-- Aim for a healthy weight.

-- Become physically active each day.

-- Let the (Food Guide) Pyramid guide your food choices.

-- Eat a variety of grains daily, especially whole grains.

-- Eat a variety of fruits and vegetables daily.

-- Keep food safe to eat.

-- Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.

-- Choose beverages and foods that limit your intake of sugars.

-- Choose and prepare foods with less salt.

-- If you drink alcoholic beverages, do so in moderation.

Definition: liquid formulated foods designed to be usedto supplement oral intakes or provide completenutrition. Typically used in hospitalized pts, often in tube feedings.

ENTERAL FEEDINGS SHOULD BE USED WHENEVERA CLIENT CAN DIGEST OR ABSORB NUTRIENTS VIATHE GI TRACT!!

“IF THE GUT WORKS, USE IT!”

Formula Types

Standard, Intact, Blenderized For Pt able to digest/Absorb nutrients

May contain pureed foods!!!!! $

Hydrolyzed-- $$Protein delivered assmall peptides/ AA forthose with compromiseddigestive function.

Often low in fat

Modular

Contain a single nutrient (pro, CHO, lipid)Combined to meet unique needs of each ptUsed least often, $$$$$

Nutrient Content of Enteral Formulas

Caloric Density (kcal per ml or cc)

0.5 1.0 1.5 2.0

Normal formula

Energy Needs Met in Smaller Volume:

• Kcal needs high• Low appetite• Volume Restricted

For pts with damaged oratrophied GI tract.

Dilute formulas allow forrecovery of GI function.

Important Considerations: Physical Properties

Formula Osmolality (# of osmotic particles per Kg of solvent)

Hypotonic Isotonic Hypertonic

280-320 mmol/kg May cause Osmolality of human gastric

plasma retention; Example: 0.85 % sodium chloride in duodenum,or “normal saline” may cause

fluid shift,5% glucose solution diarrhea, ( 5 g per 100 ml) dehydration

Other Important Physical Properties

Renal Solute Load (RSL)

Remember: Hyperosmolar solutions require increasedwater intake in order for renal excretion,particularly in the pediatric patient.

Dehydration is a great risk-- hypernatremia azotemia (high serum N) oliguria fever weight loss

Tube Feeding protocols

Frequency/ amount

Bolus*= large volume delivered intermittently

ex: 400 ml q 4 h (2,400 ml per 24 hours)

Continuous= given over 16 to 24 hours

ex: 75 ml per h for 24 hrs (1,800 ml per 24 hrs.) (final rate)

Intermittent*= gravity drip using smaller volumes than bolus; more often

*Often poorly tolerated; n/v/d, aspiration

Volume and Rate of Delivery

Standard Procedure: use full-strength formulabut control flow rate!

Nasogastric Feedings: start slow: 25-50 ml/ hour

increase 10-25 ml per 8-24 hrs.

Measuring Residuals: withdrawing formula left in stomach using a syringe

if 100-150 ml remain, no add’t feeding.

Methods of Delivery

Due to risk of aspiration--

Elevate upper body >30˚;remain at least 30 min.after feeding.

Supplemental Water can be provided in thefeeding tube. Functions to:

• flush tube to prevent clogging• meet daily fluid requirements