Enteral Nutrition (04:55)
Genevieve Kearney, Kathy Heard, and Leigh Bak will discuss feeding the diabetic patient through a tube—via nasogastric tube, gastrostomy, duodenostomy, or jejunostomy. Hear contraindications and benefits. Patient categories include neuromuscular impairment, inability to consume adequate food, and underlying illness.
Registered Dietitian's Role (01:29)
Dietitians assess the patient's energy, protein and fluid requirements, and recommend formula, strength, and total volume. Formula factors include chemical composition, caloric density, osmolality, residue content, vitamins and minerals, and cost.
Types of Feedings (02:58)
Learn about continuous and intermittent or bolus feedings, including advantages and disadvantages.
Types of Formulas (05:48)
Glycemic response depends on the enteral formula's macronutrient composition. Carbohydrate sources include starch, glucose polymers, disaccharides and monosaccharides. Kearney discusses isotonic formulas Osmolite HN and Jevity, and reduced carbohydrate formula Glucerna.
Complications of Tube Feedings (01:45)
Enteral nutrition goals include providing adequate nutrition and hydration, maintaining therapeutic blood glucose levels, and avoiding complications. These include the prescribed amount not being administered, upper GI complaints, lower GI complaints, aspiration pneumonia, and diminished mobility.
Prescribed Amount Not Administered (04:39)
Heard discusses reasons why enteral nutrition patients may receive more or less than the prescribed amount. View guidelines for handling gastric residuals.
Upper Gastrointestinal Complaints (03:34)
Bolus feedings are more frequently associated with nausea, vomiting and bloating. Gastroparesis occurs in 25% of diabetic patients; learn about symptoms, diagnosis and treatment.
Lower Gastrointestinal Complaints (03:44)
Diarrhea is a common tube feeding complication; etiologies include hypoalbuminemia, infection, feeding formula and concurrent drug therapy. Interventions include formula evaluation, examining stool and medications, limiting formula hanging time, monitoring hydration, blood glucose and electrolyte status, and considering antidiarrheal agents.
Aspiration Pneumonia (02:51)
Interventions for reducing risk among tube feeding patients include identifying high risk patients, electing continuous feeding, elevating the bed, early detection, and considering a jejunostomy tube.
Diminished Mobility and Sequelae (02:22)
Tube feeding increases decubitus ulcer risk; lowers functional abilities; and increases depression, agitation, and anxiety risk.
Managing the Diabetic Patient: Mrs. J (05:11)
Bak presents a case study of a 71 year old woman with type 1 diabetes and CVA. She had a PEG tube placed before discharge; Jevity bolus feedings caused morning hypoglycemia. Hear Bak's recommendations for normalizing blood glucose levels.
Target Glucose Levels (05:48)
Blood glucose control parameters depend on individuals. Bak explains the risks of hyperglycemia and hypoglycemia in tube feeding patients. Hear hypoglycemia causes and treatments.
Case Study: Mr. L (05:03)
Bak presents a 69 year old man with type II diabetes and CVA. He was started on Osmolite HN and switched to Glucerna with PEG tube insertion. He developed a UTI, causing hyperglycemia; hear Bak's recommendations for blood glucose control.
Case Study: Mrs. A (05:23)
Bak presents a 70 year old woman with type 2 diabetes, hypertension, CAD, atrial fibrillation, and upper GI bleed. She was started on Jevity via PEG tube and suffered hyperglycemia. Hear Bak's recommendations for blood glucose control.
Credits: Management of the Diabetic Patient While Tube Feeding (00:45)
Credits: Management of the Diabetic Patient While Tube Feeding
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