DIET FOR PATIENTS – FEEDING TYPES – NURSING PROCEDURE - Nurse Info DIET FOR PATIENTS - Feeding (Gastrojejunostomy Feeding, Breastfeeding and Artificial Feeding)

NURSING PROCEDURE – DIET FOR PATIENTS (Gastrojejunostomy Feeding, Breastfeeding and Artificial Feeding)

Purpose, General Instructions, Preliminary Assessment, Preparation of Patient and Environment, Equipment, Procedure and After Care

UPDATED 2024

GASTROJEJUNOSTOMY FEEDING

Gastrojejunostomy feeding is defined as enteral nutrition is a liquid food preparation directly into the stomach or small intestine via a tube

It is an ideal method of providing nutrition for the person who is unable to swallow food and drink normally but has intact gastrointestinal function

It is the introduction of liquid good through a tube or catheter which the surgeon has already introduced into the stomach through the abdominal wall

Indications

Tumors or operations on the upper gastrointestinal tract
Cancer of the esophagus
Stricture of the esophagus caused by poisoning in case of fistula

General Instructions

It is essential that the area of the skin around the tube be kept clean and dry
A water proof ointment such as zinc oxide may be applied around the tube to protect the skin from the irritation of the hydrochloric acid
Foods given through the gastrostomy tube are some as those given by nasogastric tube and the same amounts are given at the same intervals

Methods of Administration

Intermittent feeding: given four to six times a day rather the continuously is delivered as a bolus through a longer lumen tube. Volume for formula usually 250-450 ml is placed in a large syringe and inserted into the proximal end of the tube
Intermittent gravity drip: administration delivers a similar volume 250-450 ml of feeding over 20-30 ml a minute, four to six times a day
Continuous administration: delivers fluid through a small lumen tube at a constant rate via orogastric and nasogastric routes. The rate of flow is carefully regulated. The nurse should calculate the amount of fluid to be infused during an hour and regulates the infusion pump accordingly

Preliminary Assessment

Check

The doctors order for specific instruction
Level of consciousness of the patient
Self-care ability of the patient
Mental status to follow instructions
Articles available in the unit

Operation of the Patient and Environment

Explain the sequence of the procedure
Provide privacy
Arrange the articles at the bedside
Place the patient in a comfortable position
Keep the environment clean and tidy
Keep ready with feed to be given

Equipment

A clean tray containing

A funnel, rubber tubing, glass connection screw and a clamp
A glass of drinking water
Required amount of fed, temperature 100 degree F
Sterile lubricant to protect surrounding area
Sterile dressing and forceps in a dressing tray
Medicine as per odor
Kidney tray
Many tailed binder if required
Mackintosh and towel
Stethoscope
Syringe

Procedure

Wash hands thoroughly
Place the mackintosh or towel; clean the surrounding area of the opening. Cover the wound with sterile piece of gauze
Unscrew the clamp from the gastrostomy tube and attach the funnel and rubber tubing; keep the tube pinched to prevent air from setting in
Aspirate the gastric contents by attaching a syringe
Pour some clean water into the funnel and lower a little to let our air
Then pour the feed before the funnel is empty
If any medicines are ordered, these are given after feed
Give water after giving medicines
Disconnect the tabbling and funnel
Clean and apply sterile instrument around the wound, dress it with sterile dressing and apply the binder

After Care

Remove the Mackintosh and towel
Position the patient comfortable
Secure the tube with plaster
Replace the articles to utility room
Hand wash
Record the procedure in nurse record sheet

BREASTFEEDING

Breastfeeding is the best food for the baby. It’s not only gives nourishment but also suffice the baby’s emotional needs.

