ASSIGNMENT ON NUTRITIONAL NEEDS
(Gastrostomy, Jejunostmy and Total Parenteral Nutrition)
SUBJECT: MEDICAL SURGICAL NURSING (II) critical care nursing
1
, INDEX
S.NO. CONTENT PAGE NO. REMARKS
1. GASTROSTOMY FEEDING:
Introduction and definitions 3
Purposes and indications 3
Contraindication and types 4- 5
Procedure in detail 6- 9
Care, change to button and removing the 10
tube
2. JEJUNOSTOMY FEEDING:
Introduction and definitions 10-11
Indication and contraindication 11
Techniques 12
Administration and feeding protocol 13-14
Feeding by gastrostomy and jejunostomy 15-17
Enteral feeding complication 17-20
Care by nurse 20-23
3. TOTAL PARENTERAL NUTRITION:
Introduction and definitions 23-24
Purpose and indication 24-25
Methods of TPN 25-26
Articles required and steps of procedure 26-27
Type of TPN formulation and venous 27-29
access
Body requirement and monitoring 29-32
Care, discontinuation and complications 32-34
4. Research evidences
34-35
5. Conclusion & summary 36
6. Bibliography 37
Teacher’s signature
2
, 1. GASTROSTMY:
Introduction:
➢ Gastrostomy tubes are feeding tubes placed through the abdomen into the stomach.
Gastrostomy tubes are used to give children formula, liquids, and medicines. These tubes are
placed by a Pediatric Surgeon or by a Pediatric Gastroenterologist. A gastrostomy tube is
placed one of two ways: 1) percutaneous and 2) surgically.
➢ At hospital discharge, a referral will be made to have a nurse visit your home. The nurse will
help you care for the gastrostomy tube and give feedings and medications and, in general, serve
as a resource in your home.
➢ All children need proper nutrition for healthy growth and development. But some kids have
medical problems that prevent them from being able to take adequate nutrition by mouth. A
gastrostomy tube (also called a G-tube) is a tube inserted through the abdomen that delivers
nutrition directly to the stomach. It's one of the ways doctors can make sure kids with trouble
eating get the fluid and calories they need to grow.
➢ Fortunately, a gastrostomy is a common procedure that takes only about 30 to 45 minutes. After
spending 1 or 2 days in the hospital, children who have had a gastrostomy can get back to their
normal activities, including school and play, after the incision has healed.
Definitions:
• An opening in the stomach made surgically, usually connecting the stomach to the outside of
the abdomen so that a feeding tube or gut decompression tube can be passed into the stomach.
• Gastrostomy is a surgical procedure for inserting a tube through the abdomen wall and into the
stomach. The tube, called a "g-tube," is used for feeding or drainage.
Purposes:
➢ Gastrostomy is performed because a patient temporarily or permanently needs to be fed directly
through a tube in the stomach.
➢ Reasons for feeding by gastrostomy include birth defects of the mouth, esophagus, or stomach,
and neuromuscular conditions that cause people to eat very slowly due to the shape of their
mouths or a weakness affecting their chewing and swallowing muscles.
➢ Gastrostomy is also performed to provide drainage for the stomach when it is necessary to
bypass a longstanding obstruction of the stomach outlet into the small intestine. Obstructions
may be caused by peptic ulcer scarring or a tumor.
Indications for gastrostomy:
• Neurological swallowing disorders e.g. cerebral palsy, multiple sclerosis etc.
• Esophageal stricture or atresia
• Esophageal cancer
• Gastric outlet or small bowel obstruction
• Major neck surgeries
• Any condition which requires prolonged tube feeding for > 4weeks.
3
, Why Would a Child Need a G-Tube?
• A number of conditions might cause a child to need a G-tube. Some of the most common
include:
• congenital (present from birth) abnormalities of the mouth, esophagus, stomach, or intestines
• sucking and swallowing disorders, which are often related to prematurity, brain injury,
developmental delay, or certain neuromuscular conditions, like severe cerebral palsy
• Failure to thrive, which is a general diagnosis that refers to a child's inability to gain weight
and grow appropriately. Poor growth can be the result of an underlying medical condition such
as cystic fibrosis, certain heart defects, cancer, intestinal problems, severe food allergies, or
metabolic disorders, among other things.
• extreme difficulty taking medicines
• inability to burp after an operation to reduce reflux (stomach contents and acid moving
backward from the stomach into the esophagus)
Contraindications:
• Uncorrectable coagulopathy or thrombocytopenia
• Active gastritis or peptic ulcer disease
• History of total gastrectomy
• Severe ascites
• Active peritonitis
Types:
S. no. Type Description
1. Open gastrostomy: • Open gastrostomy: There are many types
• Stamm’s of open gastrostomy but the commonly
• Janeway’s used types are the Stamm and Janeway
gastrostomy
• Preoperatively; baseline investigations,
plain abdominal X-ray, upper G.I
endoscopy, NPO, consent
• Anesthesia; local, general
• Incision; small upper midline, left
subcostal
• The peritoneal cavity is entered and the
anterior wall of the stomach is grasp with
two pairs of Babcock forceps and the
stomach drawn unto the surface. The
stomach is incised to allow insertion of a
12 or 14Fr forley catheter whose balloon
is then inflated. Leakage alongside the
catheter is prevented in one of two ways;
Stamm’s or Janeway’s.
