Nutrition
Causes of Chronic Nutrition Problems
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- Level of Consciousness - In patients with depressed levels of consciousness:
- Elevation of the head of the bed can result in a marked decrease, but not an elimination, of reflex episodes in patients with who are receiving nutrition support with nasogastric tubes
- Monitoring should include examining for abdominal distention and checking for high gastric residuals
- Gastroesophageal Reflux - In patients with multiple episodes of aspiration pneumonia and other signs of gastroesophageal reflux:
- Medications, such as metoclopramide and cisapride, can improve gastric emptying and increase lower esophageal pressure
- Feeding can be done into the small bowel, rather than the stomach
- Surgery to limit reflex can be performed
- Swallowing Function - In patients with impaired swallowing function:
- Thickening agents may eliminate problems with swallowing liquids
- PEG tubes can be removed to provide a type of temporary access
- Permanent enteral access should be considered for progressively declining swallowing function
- Aspiration of Oropharyngeal Secretions - True aspiration of these secretions, as opposed to stomach contents, can be treated with a tracheostomy and surgical closing of the vocal cords
Based on information in Matarese LE and Gottschlich MM. Contemporary Nutrition Support Practice; A Clinical Guide. Philadelphia: Saunders, 1998; Mahan LK and Escott-Stump S. Krause's Food, Nutrition, & Diet Therapy, 9th ed. Philadelphia: Saunders, 1996; and Rombeau JL and Rolandelli RH, eds. Enteral and Tube Feeding, 3rd ed. Philadelphia: Saunders, 1997, except for information where other papers are cited.
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