Advantages

It is the best natural food for the baby
It fully meets the nutritional requirement of the infant and promotes optimal growth
It protects the baby from the infections
It satisfies the sucking reflex of the child
It is always clean and sterile
It is available at the correct temperature and requires no preparation
Lactoferrin present in the breast milk inhibits the growth of bacteria
Gastrointestinal disturbances are less in breast fed, children, due to presence of lactobacillus fibrous
It creates bonding between the mother and child
It helps parents to space their children
It reduces infant mortality rate
It helps in involution of the uterus
It gives baby a sense of security

Contraindication for Breastfeeding

Mother

Breast diseases e.g., mastitis, breast abscess
Cardiac diseases and active tuberculosis
Infectious diseases
Mental illness of mother
Unconscious mother

Baby

Babies with cleft lip and cleft palate
Premature and sick babies who have poor sucking reflex
Oral thrush

Breastfeeding Methods

General Instructions

Mother should keep her body clean and wear clean cloths
Before each feed, clean the breasts and hands of the mother
Mother should be in comfortable position during feeding
Hold the nipple between index and middle finger
Feed the baby on demand; it helps the baby to gain weight
Feed the baby for minimum 10 minutes on each breast
Instruct the mother to feed the baby even when the child is ill
Burping should be done after each feed to expel the air from the baby’s stomach
When the baby is 4 to 6 months old start weaning, because, mother’s milk is not sufficient to sustain growth after 6 months of age
If the baby’s napkin is wet, dirty, change the napkins and cloths before each feeding
Weigh the child every month and record it
Teach the mother to have adequate rest to avoid tension, fatigue and stress

ARTIFICIAL FEEDING

Artificial feeding is given to infants instead to the breast milk. Breast milk is often substituted by cow’s milk. The cow’s milk is substituted by dried milk, evaporated milk, etc.

Difference between human’s milk and cow’s milk

Human – carbohydrate (7%), protein (1.5%) and fat (3.5%)

Cow – carbohydrate (4%), protein (4%) and fat (4%)

Preparation of formula

The milk formula should be planned to meet the nutritional requirement of the infant which is based on his age and weight

Caloric requirement: 110 calories per kg of baby weight

Fluid requirement: 165 ml per kg of baby weight

Milk requirement: 100 to 130 ml per kg of body weight

Number of feeds in 24 hours: 7 feeds

Time interval between each feed: 2-3 hours

Preparation of Milk Formula for a Day

Take 460 ml of milk, 140 ml of water and add 9 teaspoonful of sugar and boil it and keep it in the refrigerator, for each feed, take 85 ml of milk, ward it and feed the baby

Different Ways of Feeding in Infant

By using the feeding bottle and teat
By nasal tubes
By belcroy feeder
By dropper
By using spoon

General Instructions

Plan the formula according to the nutritional requirement of the baby
The feeding bottle, teat and other articles used for the feeding should be sterile
The milk feed should be warm
The mother and the child should be in a comfortable position
Ensure a slow and steady flow of milk by making a hold in the teat neither too big nor too small
Change the napkin before the feed, if it is wet or soiled
The feeds should be given at regular intervals
The mother should wash her hands thoroughly before preparing the feed and feeding the child
Offer a small quantity of water at the end of each feed
Never pinch the baby’s nose to make him to open his mouth instead press his cheeks

Preliminary Assessment

Check

The doctors order for any specific instructions
Plan the formula according to the nutritional needs of the infant
Time at which the last feed was given
General condition of the baby
Baby’s ability for sucking
Articles available in the unit

Preparation of the Infant and the Environment

Arrange the articles at the bedside
Provide privacy
Change the napkin if it is wet
Bath the baby in necessary
Keep the feeding bottle ready

Equipment

A tray containing

Mackintosh and towel
Baby dress and napkin
Feeding bottle and teat in a sterile container
Required amount of feed (sterile)
Sterile water in a bottle
A piece of clean towel or flannel
Gown and mask for the nurse

Procedure

Wash hands thoroughly
Hold the baby in a position similar to one used for breastfeeding
Check the temperature of the feed by dropping few drops on the inner aspect of the wrist joint
Hold the bottle in an angle of 45 degree and bring the teat to the lips and then into the mouth of the baby
Take care to keep the teat filled with milk throughout the feeding
Break the wind (burping) in between the feeds
When the feed is finished, give sterile water to the baby

After Care