TEACHING DIGESTIVE
ENTERAL NUTRITION
Enteral Nutrition I
Instructed patent/CG about of enteral feeding. Enteral nutrition, also known as tube feeding, is a way of delivering nutrition directly to your stomach or small intestine. Your doctor might recommend tube feeding if you can’t eat enough to get the nutrients you need. Options may include: feeding tube passed through the nose or passed through the skin on your abdomen.
Enteral Nutrition Instructions I
Instructed patent/caregiver about change the bandage around the tube, the bolsters, skin barriers, and tube attachments at least every 7 days. If your bandages, barriers, or devices get dirty or wet, change them right away, and as often as needed. Keep the site covered when you shower. Tape a piece of clear adhesive plastic over the dressing to keep it dry while you shower. Do not take tub baths.
Enteral Nutrition Instructions II
SN instructed patient/caregiver for the first 4-6 weeks after placement of a new PEG. Bath water should not be so deep that the tube is under the water. Shower water should fall on your back only. For a balloon, low profile, or older PEG tube you can take a bath or shower as you normally do. Instructed patient call nurse or doctor if your body changes: your skin around tube has signs of infection: redness, warm to touch, firm to touch, tender.
Enteral Nutrition Instructions II
SN instructed patient/caregiver about keep clean skin around the tube. Wash skin around the tube with soap and warm water. Clean around G-tube to remove any drainage and / or crusting. Rinse soap off with clear water. Dry skin thoroughly. Keep this site clean and dry. check for redness, swelling, any drainage or excess skin growing around the tube. A small amount of clear tan drainage can be normal. Call your care team with any concerns.
Enteral Nutrition Bolus Feeding Instructions
SN instructed patient/caregiver about bolus feeding. A bolus feeding is an amount of formula given over a short period of time. Feeding syringe: Connect the feeding syringe to the end of the PEG tube. Pour the correct amount of formula into the syringe. Hold the syringe up high. Formula will flow into the PEG tube. The syringe plunger may be used to gently push the last of the formula through the PEG tube. Caregiver always need to flush your PEG tube before and after each use with 100 ml of water.
Enteral Nutrition Prevent Blockage
SN instructed patient/caregiver to always flush your PEG tube before and after each use. This helps prevent blockage from formula or medicine. Use at least 2 tablespoons (30 ml) of water to flush the tube. Follow directions for flushing your PEG tube. If the PEG tube becomes clogged, try to unclog it as soon as you can. Flush your PEG tube with a 60 ml syringe filled with warm water. Never use a wire to unclog the tube. A wire can poke a hole in the tube. Your healthcare provider may have you use a special medicine or a plastic brush to help unclog your tube.
Enteral Nutrition When call nurse or doctor
SN instructed patient/caregiver that is important call nurse or doctor if your body changes: Nausea or vomiting that does not go away, constipation with no bowel movement for 3 days. Diarrhea of more than 6 loose stools a day, stomach becomes bloated or swollen and tight, a stomach residual more than the amount your doctor has set for you.
Enteral Nutrition Weight
SN instructed patient/caregiver that you may need to check your weight daily or weekly, your healthcare provider may need to change your feeding if your weight changes too quickly. Instructed patient watched closely for any complications, such as an infection or bleeding.
OSTOMY
Colostomy I
SN educated patient/caregiver about of colostomy. A surgically created opening in the abdomen in which a piece of the colon (large intestine) is brought outside the abdominal wall to create a stoma through which digested food passes into an external pouching system. A colostomy is created when a portion of the colon or rectum is removed due to a disease process or damaged area of the colon.
Colostomy Stoma
SN instructed patient/caregiver about things to know about your stoma include: Your stoma is the lining of your intestine, it will be pink or red, moist, and a little shiny. Stomas are most often round or oval, a stoma is very delicate. Call your provider if: Your stoma is swollen and is more than a 1/2 inch (1 cm) larger than normal. Your stoma is pulling in, below the skin level. Your stoma is bleeding more than normal.
Colostomy When Call Doctor
SN instructed patient/caregiver when you should call the doctor: Severe watery discharge lasting more than 5 or 6 hours bad odor lasting more than a week this may be a sign of infection, a cut in the stoma. Also if there are cramps lasting more than 2 or 3 hours continuous nausea and vomiting, no ostomy output for 4 to 6 hours with cramping and nausea.
Colostomy Dehydration I
SN instructed patient/caregiver about colostomy and dehydration. Loss of appetite, drowsiness, and leg cramps may be signs of sodium loss. Fatigue, muscle weakness, and shortness of breath may be signs of potassium loss. Dehydration, low sodium, and low potassium can all be dangerous and should be treated right away. Call your doctor or 911 right away if you are dizzy, weak, or having other serious symptoms.
