Enteral Feeding

Question 1

Types of Tubes

Answer 1

NG tube
PEG tube
Button

Question 2

Closed System

Answer 2

bag of nutrition comes to you from the pharmacy
solution added during manufacturing; system cannot be opened
more common

Question 3

Open System

Answer 3

can of nutrition you put into bag
nutrition solution prepared by nurse at bedside

Question 4

Continuous Nutrition

Answer 4

administered OVER A 24 HOUR period
initial dose full strength at slow rate
rate increased every 8-12 hours until goal reached
HOB at 30 degrees at ALL times

Question 5

Cyclic Nutrition

Answer 5

continuous feeding administered in LESS THAN 24 HOURS
patient may eat during the day
HOB remains at least 30
flush with 30 mL of sterile water when finished

Question 6

Intermittent Nutrition

Answer 6

feedings usually begin at FULL strength at a SPECIFIED volume
administered over AT LEAST 30 MINS
goal is to provide needed calories and volume in 4-6 feedings a day
keep HOB up AT LEAST 1 HOUR after each feeding

Question 7

Bolus Nutrition

Answer 7

a syringe is used to deliver the formula into the stomach by gravity
delivered more rapidly than intermittent feeding
keep HOB 30 degrees for AT LEAST 1 HOUR

Question 8

High Risk for

Answer 8

diarrhea
n/v
gas/bloating/cramping
constipation
dehydration
hyperglycemia
BIGGEST RISK- ASPIRATION

Question 9

S/S for Aspiration

Answer 9

cough
shortness of breath
gurgling
raspy voice

Question 10

What should you do if aspiration is suspected?

Answer 10

stop the feeding
make sure the bed is elevated
turn patients on their right side
notify the physician
check placement with order

Question 11

Adult Tube Feeding Intolerance Algorithm: Abdominal Signs

Answer 11

distention
firm
tense
guarding
discomfort

Question 12

Adult Tube Feeding Intolerance Algorithm: Nausea

Answer 12

antiemetics
minimize narcotics
check for constipation
notify provider

Question 13

Adult Tube Feeding Intolerance Algorithm: Emesis

Answer 13

hold feeding
check for constipation
notify provider

Question 14

Gastric Residual Checks May Be Useful in Some PT Populations

Answer 14

critically ill surgery patients
critically ill trauma patients
head injuries
post op abdominal surgery
obtunded/vegetative state

Question 15

Before proceeding with a feed

Answer 15

assess the patient’s GI system: bowel sounds, location of enteral tube
HOB at 30 degrees
check room temperature
prime the tube

Question 16

Checking Placement: Steps

Answer 16

1. verify tube placement (xray)
2. aspirate to assess tube patency/gastric contents if patient is symptomatic
3. measure with contents and return- see protocol
4. flush with 30 mL sterile water
5. document findings

Question 17

Do NOT proceed if

Answer 17

there is more than 500 mL residual

Question 18

Gravity

Answer 18

ensure HOB is 30
connect device and administer via gravity flow- slowly
flush with 30 mL of sterile water
keep HOB up at least 1 hour

Question 19

Pump

Answer 19

ensure HOB greater than or equal to 30
connect primed pump tubing
ensure pump rate as ordered
open clamp and start infusion
monitor gastric residual q4hrs IF THERE ARE SIGNS OF INTOLERANCE
flush per protocol

Question 20

Nursing Interventions/Care (Monitor)

Answer 20

monitor constantly for signs of intolerance
intake and output
daily weight
oral care
monitor accu-checks carefully

Question 21

Nursing Interventions/Care

Answer 21

always assess tubes for correct placement and properly labeled
change prepared feedings every 8 hrs and closed enteral feedings every 24 hrs or when empty- NEVER LET TUBING RUN DRY
be aware of tubes when transferring or changing position

Question 22

Skin Irritation and Infection Prevention

Answer 22

thin gauze or external disk
clean site regularly
monitor skin for: irritation/breakdown, drainage/bleeding, yeast infection, need to rotate/replace bumper