Gastrostomy feedings / Nasoduodenal and nasojejunal tubes / Total Parenteral Nutrition / Family teaching and home care

      • Gastrostomy feedings
        • Often used for children in whom passage of a tube through the mouth, pharynx, esophagus, and cardiac sphincter of the stomach is contraindicated or impossible. 
        • It is also used to avoid the constant irritation of an NG tube in children who require tube feeding over an extended period. 
        • A gastrostomy tube may be placed with the child under general anesthesia or percutaneously using an endoscope with the patient sedated and under local anesthesia (percutaneous endoscopic gastrostomy [PEG]).
      • Nasoduodenal and nasojejunal tubes
        • Children at high risk for regurgitation or aspiration such as those with gastroparesis, mechanical ventilation, or brain injuries may require placement of a postpyloric feeding tube. 
        • A trained practitioner inserts the nasoduodenal or nasojejunal tube because of the risk for misplacement and potential for perforation in tubes requiring a stylet.
      • Total Parenteral Nutrition
        • TPN provides for the total nutritional needs of infants and children whose lives are threatened because feeding by way of the gastrointestinal tract is impossible, inadequate, or hazardous.
        • The major nursing responsibilities are the same as for any IV therapy and include control of sepsis, monitoring of the infusion rate, and assessment of the patient
        • General assessments, such as vital signs, input and output measurements, and checking results of laboratory tests, facilitate early detection of infection or fluid and electrolyte imbalance.
          • Additional amounts of potassium and sodium chloride are often required in hyperalimentation.
            • Therefore, observation for signs of potassium or sodium deficit or excess is part of nursing care. 
          • This is rarely a problem except in children with reduced renal function or metabolic defects. 
          • Hyperglycemia may occur during the first day or two as the child adapts to the high-glucose load of the hyperalimentation solution. 
            • Although hyperglycemia occurs infrequently, insulin may be required to help the body adjust.
          • When this occurs, nursing responsibilities include blood glucose testing. To prevent hypoglycemia when the hyperalimentation is disconnected, the rate of the infusion and the amount of insulin are decreased gradually.
      • Family teaching and home care
        • The family needs to learn how to feed the child with an NG, gastrostomy, or TPN feeding regimen.
          • Plan ample time for the family to learn
          • Perform the procedures under supervision before they assume full responsibility for the child’s care
          • Refer the family to community agencies that provide support and practical assistance

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