Colostomy Avoid Dehydration
SN instructed patient/caregiver about colostomy and avoid dehydration. Avoid dehydration, you should try to drink 8 to 10 eight-ounce glasses of fluid a day. If you have diarrhea, you may need more. Drinks such as Gatorade®, PowerAde, or Pedialyte contain potassium and sodium. But any liquid containing water (soda, milk, juice, tea, etc.) helps to meet your daily need for fluid.
Colostomy Dehydration II
SN instructed patient/caregiver about colostomy and dehydration. Dehydration is also a serious concern. Symptoms include increased thirst, dry mouth, decreased urine output, feeling light-headed, and feeling tired. If you get dehydrated, you’ll need to drink more fluids.
Colostomy Odors
SN instructed patient/caregiver about colostomy and odors. Many factors, such as foods, normal bacteria in your intestine, illness, certain medicines, and vitamins can cause odor. Some foods can produce odor: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and coffee are among them. If you find that certain foods bother you, avoid them.
Urostomy I
SN educated patient/caregiver about of Urostomy. A surgically created opening in the abdominal wall through which urine passes. A urostomy may be performed when the bladder is either not functioning or has to be removed. There are several different types of surgeries, but the most common are ileal conduit and colonic conduit.
Urostomy Contact Nurse or MD
SN instructed patient/caregiver When contact your nurse or doctor? You have a fever, blood in your urine, and your urine has a strong odor, your incision wound or stoma is red or swollen, or you have a rash. Also, if you have nausea, bloating, pain, or are vomiting, you have little or no urine coming from your stoma, your stoma changes in size or appearance, you are weak and unable to do your normal activities.
Urostomy lifestyle I
SN instructed patient/caregiver how can a urostomy fit into your lifestyle: Reduce odor. Some foods, such as asparagus, cheese, and eggs may cause your urine to have a strong odor. Vitamin C may help to decrease urine odor. Drink liquids as directed. Most people should drink at least 8 (8-ounce) cups of liquids each day.
Urostomy lifestyle II
SN instructed patient/caregiver how can a urostomy fit into your lifestyle: Stay active and exercise as directed. Ask your caregiver about the best exercise plan for you. Wear your pouch when you swim. Use waterproof tape over the edges of your skin barrier to keep your pouch from leaking.
Ileostomy I
SN educated patient/caregiver about of ileostomy. A surgically created opening in the abdomen in which a piece of the ileum (lowest part of the small intestine) is brought outside the abdominal wall to create a stoma through which digested food passes into an external pouching system.
VOMITING
Nausea and Vomiting
SN educated patient/caregiver about nausea and vomiting are common signs and symptoms that can be caused by numerous conditions. Nausea and vomiting most often are due to viral gastroenteritis — often mistakenly called stomach flu — or the morning sickness of early pregnancy. Many medications can cause nausea and vomiting, as can general anesthesia for surgery. Rarely, nausea and vomiting may indicate a serious or even life-threatening problem.
Vomiting Seek Immediate Medical Attention
SN educated patient/caregiver to seek immediate medical care if any of the following situations occur besides vomiting: blood presence in the vomit, severe headache, severe abdominal pain, fever over 101 degrees Fahrenheit, diarrhea or rapid breathing or pulse.
Vomiting Call 911
SN educated patient/caregiver to seek prompt medical attention if nausea and vomiting are accompanied by other warning signs, such as: chest pain, severe abdominal pain or cramping, blurred vision, confusion, high fever and stiff neck, fecal material or fecal odor in the vomit, rectal bleeding.
Vomiting Medical Appointment
SN educated patient/caregiver to make an appointment with your doctor if: Vomiting lasts more than two days for adults, 24 hours for children under age 2 or 12 hours for infants. You’ve had bouts of nausea and vomiting for longer than one month. You’ve experienced unexplained weight loss along with nausea and vomiting.
Vomiting While You Wait for Your Medical Appointment
SN educated patient/caregiver what to do while you wait for your appointment with your doctor. Rest might make nausea worse. Stay hydrated: Take small sips of cold, clear, carbonated or sour drinks, such as ginger ale, lemonade and water. Mint tea also may help. Oral rehydration solutions, such as Pedialyte, can aid in preventing dehydration. Avoid strong odors and other triggers. Eat bland foods such as gelatin, crackers and toast. Avoid fatty or spicy foods. Wait to eat solid foods until about six hours after the last time you vomited.
DIARRHEA
Diarrhea I
SN educated patient/caregiver about diarrhea. Everyone occasionally has diarrhea — loose, watery and more-frequent bowel movements. Acute diarrhea lasts from 2 days to 2 weeks. Persistent diarrhea lasts 2 to 4 weeks. Acute and persistent diarrhea are typically caused by a bacterial, viral or parasitic infection of some sort. Chronic diarrhea lasts longer than does acute or persistent diarrhea, generally more than four weeks.
