High nutritional requirements

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Introduction and Background

Patients need enough food to recover from any disease. Patients with serious illnesses have high nutritional requirements and can become malnourished very quickly. Research findings suggest that early nutrition is important for patient outcomes. The nutritional needs of all patients are reviewed daily and nutrition is initiated as soon as possible, usually on the first day of admission.

The best way to feed the patient is to use his or her digestive system (stomach and intestines). Gastrointestinal feeding is called gastrointestinal feeding. We also refer to this as feeding through the gastrointestinal tract. Because patients cannot swallow food if they have a tube to breathe in their throats, they are fed through the feeding tube. A tailor-made solution containing the nutrients the patient needs to recover is provided. Most feeding tubes are inserted into the nose or mouth, and the tube is inserted into the stomach. Feed is mixed in a sterile bag and given as a fixed syringe lasting 24 hours a day. A pump similar to an intravenous pump is used to connect the feeding solution.

When patients are in critical condition, the digestive system may not function properly. Food in the stomach may not be emptied to the intestines as it should. Food that does not move from the stomach can enter the lung. This is called aspiration. aspiration is a serious complication that can cause pneumonia. Food that does not leave the stomach and enters the intestine will not meet the patient’s dietary requirements.

The feeding tubes in the small intestine reduce the risk of aspiration and encourage more successful feeding. The so-called small bowel feeding tubes. When the feeding tube is inserted through the nose or mouth, the nurse or doctor will try to treat the tube in a way that encourages it to move from the stomach to the intestine. If the feeding tube does not progress to the small intestine and the patient has difficulty feeding, nutrition can be introduced through a small hole in the abdominal wall. A hole is called through the skin “by the skin” (“skin” means skin, “per” means through). The feeding tube that is inserted through the puncture hole is called the feeding tube via the skin. The tubes that end in the stomach are called “stomach” or G. tubes emptying the stomach towards the right side and in the small intestine. The first part of the small intestine (or small intestine) is called the twelve. The tube that ends in the twelve is called the twelve tube. The next section of the small intestine is the fasting person. The tube inserted in the fastener is called a “J” tube or a Jejunaltube. If the tube is inserted through the nose, it is called the “nasal tube”. The stomach tube inserted through the nose is called a nasal tube or NG. Pipes that are inserted through the mouth are called “oral” tubes. Oral tube or OG is the stomach tube that is inserted through the mouth. The OJ is a small intestinal feeding tube (ending in Jejunum) that is introduced through the mouth. Finally, a tube inserted through the hole can be identified at the end of the floor. The hole is called “stoma” or “ostomy”. The stomach tube that is inserted through the hole is called as gastrostomy. The Jejunal tube placed through a hole is a hole in the fast. Larger tubes can also be inserted into the stomach to drain the contents of the stomach. This is called gastric discharge. This is done to enhance patient comfort and prevent vomit or ambition. It can be connected with low suction (or low vacuum), to help keep the stomach empty. Gastric suction tubes and small bowel feedtubebe able to be use at the similar time. The gastric tube will keep the stomach empty while the small intestinal feeding tube delivers food under the stomach. If, despite efforts to promote successful intestinal nutrition, the patient cannot feed through the digestive system, the patient may need to be fed by a special venous formula called Total Parenteral Nutrition or TPN. TPN contains carbohydrates, fats and protein. Two concentrations of sugar preparation (called dextrose) are provided. The low concentration is called Peripheral TPN (PTPN). It can be administered safely in small peripheral veins, however, may not provide enough calories to meet the needs of a sick patient. The central TPN (CTPN) has a higher concentration of dextrose, so, it provides more calories. The high concentration of dextrose is an irritant to the blood vessels and must be given to a large(1) Although intestinal feeding therapy has existed since ancient Egypt, most of the major advances in gastrointestinal feeding techniques and formulas occurred during the 20th century, including postpartum placement in 1910. Continuous and controlled delivery of liquid feeding in 1916; Nutrient intake in 1918; nutrition by pump in 1930; recognition of the importance of nutritional therapy during the recovery period of infections and the addition of micronutrients and early post-operative nutrition in 1940; introduction of commercial products during the 1950s using chemically defined formulas A decade; and the development of modern formulas during the 1970s. The purpose of this review is to provide a historical account of intestinal nutrition, including ways and means of delivery, types of diet, improvements in delivery techniques and formulas and to provide the history of treatment as a resource for the development and improvement of intestinal nutrition techniques and therapies and the implementation of optimal patient care strategies(2) This is used in many developing countries, mainly because it is cheaper than commercially prepared feed, although it is generally not used in the developed world. The feeding tube may be sticky and cut, and although larger cavity tubes can be used, this increases the risk of complications. Patients with impaired digestion and absorption may benefit from predigested nutrients. Fodder contamination, later discussed Pearce CB, Duncan HD.

Problem Statement

Enteral feeding consists of multi steps, which could lead to different complications with insufficient nurses’ knowledge. Therefore, To ensure the patient safety, nurses required to have a good and satisfactory knowledge about feeding care, insertion, removal, and feeding, in addition to the need to adhere to infection control policy that’s could prevent associated infection.

Objectives and Aims

The goal is to assess the knowledge and awareness regarding enteral feeding among staff nurses. And to find out the association between knowledge regarding enteral feeding among the staff nurses with demographic variable.

Review of Literature

Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs).

