1. ENTERAL AND PARENTERAL FEEDINGS

2. TUBE FEEDING

3. ENTERAL NUTRITION Definition  Feeding via tube into the gastrointestinal tract (GIT), bypassing the oral cavity, esophagus and, if needed, the stomach. Indications  When patient cannot or will not eat enough but GIT is still functional  Examples: oral ulcers, obstructions, dysphagia, surgical procedures, anorexia nervosa

4. TF  Types: placement determines type of TF used:  Nasogastric  Nasoduodenal  Gatrostomy  Jejunostomy

5. TUBE FEEDINGS – NON SURGICAL

6. TUBE FEEDINGS-SURGICAL

7. REQUIREMENTS  Nutritionally complete  Varying caloric levels depending on tube feeding – must meet individual needs  Increase calorie content  increase viscosity  CHO, PRO, FAT to meet energy needs  Density  Vitamins and minerals  With or without fiber  Lactose free

8. SPECIALTY FORMULAS  Stress, pulmonary, pediatric, liver, renal  Modular formulas Carbohydrates Proteins Lipids

9. ADMINISTRATION  Bolus  Gravity  Intermittent  Continuous

10. COMPLICATIONS  Clogging  Aspiration  Drug incompatibility  Nausea and vomiting  Diarrhea or constipation  Infections  Contaminated formula

11. IF THE GUT WORKS, USE IT!

12. PARENTERAL NUTRITION  Peripheral parenteral nutrition  Short – term  Partially meets nutritional needs

13. PERIPHERAL PARENTAL NUTRITION

14. PARENTERAL NUTRITION  Total parenteral nutrition  Long-term  Nutritionally complete

15. TPN

16. INDICATIONS  Inability to use the GIT  Hypermetabolism  Others

17. REQUIREMENTS  Can be tailored to meet individual needs  CHO or CHO and fat for calories  Protein (AA) to meet nitrogen needs  Vitamins, minerals  Unique: nutrients placed directly into blood stream – no gut control

18. COMPLICATIONS  Infection  Gastrointestinal atrophy  Refeeding  Bacterial translocation