Diarrhea Complications I
SN instructed patient/caregiver in complication of diarrhea such as dehydration, electrolyte imbalance or anal excoriation. Dehydration is indicated by dry mouth, poor skin turgor, dry, flushed skin, decreased urine output, sunken eyes and weak, rapid pulse.
Diarrhea Complications II
SN instructed patient/caregiver about severe diarrhea (greater than 10 bowel movements a day or diarrhea where fluid losses are significantly greater than oral intake) can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems.
Diarrhea Ricks Factors
SN instructed patient/caregiver in factors that increase the risk of diarrhea such as drug side effects, food allergies, infections, ingestion of toxins, fecal impactions, radiation, laxative abuse, stress, lactose intolerance, or diseases like cancer, diverticulosis and others.
Diarrhea Medical Attention for A Child
SN instructed patient/caregiver seek medical attention for a child with these signs and symptoms: Diarrhea that doesn’t improve after 24 hours. No wet diaper in three or more hours. A fever of more than 102 F (39 C). Bloody or black stools. A dry mouth or tongue or cries without tears. Unusually sleepy, drowsy, unresponsive or irritable. A sunken appearance to the abdomen, eyes or cheeks. Skin that doesn’t flatten if pinched and released.
Diarrhea Medical Appointment for an Adult
SN instructed patient/caregiver schedule a doctor’s visit for an adult with these symptoms: Diarrhea lasts more than two days without improvement. Excessive thirst, dry mouth or skin, little or no urination, severe weakness, dizziness or lightheadedness, or dark-colored urine, which could indicate dehydration. Severe abdominal or rectal pain. Bloody or black stools. A fever of more than 102 F (39 C).
CONSTIPATION
Constipation I
SN educated patient/caregiver that constipation happens when fecal material (stool) moves through the large bowel (colon) too slowly. The fluid portion of the stool is absorbed back into the body, so the stool becomes hard and dry. This makes it difficult to pass the stool that difficult or infrequent passage of hard. Dry stool may constitute as a sign/symptom of constipation. Also, decreased appetite, nausea and/or vomiting. If constipation persists longer than 3-5 days, please notify the SN or MD.
Managing Constipation
SN instructed patient/caregiver on some measures aimed to controlling/managing constipation, such as: establish regular times for evacuations usually after a meal and drink a warm liquid one-half hour before breakfast to stimulate bowel movement, avoid laxative and enema abuse.
Constipation Complications
SN instructed patient/caregiver on some potential complications of constipation, such as: stool impaction (liquid bowel movement may ooze around hard stool in the colon), bowel blockage (no stool passes and pain occurs), Valsalva maneuver (may be caused by straining causing a slowed pulse, decreased blood return and increased venous pressure), rectal bleeding and rectal pain, among others.
Prevent Constipation
SN instructed patient/caregiver measures to prevent constipation: increasing fluids, eating a diet high in fiber, and avoiding foods with sugars (pasta, pastries, cheese, rice, etc.). Also, exercise regularly at a slow, steady pace, as directed by MD.
Constipation Ricks Factors
SN educated patient/caregiver on some factors that may increase the risk of developing/exacerbating constipation, such as: organic problems, inactivity and chronic use of laxatives and enemas, among others.
ABDOMINAL PAIN
Abdominal Pain I
SN instructed patient/caregiver about abdominal pain. Abdominal pain can be mild or severe. It may be continuous or come and go. Abdominal pain can be short-lived (acute) or occur over weeks, months or years (chronic). Call your doctor right away if you have abdominal pain so severe that you can’t move without causing more pain, or you can’t sit still or find a comfortable position.
Abdominal Pain Seek Immediate Medical Help
SN instructed patient/caregiver to seek immediate medical help if pain is accompanied by other worrisome signs and symptoms, including: severe pain, fever, bloody stools, persistent nausea and vomiting, weight loss, skin that appears yellow, severe tenderness when you touch your abdomen, swelling of the abdomen.
Abdominal Pain Call 911
SN instructed patient/caregiver when call 911. Seek help if your abdominal pain is severe and is associated with trauma, such as an accident or injury or pressure or pain in your chest.
DIET
Regular Diet
SN educated patient/caregiver about of regular diet can also be referred to as a general or normal diet. Its purpose is to provide a well-balanced diet and ensure that individuals who do not require dietary modifications receive adequate nutrition. Based on the Dietary Guidelines and the Food Guide Pyramid, it incorporates a wide variety of foods and adequate caloric intake (provides approximately 3375 calories).
Clear Liquid Diet
SN educated patient/caregiver about of Clear Liquid Diet. To leave little residue in the GI tract, this short-term diet provides clear liquids that supply fluid and calories without residue. It is often used with acute illness, before and after surgery, and other procedures such as x-ray, CT scan, etc. It includes coffee, tea, clear juices, gelatin and clear broth.
