -24 hours.
 Tube Feeding Administration
• Body Positioning
The patient's body position is also important when administering
a TF for both continuous drip and bolus feedings. The patient's
head should be elevated at least 30 degrees during and after the
feeding to prevent regurgitation.
• If the patient is receiving a tube feeding into the intestine,
positioning is not critical.
Parenteral Feeding
 COMPONENTS OF PARENTERAL
NUTRITION

• Components are in elemental or “pre-digested” form

Protein as amino acids
CHO as dextrose
Fat as lipid emulsion
Electrolytes, vitamins and minerals
 Advantage and Disadvantage
Advantage:
Potentially life-saving when GI tract cannot be
used or when oral/parenteral nutrition cannot
meet nutrient requirements of patient.
Disadvantage:
• Costly
• Long term risk of liver dysfunction, kidney and
bone disease, and nutrient deficiencies
 Indications
and
Contraindications
 Indications
• Common Indications
o Inability to absorb adequate nutrients via the GI tract :
 Massive small-bowel resection / short bowel syndrome
 Severe, untreatable steatorrhea / diarrhea / malabsorption
 Complete bowel obstruction, or intestinal pseudo-
obstruction
 Prolonged acute abdomen or ileus
o Severe catabolism & GI tract unusable within 5–7 days
o Enteral access not feasible, not adequate or not
tolerated
o Pancreatitis with intolerance (eg pain) of jejunal
nutrition
o High output EC fistula (>500 mL) & no distal enteral
access
 Indications
• Potential Indications
o Enterocutaneous fistula
o IBD unresponsive to medical therapy
o Hyperemesis gravidarum – persistent for > 5–7 days
and enteral nutrition not possible
o Partial small bowel obstruction
o Intensive chemotherapy / severe mucositis
o Major surgery if enteral nutrition unlikely for >7–10
days
o Intractable vomiting if jejunal feeding not possible
o Chylous ascites or chylothorax when low
 Indications
• Total parenteral nutrition (TPN) is provided when
the gastrointestinal tract is nonfunctional
because of an interruption in its continuity (it is
blocked, or has a leak - a fistula) or because its
absorptive capacity is impaired.It has been used
for comatose patients, although enteral feeding is
usually preferable, and less prone to
complications. Parenteral nutrition is used to
prevent malnutrition in patients who are unable
to obtain adequate nutrients by oral or enteral
routes.
 Contraindications
• Functioning gastrointestinal tract
• Treatment anticipated for < 5 days in patients
without severe malnutrition
• Inability to obtain venous access
• Poor prognosis that does not warrant aggressive
nutrition support
• When the risks of PN are judged to exceed the
potential benefits
 PN Central Access
• May be delivered via femoral lines, internal
jugular lines, and subclavian vein catheters in
the hospital setting
• Peripherally inserted central catheters (PICC)
are inserted via the cephalic and basilic veins
• Central access required for infusions that are
toxic to small veins due to medication pH,
osmolarity, and volume
 PICC Lines (peripherally inserted central
catheter)
• PICC lines may be used in ambulatory settings
or for long term therapy
• Used for delivery of medication as well as PN
• Inserted in the cephalic, basilic, median
basilic, or median cephalic veins and threaded
into the superior vena cava
• Can remain in place for up to 1 year with
proper maintenance and without
complications
 Parenteral Base Solutions
• Carbohydrate
– Available in concentrations from 5% to 70%
– D30, D50 and D70 used for manual mixing
• Amino acids
– Available in 3, 3.5, 5, 7, 8.5, 10, 15, 20% solutions
– 8.5% and 10% generally used for manual mixing
• Fat
– 10% emulsions = 1.1 kcal/ml
– 20% emulsions = 2 kcal/ml
– 30% emulsions = 3 kcal/ml (used only in mixing TNA, not
for direct venous delivery)
 Other Requirements
• Fluid—30 to 50 ml/kg (1.5 to 3 L/day)
– Sterile water is added to PN admixture to
meet fluid requirements
• Electrolytes
– Use acetate or chloride forms to manage
metabolic acidosis or alkalosis
Complications
and
Problems
 Complications and Problem
 Infectious
– e.g. Catheter and systemic infections
 Mechanical
– e.g. Catheter obstruction, Hydrothorax,
Venous thrombosis
 Metabolic
– e.g. Bone disease,
Hepatobiliary disease,
Renal disease
 Complications and Problem
• Infection
o TPN requires a chronic IV access for the solution
to run through, and the most common
complication is infection of this catheter. Infection
is a common cause of death in these patients,
with a mortality rate of approximately 15% per
infection, and death usually results from septic
shock
 Complications and Problem
• Blood clots
o Chronic IV access leaves a foreign body in the
vascular system, and blood clots on this IV line are
common. Death can result from a clot that starts
on the IV line but breaks off and goes into the
lungs. This process is called a pulmonary
embolism
o Patients under long-term TPN will typically receive
a periodic heparin flush to dissolve such clots
before they become dangerous.
 Complications and Problem
• Fatty liver and liver failure
o Fatty liver is usually a more
long term complication of
TPN, though over a long
enough course it is fairly
common. The pathogenesis
is still unknown

Micrograph of periportal fatty

liver as may arise due to TPN.
Trichrome stain.
 Other complications
• Total parenteral nutrition increases the risk of acute
cholecystitis due to complete disuse of gastrointestinal
tract, which may result in bile stasis in the gallbladder.
• Other potential hepatobiliary dysfunctions include
steatosis, steatohepatitis, cholestasis, and
cholelithiasis.
• Catheter complications include pneumothorax,
accidental arterial puncture, and catheter-related
sepsis
• Metabolic complications include the refeeding
syndrome characterised by hypokalemia,
hypophosphatemia and hypomagnesemia.
 Finish!!!!!

MELANIA SILVA-BANATICLA,
RN,MAN
UPHSD-CALAMBA