Naso-duodenal tube feeding is recommended for hospitalized patients. This means that Sharyn does not need the assessment of the caretakers and the important home details. However, like any other patient, Sharyn needs to be psychologically prepared to the feeding method. Therefore, there will be need to establish an understanding between the hospital caregivers and Sharyn. This will include explaining to the patient everything concerning the procedure including the indication and contraindication. Hospitals will often provide the outlined procedure for the administration of the feeding method and this should be followed to the latter. According to the hospital procedure and the formula provider’s orders, it is important to conduct bedside assessments. Finger-stick blood glucose is one of the most important bedside assessment not to forget. It is also important to auscultate for bowel sounds because it will act as a baseline for the peristalsis subsequent evaluation. A Naso-duodenal tube feeding procedure does not require gastric residual testing since the intestines only have a forward propulsion. The other preparations needed are mainly for the components of the procedure and cleaning of the components/equipment.
Naso-duodenal tubes are preferred in cases where the patient is unable to tolerate food in the stomach. These refer to individuals with stomach related complications which prevent them from taking food straight into the stomach. Such patients may show complications such as severe vomiting or severe reflux. The complications may be due to the stomach dysfunction or sometimes due to impaired gastric motility. In such a case, it would be impossible to administer Naso-gastric feeding without causing problems to the patient. For such patients, the physicians may recommend either Naso-jejunal or Naso-duodenal tube feeding.
According to the provider, Sharyn requires 2200ml of the formula per day. However, the physician has determined that the patients require feeding continuously for 18 hours. This means that the patient will require a pump. Using the syringe will require at least 60ml administration of the formula for every 30mins. This means that the formula will be administered using 60ml syringes every half hour for 18hrs every day. As a precaution, it is important to ensure that the caregiver flushes water in the feeding tube intermittently to prevent clogging. This should be done before and after feeding. The patient will require similar precautions after gastric aspiration and after the medication. It is also important to keep the proximal ends capped when the tubes are not in use. Documentation of the feeding and the patients concerns is also important. This is important in ensuring the patient's comfort.
Diarrhea is one of the common complications in tube feeding.it may be caused by changes in the formula or the infusion rate. However, there may also be other causes like bacterial infections and contaminations, medication, and sometimes impaction. Medication causes diarrhea because many of the liquid medications used contain sorbitol which ca cause the complication. Some medications may also contain nonsteroidal anti-inflammatory drugs and Magnesium which may contribute to the diarrhea. To prevent changes in the formula, open formula should always be kept in a cool dry place such as the refrigerator. Ensuring all equipment are clean is also very important in preventing contamination and bacterial infection. To manage the diarrhea, reducing the rate of feeding flow will be effective. Another possible solution would be to supplement the formula with fiber.
Dara Calloway
Irritable bowel syndrome is often associated with stress, anxiety and depression. Earlier, the problem has been associated with intestinal infections but more often it is associated with the aforementioned factors. Dara has experienced the symptoms of the syndrome for a long period of time. In college, Dara may have experienced the problem because of anxiety of student related problems like stress due to excessive studying or too much work at school. Some of the symptoms for Dara include diarrhea and abdominal pain. Dara also reported to have experienced cramping. After getting her first job, Dara could have experienced stress and anxiety due to the new environment and pressure to impress. However, Dara has dietary problems related to her unbalanced diet and very little daily intake of fiber. Dara’s problem is both dietary and mental. Stress is one of the major causes of irritable bowel syndrome, as mentioned above, and may be one of the main causes of the problem for Dara.
Dara’s diet in general could be aggravating the IBS. Her combination of food and drinks make the situation worse. Caffeine is not healthy for a person with IBS, yet Dara took several cups of coffee every morning. Dara also took several cans of soda on a daily basis, yet carbonated drinks tend to aggravate IBS. In addition, Dara also took large meals making the situation even worse. Another group of food in her diet that may have aggravated her IBS is the fatty foods that she took. However, Dara was taking too little fiber which may also have played a part. Too much fiber aggravates IBS, especially insoluble fiber, but fiber is crucial in digestion and too little of it may lead to indigestion. In devising an appropriate dietary plan for Dara, it would be important to reduce the rate of intake of carbonated drinks, reduce the intake of fatty foods and caffeine. It would also be very important to increase the intake of soluble fiber and advise Dara not to consume large meals. Dara also requires a change in the meals schedule.
After a review of the patient’s diet and life situation, the physician will be able to identify the stressors in the patient’s life and identify the dietary problems. It will also be possible to identify the causes of the IBS for the particular patient and establish the best possible solution. In most cases, the IBS symptoms are caused by the process of consuming the food and not a specific type of food. Sometimes, the eating process stimulates the digestive tract and causes the symptoms due to over-response caused by IBS. Therefore, the first step of controlling and treating IBS is reducing the size of the meal. The meals should be spread throughout the day in order to complete the nutrition requirement of the body. While eating, IBS patients are advised to take time and eat slowly without a rush. Eating fast may cause overresponse of the digestive tract. It is also advisable to avoid meals that are known to overstimulate the gut. High-fat foods and large meals often overstimulate the gut.
In addition taking breakfast is also important in the stimulation of bowel movement to prevent constipation. Specific types of food are related to the gastrointestinal problems including lots of caffeine and chocolate. It is therefore, recommended to reduce the consumption of such foods. Insoluble fiber may also aggravate IBS. Meaning that patients should be advised to reduce the rate of consumption of insoluble fiber and maintain a normal rate of fiber consumption. Patients will understand changes in diet whenever the changes specify the types of meals. However, for people with IBS, changes in diet is most often the amount consumed and the process of consumption. This may result in malnutrition and reduced quality of life. IBS patients will also need to combine the change in diet with a change in the lifestyle. This will help reduce the stressor and provide the patient with time to rest.