Full Liquid Diet
SN educated patient/caregiver about of Full Liquid Diet. As a transition between clear liquid and a soft or regular diet, this plan provides easily tolerated foods. The diet includes milk, strained and creamed soups, grits, creamed cereal and fruit and vegetable juices. We also serve scrambled eggs because of their high water content and they are an excellent source of protein.
Mechanical Soft Diet
SN educated patient/caregiver about of Mechanical Soft Diet. The mechanical soft diet consists of foods soft in texture, moderately low in fiber, and processed by chopping, grinding or pureeing to be easier to chew. Most milk products, tender meats, mashed potatoes, tender vegetables and fruits and their juices are included in the diet. However, most raw fruits and vegetables, seeds, nuts and dried fruits are excluded.
GI Soft Diet
SN educated patient/caregiver about of GI Soft Diet. This diet can serve as a transition between a full liquid and a regular diet by providing foods low in fiber and soft in texture. Most raw fruits and vegetables, nuts, seeds, coarse breads and cereals are avoided. Milk, lean meats, fish, most forms of potatoes and white breads are served on this diet plan.
Low Residue/Low Fiber Diet
SN educated patient/caregiver about of Low Residue/Low Fiber Diet. This type of diet tried to limit fiber, a kind of carbohydrate found in some plant-derived foods. The diet limits intake around ten grams of fiber daily and is designed to minimize the frequency and volume of residue in the intestinal tract.
Salt-restricted (Low Sodium) Diet
SN educated patient/caregiver about of Salt-restricted (Low Sodium) Diet. Sodium controlled diets are usually prescribed for patients with hypertension and for those with excess fluid accumulations. Intake of commercially prepared foods such as cured or smoked meats, canned vegetables and regular soups as well as buttermilk, salt and salty foods are limited or avoided. White milk, fresh or frozen meats, unsalted vegetables and fruits and low sodium foods are included.
Fat-Restricted Diet
SN educated patient/caregiver about of Fat-Restricted Diet. This diet is often prescribed for patients with gastrointestinal disorders or excessive body weight. It limits the intake of fatty food such as margarine, mayonnaise, dressings, oils and gravies. The diet usually includes whole wheat breads, lean cuts of meat, skim milk, low-fat cheese products, eggs, vegetables, and other food items prepared without extra fat.
Cholesterol-Restricted Diet
SN educated patient/caregiver about of Cholesterol-Restricted Diet. Lowering blood cholesterol can reduce your risk of heart disease. Cholesterol is found only in foods of animal origin. Certain oats, beans, and fruits are actually effective at lowering cholesterol levels in the body. A cholesterol-restricted diet limits the intake of meats, poultry, fried foods, egg yolks, and whole milk products. Food high in saturated fat and trans fatty acids such as palm kernel oil, coconut oil, margarine, and shortening are also limited. The diet includes skim milk, lean meats, fruits, vegetables, and whole grain products.
Vegetarian Diet
SN educated patient/caregiver about of Vegetarian Diet. This diet varies widely depending on personal choice. It may include only plant foods- grains, vegetables, fruits, legumes, nuts, seeds, and vegetables fats. Some variations designed to be lower in cholesterol and saturated fat and higher in dietary fiber. Thus, it may be helpful in the prevention of heart disease and cancer risk.
Consistent Carbohydrate (Diabetic Diet)
SN educated patient/caregiver about of Consistent Carbohydrate (Diabetic Diet). A diabetic diet varies from patient to patients depending on the type and intensity of the diabetes, the patients’ personal history, and individual nutrient needs. The Exchange List for Meal Planning established the serving size amount of carbohydrates per meal based on calorie recommendations. Meals are basically like those found on a regular menu, but carbohydrate servings are carefully controlled and small snacks may be included in the meal plan. Carbohydrates are starches, starchy vegetables, juice, fruit, milk, and sugars.
Renal Diet
SN educated patient/caregiver about of Renal Diet. A renal diet is carefully planned with special consideration of nutrients, and it is often adjusted as kidney disease progresses. A renal diet may serve the purpose of attempting to slow down the process of renal dysfunction. If dialysis treatments are not being taken, the doctor may restrict protein intake of foods such as potatoes, tomatoes, oranges, and bananas. A phosphorous restriction may limit the intake of milk and dairy products, dried beans and peas, while grain breads and cereals, coffee, tea, and “dark-colored” soda beverages.
MISCELLANEOUS
Food pyramid
SN instructed Pt/CG that all meals should be balanced with proper types of foods (i.e., protein, carbohydrates and vegetables.) in accurate amounts according to food pyramid (Mypyramid.gov).