ASSESSMENT |
INTERVENTION |
EVALUATION/OUTCOME |
Once the decision is made to tube feed, have a gastrointestinal work-up done to document intestinal motility, anatomic integrity, and presence/absence of gastroesophageal reflux. |
Determine most appropriate feeding route: Site of delivery (i.e., gastric, duodenal, or jejunal) Tube placement (i.e., nasal or surgical) |
Caregiver(s) and all involved medical professionals contribute to decisions regarding feeding route. |
Have a medical/surgical assessment done. |
Determine requirements for the following:
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Patient is receiving a nutritionally adequate feeding. |
Before starting tube feeding, do a complete nutrition assessment, including the following areas: Please see section on Nutrition Assessment.
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Determine most appropriate type of formula or breast milk and supplements. |
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Determine most appropriate method of formula delivery (i.e., bolus, continuous drip, or combination.) Establish regular plan to increase volume with growth to maintain adequate nutrient intake (for young infants intake should be increased weekly) |
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Instruct caregiver(s) about the following:
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Caregiver(s) obtain appropriate formula and supplements Caregiver(s) demonstrate appropriate techniques for feeding. and stoma/skin care Caregiver(s) know when to call MD |
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Once tube feeding has begun, monitor tolerance to tube feeding closely: Maintain frequent contact with family by phone or clinic visits. Check for vomiting, diarrhea, constipation, and other adverse reactions. See section on Complications in Technical Aspects of Enteral Feeding. |
As necessary make changes in:
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Child tolerates feeding regimen and formula well. (No gastrointestinal disturbances or other signs of formula intolerance.) |
Growth and indicators of fat and muscle stores, every 1 - 2 months until weight gain has been stable for 2 months. |
Once child achieves appropriate weight for height (or length), evaluate need for reducing caloric intake to compensate for low energy needs due to immobility or paralysis. |
Weight gain is stable and adequate. |
Once weight gain has been stable for 2 months, reevaluate every 6 months (more often in periods of rapid growth, such as infancy and adolescence):
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Make changes in formula and delivery method as indicated by nutritional status. |
Weight is appropriate for height (or length). Formula meets requirements for calories, protein, vitamins, minerals, and electrolytes. Fluid intake is adequate. |