NUTDTH / NUTDTL

• Several issues must be considered with

INDICATION OF TUBE FEEDING concurrent administration of oral
• indicated in patients who cannot main medications and enteral formulas,
adequate oral intake of food or nutrition to particularly continuous tube feeding,
meet their metabolic demands because incorrect administration
• Comatose patients on mechanical methods may result in clogged feeding
ventilation or with severe head injury tubes, decreased drug effectiveness,
• A neuromuscular disorder affecting increased adverse effects, or drug–
swallowing reflex: Parkinson disease, formula incompatibilities.
multiple sclerosis, cerebrovascular
accident. WHAT MEDICATION IS MOST COMMONLY
• Severe anorexia from chemotherapy, ASSOCIATED WITH DIARRHEA AMONG
HIV, sepsis TUBE-FED PATIENTS?
• Upper GI obstruction esophageal stricture • Diuretic
or tumor • Anti-inflammatory drugs.
• Conditions associated with increased
metabolic and nutritional demands PH OF THE BODY (STOMACH)
sepsis, cystic fibrosis and burns • After swallowing, the food reaches the
• Mental illness like dementia stomach where upper and lower parts of
stomach have different pH values. The
CONTRAINDICATION OF TUBE FEEEDING upper part has a pH of 4−6.5, while the
lower part is highly acidic with a pH of
Absolute Contraindications 1.5−4.0. It then enters the intestine which
• Hemodynamic instability with poor end- is slightly alkaline, with a pH of 7−8.5.
organ perfusion. Enteral feeding in
patients with bowel ischemia or necrosis PARENTERAL VS. ENTERAL FEEDING
can make a bad situation worse • "Parenteral" means "outside of the
digestive tract." Whereas enteral nutrition
• Active GI bleeding is delivered through a tube to your
stomach or the small intestine, parenteral
• Small or large bowel obstruction
nutrition bypasses your entire digestive
• Paralytic ileus secondary to electrolyte system, from mouth to anus
abnormalities, peritonitis
CAUSES (RISK FACTORS), SIGNS AND
Relative Contraindications SYMPTOMS, TREATMENT/ MANAGEMENT OF
• Moderate to severe malabsorption THE FOLLOWING DISEASES:

• Diverticular disease DIABETES MELLITUS

• Fistula in the small bowel
RISK FACTORS
• Short bowel disease in the early stages.
TYPE 2
COMPLICATIONS OF TUBE FEEDING • Have prediabetes.
• Constipation. • Are overweight.
• Dehydration. • Are 45 years or older.
• Diarrhea. • Have a parent, brother, or sister with
• Skin Issues (around the site of your tube) type 2 diabetes.
• Unintentional tears in your intestines • Are physically active less than 3 times a
(perforation) week.
• Infection in your abdomen (peritonitis) • Have ever had gestational diabetes
• Problems with the feeding tube such as (diabetes during pregnancy) or given
blockages (obstruction) and involuntary birth to a baby who weighed over 9
movement (displacement) pounds.

WHAT ARE THE CONCERNS OF DRUG TYPE 1

ADMINISTRATION VIA FEEDING TUBES?
 • Family history. Anyone with a parent or • Diabetes and high blood pressure are the
sibling with type 1 diabetes has a slightly more common causes of CKD in adults.
higher risk of developing the condition. Other risk factors include heart disease,
• Genetics. Having certain genes obesity, a family history of CKD,
increases the risk of developing type 1 inherited kidney disorders, past
diabetes. damage to the kidneys, and older age.
• Geography. ... Managing blood sugar and blood
• Age. pressure can help keep kidneys healthy.

SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS

• weight loss and poor appetite
TYPE 2 • swollen ankles, feet or hands – as a
• Increased thirst result of water retention (oedema)
• Frequent urination • shortness of breath
• Increased hunger • tiredness
• Unintended weight loss • blood in your pee (urine)
• Fatigue • an increased need to pee – particularly
• Blurred vision at night
• Slow-healing sores • difficulty sleeping (insomnia)
• Frequent infections • itchy skin
• Numbness or tingling in the hands or feet • muscle cramps
• Areas of darkened skin, usually in the • feeling sick
armpits and neck • headaches
TYPE 1 • erectile dysfunction in men
• Feeling more thirsty than usual.
• Urinating a lot. TREATMENT / MANAGEMENT
• Bed-wetting in children who have never • Peritoneal Dialysis (PD) at Home
wet the bed during the night. - Peritoneal dialysis (PD) is a treatment that
• Feeling very hungry. uses the lining of your abdomen
• Losing weight without trying. (peritoneal membrane) as a filter to clean
• Feeling irritable or having other mood your blood while dialysis solution is in
changes. your peritoneal cavity. Because of this,
• Feeling tired and weak. peritoneal dialysis (PD) can be performed
• Having blurry vision. at home, at work, or while travelling, either
by yourself or with the support of a
TREATMENT / MANAGEMENT caregiver. You can perform peritoneal
dialysis (PD) during the day or while you
TYPE 2 sleep, giving you the flexibility to plan your
• Healthy eating dialysis treatments around your daily
• Regular exercise schedule. Peritoneal dialysis (PD) is
• Weight loss typically performed every day.
• Possibly, diabetes medication or insulin
therapy • Home Hemodialysis (Home HD)
• Blood sugar monitoring - Haemodialysis (HD) filters your blood
TYPE 1 using a machine that has a synthetic
• Taking insulin membrane called a dialyser. It can be
• Counting carbohydrates, fats and protein performed at home, either during the day
• Monitoring blood sugar often or while you sleep, typically with the
• Eating healthy foods support of a caregiver. The ability to treat
• Exercising regularly and keeping a without a clinician’s assistance may allow
healthy weight you to plan your treatment schedule
around work, school, or other activities.
RENAL DISEASE Home haemodialysis (Home HD) is
typically performed 3-6 times per week.

RISK FACTORS • In-Center Hemodialysis (In-Center HD)

 - Haemodialysis (HD) can also be • early morning headaches
performed in a hospital or dialysis clinic • nosebleeds
under the supervision of your clinician. In- • irregular heart rhythms
Centre HD typically requires that you visit • vision changes
the hospital or clinic 3 times a week for • buzzing in the ears.
treatments that last between 3-5 hours Severe hypertension:
each time. Your treatment will be closely
• Fatigue
supervised, and you will be around others
• Nausea
who are receiving a similar treatment.
• Vomiting
• Kidney Transplant & Conservative • Confusion
Care • Anxiety
- You may also consider kidney disease • chest pain
treatment options other than dialysis. For • muscle tremors.
example, a kidney transplant if you meet
the necessary requirements. For some, TREATMENT / MANAGEMENT
conservative care without dialysis may be • Eating a heart-healthy diet with less salt.
a suitable option. • Getting regular physical activity.
• Maintaining a healthy weight or losing
GOUTY ARTHRITIS weight.
• Limiting alcohol.
RISK FACTOR • Not smoking.
• The risk of gout is greater as alcohol • Getting 7 to 9 hours of sleep daily.
intake goes up. Eating or drinking food
and drinks high in fructose (a type of
sugar). Having a diet high in purines,
which the body breaks down into uric
acid.

SIGNS AND SYMPTOMS

• severe pain in one or more joints
• the joint feeling hot and very tender
• swelling in and around the affected joint
• red, shiny skin over the affected joint

TREATMENT / MANAGEMENT
• Manage the pain of a flare. Treatment for
flares consists of nonsteroidal anti-
inflammatory drugs (NSAIDs) like
ibuprofen, steroids, and the anti-
inflammatory drug colchicine.
• Prevent future flares. ...
• Prevent tophi and kidney stones from
forming as a result of chronic high levels
of uric acid.

HYPERTENSION

RISK FACTORS
• Diabetes
• Unhealthy Diet
• Physical Inactivity
• Obesity
• Too Much Alcohol
• Tobacco Use
• Genetics and Family History
SIGNS AND SYMPTOMS