常見(jiàn)管灌餵食之問(wèn)題與對(duì)策

1、常見(jiàn)管灌餵食之問(wèn)題與對(duì)策常見(jiàn)管灌餵食之問(wèn)題與對(duì)策萬(wàn)芳醫(yī)院萬(wàn)芳醫(yī)院 金美雲(yún)金美雲(yún)2Complications of enteral nutritionnAccess problems Pressure necrosis/ulceration/stenosis Tube displacement/migration Tube obstruction Leakage from ostomy /stoma site 3Complications of enteral nutritionnAdministration problems Regurgitation Aspiration Microbial

2、 contamination4Complications of enteral nutritionnGastrointestinal complications Nausea/vomiting Diarrhea Distention/bloating/cramping Osmotic Delayed gastric emptying Secretory Constipation Drugs/medications High gastric residuals Treatment/therapies Hypoalbuminemia Maldigestion/malabsorption Formu

3、la choice/rate5Complications of enteral nutritionnMetabolic complications Refeeding syndrome Drug-nutrient interactions Glucose intolerance/hyperglycemia/hypoglycemia Hydration status-dehydration/overhydration Hyponatremia Hyperkalemia/hypokalemia Hyperphosphatemia/hypophosphatemia Micronutrient def

4、iciencies6Prevention or correction of tube-feeding complications nAspiration pneumoniaPossible causes- compromised gastroesophageal sphincter, delayed gastric emptying, gastric obstructionPreventive/corrective measures- nasoenteric, gastrostomy, or jejunostomy feeding in high-risk clients small-diam

5、eter transnasal tube elevate head of bed during and 30 minutes after feeding continuous drip method of delivery check gastric residualStable patients, especially those on long-term feeding, do not need residuals checked regularly. 7Prevention or correction of tube-feeding complicationsnClogged feedi

6、ng tubePossible causes- formula too thick for tube medicationsPreventive/corrective measures- select appropriate tube size, dilute formula with water, flush tubing with water before and after giving formula use oral, liquid, or injectable drugs whenever possible; dilute thick or sticky liquid drugs

7、with water before administering; crush tablets to a fine powder and mix with water; flush tubing with water before and after drugs are given; give drugs individually; do not mix drugs with formula 8Prevention or correction of tube-feeding complicationsnDehydration and electrolyte imbalancePossible c

8、auses- excessive diarrhea inadequate fluid intake carbohydrate intolerance excessive protein intakePreventive/corrective measures- provide additional fluid use continuous drip administration of formula; monitior blood glucose; consider administering insulin; change amount or type of carbohydrate mon

9、itor blood electrolyte levels; reduce protein intake 9Prevention or correction of tube-feeding complicationsnDiarrhea, cramps, distentionPossible causes- bacterial contamination; lactose intolerance; hypertonic formula; rapid formula administration; malnutrition/low serum albumin; drug therapyhypero

10、somolar medications- magnesium-containing antacids, sorbital-containing elixirs, electrolyte replacement supplements10Prevention or correction of tube-feeding complicationsnDiarrhea, cramps, distentionPreventive/corrective measures- use fresh formula every 24 hours; store opened or mixed formula in

11、a refrigerator; rinse feeding bag and tubing before adding fresh formula; change feeding bag every 24 hours; prepare formula with clean hands using clean equpment in a clean environment. use lactose-free formula in lactose-intolerant and high-risk clients use a small volume of formula and increase v

12、olume gradually; dilute formula; use isotonic formula. slow administration rate or use continuous drip feedings use a small volume of dilute formula and increase volume and concentration gradually. use antidiarrheal agents; change drug, drug form, or dosage; if possible. soy polysaccharide, pectin,

13、other fibers, bulking agents11Prevention or correction of tube-feeding complicationsnConstipationPossible causes- low-fiber formula lack of exercise drug therapyPreventive/corrective measures- provide additional fluids; use high-fiber formula encourage walking and other activities change drug therap

14、y if possible; give laxatives or enemas if indicatedDiarrhea can coexist with constipation, usually when a patient is impacted. 12Prevention or correction of tube-feeding complicationsnHyperglycemiaPossible causes- primary medical condition diabetes, hypermetabolism, drug therapyPreventive/correctiv

15、e measures- treat disorder check blood glucose; slow administration rate; provide adequate fluid; limit type or amount of carbohydrate; consider administering insulin.13Prevention or correction of tube-feeding complicationsnNausea and vomitingPossible causes- obstruction; delayed gastric emptying; i

16、ntolerance to concentration or volume of formula; drug therapy; psychological reaction to tube feedingPreventive/corrective measures- discontinue tube feeding check gastric residual; slow administration rate, use continuous drip feedings, or discontinue tube feeding . use small volume of dilute form

17、ula and increase volume and concentration gradually; use continuous drip feeding. change drug, drug form, or dosage if possible; use antinausea and antiemetic drugs.14Prevention or correction of tube-feeding complicationsnSkin irritation at enterostomy sitePossible causes- leakage of GI secretions a

18、nd friction caused by the tubePreventive/corrective measures- keep site clean; inspect area for redness, tenderness, and drainage; use protective skin cream.Note: Many of the complications presented here can be caused by the clients primary disorder rather than the tube feeding.Nutrition AssessmentFunctional GI tractNoYesDiffuse Peritonitis,intestinal