4
(Gastrostomy, Jejunostmy and Total Parenteral Nutrition)
SUBJECT: MEDICAL SURGICAL NURSING (II) critical care nursing
1
, INDEX
S.NO. CONTENT PAGE NO. REMARKS
1. GASTROSTOMY FEEDING:
Introduction and definitions 3
Purposes and indications 3
Contraindication and types 4- 5
Procedure in detail 6- 9
Care, change to button and removing the 10
tube
2. JEJUNOSTOMY FEEDING:
Introduction and definitions 10-11
Indication and contraindication 11
Techniques 12
Administration and feeding protocol 13-14
Feeding by gastrostomy and jejunostomy 15-17
Enteral feeding complication 17-20
Care by nurse 20-23
3. TOTAL PARENTERAL NUTRITION:
Introduction and definitions 23-24
Purpose and indication 24-25
Methods of TPN 25-26
Articles required and steps of procedure 26-27
Type of TPN formulation and venous 27-29
access
Body requirement and monitoring 29-32
Care, discontinuation and complications 32-34
4. Research evidences
34-35
5. Conclusion & summary 36
6. Bibliography 37
Teacher’s signature
2
, 1. GASTROSTMY:
Introduction:
➢ Gastrostomy tubes are feeding tubes placed through the abdomen into the stomach.
Gastrostomy tubes are used to give children formula, liquids, and medicines. These tubes are
placed by a Pediatric Surgeon or by a Pediatric Gastroenterologist. A gastrostomy tube is
placed one of two ways: 1) percutaneous and 2) surgically.
➢ At hospital discharge, a referral will be made to have a nurse visit your home. The nurse will
help you care for the gastrostomy tube and give feedings and medications and, in general, serve
as a resource in your home.
➢ All children need proper nutrition for healthy growth and development. But some kids have
medical problems that prevent them from being able to take adequate nutrition by mouth. A
gastrostomy tube (also called a G-tube) is a tube inserted through the abdomen that delivers
nutrition directly to the stomach. It's one of the ways doctors can make sure kids with trouble
eating get the fluid and calories they need to grow.
➢ Fortunately, a gastrostomy is a common procedure that takes only about 30 to 45 minutes. After
spending 1 or 2 days in the hospital, children who have had a gastrostomy can get back to their
normal activities, including school and play, after the incision has healed.
Definitions:
• An opening in the stomach made surgically, usually connecting the stomach to the outside of
the abdomen so that a feeding tube or gut decompression tube can be passed into the stomach.
• Gastrostomy is a surgical procedure for inserting a tube through the abdomen wall and into the
stomach. The tube, called a "g-tube," is used for feeding or drainage.
Purposes:
➢ Gastrostomy is performed because a patient temporarily or permanently needs to be fed directly
through a tube in the stomach.
➢ Reasons for feeding by gastrostomy include birth defects of the mouth, esophagus, or stomach,
and neuromuscular conditions that cause people to eat very slowly due to the shape of their
mouths or a weakness affecting their chewing and swallowing muscles.
➢ Gastrostomy is also performed to provide drainage for the stomach when it is necessary to
bypass a longstanding obstruction of the stomach outlet into the small intestine. Obstructions
may be caused by peptic ulcer scarring or a tumor.
Indications for gastrostomy:
• Neurological swallowing disorders e.g. cerebral palsy, multiple sclerosis etc.
• Esophageal stricture or atresia
• Esophageal cancer
• Gastric outlet or small bowel obstruction
• Major neck surgeries
• Any condition which requires prolonged tube feeding for > 4weeks.
3
, Why Would a Child Need a G-Tube?
• A number of conditions might cause a child to need a G-tube. Some of the most common
include:
• congenital (present from birth) abnormalities of the mouth, esophagus, stomach, or intestines
• sucking and swallowing disorders, which are often related to prematurity, brain injury,
developmental delay, or certain neuromuscular conditions, like severe cerebral palsy
• Failure to thrive, which is a general diagnosis that refers to a child's inability to gain weight
and grow appropriately. Poor growth can be the result of an underlying medical condition such
as cystic fibrosis, certain heart defects, cancer, intestinal problems, severe food allergies, or
metabolic disorders, among other things.
• extreme difficulty taking medicines
• inability to burp after an operation to reduce reflux (stomach contents and acid moving
backward from the stomach into the esophagus)
Contraindications:
• Uncorrectable coagulopathy or thrombocytopenia
• Active gastritis or peptic ulcer disease
• History of total gastrectomy
• Severe ascites
• Active peritonitis
Types:
S. no. Type Description
1. Open gastrostomy: • Open gastrostomy: There are many types
• Stamm’s of open gastrostomy but the commonly
• Janeway’s used types are the Stamm and Janeway
gastrostomy
• Preoperatively; baseline investigations,
plain abdominal X-ray, upper G.I
endoscopy, NPO, consent
• Anesthesia; local, general
• Incision; small upper midline, left
subcostal
• The peritoneal cavity is entered and the
anterior wall of the stomach is grasp with
two pairs of Babcock forceps and the
stomach drawn unto the surface. The
stomach is incised to allow insertion of a
12 or 14Fr forley catheter whose balloon
is then inflated. Leakage alongside the
catheter is prevented in one of two ways;
Stamm’s or Janeway’s.
4
