#36 Nutrition

A patient’s nutrition status is often an afterthought for nurses. Clinical nurse specialist, Janice Powers, PhD, RN explains how nutrition improves patient outcomes and reviews evidence based enteral feeding practices in hopes that nurses will play a more central role in facilitating adequate nutrition for our patients.

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Why is early enteral feeding important?

  • Maintain mucosal and alveoli integrity
  • Reduce bacterial translocation
  • Decrease further metabolic deterioration
  • Prevent loss of lean muscle

Myth busting!

Myth: Proned patients should not getting tube feeding (TF)
Fact: Proned positioning is not a contraindication to TF and should not be held!

Myth: I need to turn off TF when I reposition my patient.
Fact: The amount of TF a patient gets when a patient lays flat for repositioning is short enough that it is not a risk for aspiration. Leave the TF on!

Myth: Bowel sounds must be auscultated before starting TF.
Fact: Studies have shown that auscultating bowel sounds is not a useful practice for assessing bowel status. Absence of bowel sounds is not a contraindication to starting TF!

Myth: Gastric residual volume (GRV) is an important marker of feeding tolerance.
Fact: GRV can be an inaccurate measurement due to patient positioning and gastric/salivary secretions. That being said, the American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine guidelines are to hold enteral feedings once gastric residuals are greater than 500 mL.

De-clogging

  • Soda can cause future clogs. Use enzymatic solutions provided by your facility
  • A newer solution is the TubeClear System