GI/GU: Other ways of providing fluids and nutrition

There are many reasons why a client might encounter problems with eating or drinking. It could be due to difficulties with chewing, swallowing, or digestion as a result of trauma, surgery, or various medical conditions.

Several alternative methods of providing them the nutrients and fluids they need are available, and a nursing assistant should be familiar with them.Okay, let’s start with intravenous, or IV, therapy.

This consists of a pre-filled IV bag that delivers fluids, one drop at a time, through a drip chamber and a tube into a catheter that goes directly into a vein, most commonly on the back of the hand or the arm.

The tube also possesses a clamp that can adjust or pause the flow. Some IV sets are also connected to an electronic pump that regulates the flow rate.

Now, IV therapy cannot replace normal nutrition, but it’s typically used to provide water as well as glucose, vitamins, and minerals.

It’s also a good way to administer IV medications, like antibiotics or pain relievers or even blood! What’s most important for you to remember about clients on IVs is to notify the nurse immediately if the catheter is out of place.

In this case, the fluid may leak into the surrounding tissue, which is known as infiltration. The client will likely report a burning or tight sensation around the IV catheter insertion site, and there’ll be swelling, blanching, and cooling of the skin in the area.

Also, make sure to let the nurse know if the dressing over the IV site is loose or soiled, the IV bag is empty, the fluid is not flowing into the drip chamber, or blood has flowed back into the IV catheter.Some IV pumps may also make an alarm sound if there’s something wrong, like air in the catheter, low battery in the pump, blocked flow due to kinks in the tubing, or the client laying on top of or pulling on the IV line.Next, some clients might receive enteral nutrition, otherwise known as “tube feeding.” This means nutrition is delivered through a tube directly into the gastrointestinal, or GI, tract.

And this might be especially helpful for those who can’t properly chew or swallow as a result of head or neck trauma; surgery; coma; dementia; nervous system disorders; or tumors of the head, neck, or esophagus that block the passage of food.

Now, there are various ways the feeding tube can go into the GI tract. The most common one is a nasogastric tube connected to a feeding bag or delivered through a pump; it goes through the nose and down into the stomach.

A nasointestinal tube also goes through the nose but ends in the small intestines. These tubes can irritate the client’s throat and nose, and the clients will often dislodge the tubes.

Next, tubes can be inserted through a surgical opening, or stoma, in the abdominal wall and into the stomach, known as a gastrostomy tube.

Tubes can also be inserted into a part of the small intestine called the jejunum, which is known as a jejunostomy tube. A common type of gastrostomy tube is the percutaneous endoscopic gastrostomy tube, or PEG tube for short.

Here, an endoscope, or a tube with a light, camera, and guidewire, is inserted through the mouth and into the stomach. The endoscope lets the doctor see where the surgical incision should be made.

Next, a guidewire is inserted through the incision and pulled up and out through the mouth along with the endoscope. The PEG tube is then attached to the guidewire and sent through the mouth until it can be pulled out through the stoma opening in the abdominal wall, creating a path directly into the stomach from the outside.

Nasogastric and nasointestinal tubes are mostly preferred when enteral feeding is needed for a short period of time, typically a few days to 6 weeks; whereas gastrostomy, jejunostomy, and PEG tubes are usually used for more than 6 weeks or when a nasogastric or nasointestinal tube cannot be used.

You will not need to insert a feeding tube, but you will likely care for clients with one in place. What you should remember is that these clients are especially prone to aspiration.

This occurs when food, fluid, or even saliva enters the lungs instead of the esophagus. To prevent that, it’s important to ensure that the head of the bed is raised at least 30-45 degrees so that they remain upright during the meal and at least 1 hour afterward.

Inform the nurse right away if you observe any signs of aspiration, like coughing, choking, gagging, or difficulty breathing during or after the meal; if the feed tube is not in place, is disconnected; or if there’s fluid leaking around the site of tube insertion.

Also, report any unusual signs or symptoms, including the client complaining of nausea, discomfort, abdominal bloating, swelling, or diarrhea.Now, some clients cannot handle any food in their gastrointestinal tract.

This could be due to gastrointestinal trauma; surgical procedures; or various disorders, like cancer or inflammation. In these cases, the person is put on total parenteral nutrition, where all nutrients, including carbohydrates, proteins, lipids, vitamins, minerals, and water, are delivered through a large catheter into a big vein close to the heart.

This is known as total parenteral nutrition, or TPN for short. It can be also called hyperalimentation, meaning above or not involving the gastrointestinal tract.

Now, total parenteral nutrition tends to increase the risk of infection, elevated blood glucose, and fluid disturbances.

When caring for a client with TPN, ensure there are no kinks or pulls on the catheter. Then, make sure to notify the nurse immediately if you notice any symptoms or signs of infection, like fever, chills, cough, breathing difficulty, nausea, vomiting, or diarrhea, or if the client complaints of anything pointing to blood glucose or fluid imbalance, like feeling extremely hungry, thirsty, irritable, or urinating too frequently.

Also, tell the nurse if the client reports any discomfort around the site of catheter insertion; if the insertion site is damp or soiled; or you observe any skin redness, irritation, or swelling in the area.

Alright, as a quick recap... Many clients require alternative ways of getting their essential fluids and nutrients.

IV therapy uses an IV bag and a catheter inserted in a small vein to provide the client with water, vitamins, minerals, and glucose.

In enteral nutrition, feeding tubes can be inserted through the nose and either into the stomach, which are called nasogastric tubes, or into the small intestines, called nasointestinal tubes.

Feeding tubes can also go through a surgical opening and directly into the stomach, called gastrostomy tubes, or into the jejunum, called jejunostomy tubes.

Finally, in total parenteral nutrition, all nutrients and fluids are delivered through a catheter into a large vein close to the heart.

Total parenteral Nutrition, all nutrients, and fluids are delivered through a catheter into a large