According to Mehta, N. M., McAleer (2012) the aim of the study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses’ perception, and their knowledge of enteral feeding.

The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit.

Sixty questionnaires were distributed and the results analyzed. A database was ready and the audit was done. Forty-two (70%) questionnaires were filled and returned. A majority (38) of staff nurses expressed knowledge of nutrition guidelines. A large number (30) of staff nurses knew about nutrition protocols of the ICU. Mehta, N. M., McAleer, D., Hamilton, S., Naples, E., Leavitt, K., Mitchell, P., & Duggan, C. (2010). Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit. Journal of Parenteral and Enteral Nutrition, 34(1), 38-45.

Poor nursing adherence to evidence‐based guidelines has negative consequences leading to higher death rates, delayed recovery and longer length of stay. Evidence‐based practice has the potential to minimize complications and discrepancies between nurses.

according to Kalaldeh (2013)in their study which aimed to assess nurses’ practice and perception of their knowledge and responsibility in relation to enteral feeding(EF) in the critically ill.

and his using descriptive association design was applied to nurses working in intensive care units (ICU) from 3 health care sectors in Jordan. Nurses were recruited using a stratified sampling technique. A pre‐prepared questionnaire focusing on nurses’ practice and perception towards EF was used. Was the results total of 253 ICU nurses completed the questionnaire(Kalaldeh, 2013).

Critical illness may cause hyper-metabolism and adequate nutrition is required to limit power wasting, respiratory and gastrointestinal dysfunction and alterations in immunity1. In critical illness, feeding behaviors change; patients may experience physical obstruction to swallowing or inability to ingest food. This calls for nurses’ attention to be focused on the provision of alternative to oral intake. One of these alternatives is the provision of enteral (tube) feeding. Enteral feeding includes deliver a complete feed via NGT or OGT tube into the stomach or percutaneous tubes into the jejunum or duodenum3.This feeding is associated with a reduced period of hospital stay, reduced mortality, lower costs and fewer complications as compared to parenteral feeding Mula

According to Ncama (2014) asurvey was done to assess the nurses’ level of information in enteral feeding, to describe their current practice in enteral feeding certification and to determine challenges experienced in enteral feeding practice. In this study “enteral feeding” was used interchangeably with “tube feeding.” The conceptual model guide the study was drawn from the American Association of Critical Care Nurses (AACN) Synergy Model for Patient Care. This model defines nursing practice based on the needs of the patient. The model contends that when nurse competencies relate to patient needs, and the characteristics of the nurse and patient synergies, optimal patient outcomes can result Nursing.The

author contends that each patient brings unique needs and characteristics to the clinical situation. Therefore to meet patient needs, nurses must apply certain characteristics and competencies to patient care. These competencies are identified as: clinical judgment, advocacy and moral agency, caring practices, collaboration, systems thinking, responses to diversity, facilitation of learning, and clinical inquiry. This model was chosen because of its relevance in recognizing nurse competencies as important and that when nurse competencies and patient needs synergize, optimal patient outcome can result,(Ncama&Maluwa, 2014)

Nurses have an important role in the delivery and management of enteral nutrition in critically ill patients, to prevent iatrogenic malnutrition. It is not clear how nurses source enteral nutrition information.

According to Julia Morphet 2016 the objective of this study aimed to explore Australian nurses’ enteral nutrition knowledge and sources of information.

Data were collected from members of the Australian College of Critical Care Nurses in May 2014 using an online questionnaire. A combination of descriptive statistics and non-parametric analyses were undertaken to evaluate quantitative data. Content analysis was used to evaluate qualitative data.

The researcher got the results of 395 responses and included in data analysis. All respondents were Registered Nurses with experience working in an Australian intensive care unit or high dependency unit. Most respondents reported their enteral nutrition knowledge was good (n or excellent but many lacked knowledge regarding the effect of malnutrition on patient outcomes. Dietitians and hospital protocols were the most valuable sources of enteral nutrition information, but were not consistently utilized(Morphet, 2016).

Methodology

Study Design

Non-experimental, cross-sectional research design have been identify nurses knowledge regarding enteral feeding among nurses at King Khaled hospital – Hail

The study describe knowledge by using a quantitative method.

Study Population Sample

Survey a diverse and representative sample of registered nurse, nursing staff in King Khaled hospital – Hail , The response period will be limited to one months.

Tools for Data Collection

The following is the explanation of the questionnaire. First, dimensions of questionnaire forms were obtained from the literature and used to compile questionnaires. Second, the dimensions were slightly modified to create initial questionnaires based on the research purposes.

Questionnaire will be used to collect data from participants as a primary source of data. The questionnaire is able to determine a level of participants’ knowledge.

Procedures

200 copies of the questionnaire will be distributed in King Khaled hospital – Hail , will be collected between February 2021 and April 2021.

Data Analysis

The collected data will be analyzed by using descriptive and inferential statistics like frequency, percentage, and Chi-square test. The data will be organized and presented in the form of tables and figures.

Quality

Statistical software packages will be used for data analysis and processing.

Ethics and Human Subjects Protection

All ethical consideration will be followed. Confidentiality and anonymous of participants will be guaranteed. All potential risk will be identify for participants

An explanatory statement will be attached to each questionnaire to identify a purpose of study. As well, participants’ rights has been explained as they have the right to withdraw from a study at any time.

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