Alternate Nutrition and Hydration (ANH) Flashcards Preview

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Flashcards in Alternate Nutrition and Hydration (ANH) Deck (19):
1

1. ANH (2)

2. Decision based on:

1. Considered when the patient has a functional gastrointestinal tract but is unable to meet nutritional needs by mouth for a variety of reasons.

2. Also used when the patient does not have a functional GI tract.

--- We rec. alternate nutrition and hydration

2. Decision based on:

a. clinical and instrumental examinations of swallowing;

b. medical status;

c. nutritional status; (may need tube and oral feeding)

d. behavioral/cognitive status.

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Non-oral Feeding

Nutrition not taken by mouth can be divided into two main groups:

1. Parenteral- given through a vein (pic line)

2. enteral (tube)

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Parenteral nutrition

1. Given intravenously into either a peripheral vein, or a large central vein

a. such as the jugular or subclavian.

2. A central vein allows hypertonic (more concentrated) solutions to be infused.

3. It bypasses the gastrointestinal system.

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Parenteral nutrition (Indications for use)

1. Supplemental hydration (IV)

2. Restoration of fluid and electrolyte balance (Central line)

3. TPN- get calories from this (but still doesn’t go through the GI tract)

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Possible complications of parenteral complications

1. Simple IV (4)

1. Infection

2. Edema

3. Bleeding

4. Weakened & collapsed veins

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Possible complications of parenteral complications

1. Central Line- Subclavian Vein (7)

1. Air embolism

2. Pneumothorax

3. Myocardial perforation

4. Phlebitis

5. Blood clot

6. Infection

7. Sepsis

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Non-oral alternatives (Enteral options) (4)

1. NG/NJ tube NG- nasogastric, Nasojejunum- to small intestine

2. DHT- very small and very flexible

3. PEG- percutaneous (through the skin) endoscopic gastrostomy

4. PEJ- percutaneous endoscopic jejunostomy


- NG tube is as wide as pinky and not flexible, not comfortable

- DHT and NG/NJ are short term

- PEG or PEJ – long term

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Enteral nutrition

1. refers to nutrition given directly into the gastrointestinal system

2. allows more natural absorption of nutrients to occur.

3. It can be given through

a. nasogastric (NG/DHT) tubes manually placed

b. PEG or PEJ tubes placed endoscopically and percutaneously with radiologic guidance.

c. gastrostomy or jejunostomy tubes placed surgically (may need to be done if pt. has too much scar tissue or other complications)

4. Nasogastric tubes are commonly used in hospitals.

5. The standard polyvinyl tube is uncomfortable and can be irritating to the nasal, esophageal and gastric tissue. (width of pencil, irritating)

6. Smaller, more flexible tubes made of silicon and polyurethane are more comfortable and thought to be less irritating to the

a. Oropharynx

b. Esophagus

c. Esophageal sphincter.

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Indications for use for NG/NJ and DHT

1. Short-term alternative (~ 2 weeks)

2. Transnasal insertion

3. Easily removed

*** Can be 6-8 weeks, but the less time the better

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Possible Complications of enteral nutrition (6)
NG/JG or DHT

1. Misplacement into the airway

2. Irritation to nasal, pharyngeal, esophageal mucosa

3. Discomfort

4. Negative cosmesis

5. May contribute to reflux & aspiration (goes through UES and LES, so causes leakage)

6. May impact swallow function

*** placed at bedside so complications are common

*** pt. may try to tear them out

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Gastrostomy or jejunostomy tubes

1. Gastrostomy or jejunostomy tubes are preferred for long-term enteral nutrition.

2. With their use, patients no longer have to deal with the nasopharygeal irritation associated with NG tubes.

-- They can still eat, there are no cosmetic issues, under clothes

3. Does not necessarily preclude oral intake

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Possible Complications (PEG) (8)

1. Nausea

2. Vomiting

3. Diarrhea (#2)

4. Constipation

5. Reflux

6. Clogged tube (small tube, pills can get stuck)

7. Skin irritation (#1)

8. Aspiration

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Indications for Use (PEJ)

1. Does not require stomach in digestion

2. Enteral nutrition earlier after stress or trauma

3. Less risk of reflux and aspiration (deeper in the system)

- Bypasses the stomach, right into the intestines

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Possible Complications (PEJ) (4)

1. Loss of controlled emptying of the stomach

2. Misplacement

3. Diarrhea

4. Dehydration- less time for the liquid to be absorbed

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Non-oral feeding with intermittent bolus feeding

1. clothing can cover the tube when the patient is not receiving feedings

2. allows fuller freedom to participate in activities without being obvious to others that there is a tube present.

16

Hypodermal Clysis

- Subcutaneous placement used as a hydration supplement for mild-moderate dehydration

- Mild subcutaneous edema – possible complication

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Issues in decision making- non-oral feeding

1. When a feeding tube is being considered

a. share all available information with the patient and his or her family.

2. Questions must be answered by the care team and family members to help arrive at the best decision regarding tube placement.

a. Know the underlying condition that resulted in feeding tube placement.

b. Document the contents of any conversation you have with the patient and family regarding this issue.

c. Know the prognosis based on the illness

d. Is tube placement only for short-term, like getting over pneumonia or do they have a progressive terminal illness.

- Swallowing in first time strokes usually resolves

- If it is a degenerative disorder, it won’t get better

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Common misconceptions for ANH (5)

1. aspiration pneumonia

2. malnutrition

3. dehydration

4. provide comfort

5. prolong life

- It can do all of these things, but there are times when it does none of these.

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Our responsibility re: recommending ANH (4)

1. Consider current condition

2. Consider prognosis

3. Completely discuss treatment options (pros, cons, benefits and risks) with family

4. Consider patient/family values, beliefs and wishes

- (more on these concepts in another lecture)