Enteral Feeding Flashcards
Types of Tubes
NG tube
PEG tube
Button
Closed System
bag of nutrition comes to you from the pharmacy
solution added during manufacturing; system cannot be opened
more common
Open System
can of nutrition you put into bag
nutrition solution prepared by nurse at bedside
Continuous Nutrition
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
Cyclic Nutrition
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
Intermittent Nutrition
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
Bolus Nutrition
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
High Risk for
diarrhea
n/v
gas/bloating/cramping
constipation
dehydration
hyperglycemia
BIGGEST RISK- ASPIRATION
S/S for Aspiration
cough
shortness of breath
gurgling
raspy voice
What should you do if aspiration is suspected?
stop the feeding
make sure the bed is elevated
turn patients on their right side
notify the physician
check placement with order
Adult Tube Feeding Intolerance Algorithm: Abdominal Signs
distention
firm
tense
guarding
discomfort
Adult Tube Feeding Intolerance Algorithm: Nausea
antiemetics
minimize narcotics
check for constipation
notify provider
Adult Tube Feeding Intolerance Algorithm: Emesis
hold feeding
check for constipation
notify provider
Gastric Residual Checks May Be Useful in Some PT Populations
critically ill surgery patients
critically ill trauma patients
head injuries
post op abdominal surgery
obtunded/vegetative state
Before proceeding with a feed
assess the patient’s GI system: bowel sounds, location of enteral tube
HOB at 30 degrees
check room temperature
prime the tube
Checking Placement: Steps
- verify tube placement (xray)
- aspirate to assess tube patency/gastric contents if patient is symptomatic
- measure with contents and return- see protocol
- flush with 30 mL sterile water
- document findings
Do NOT proceed if
there is more than 500 mL residual
Gravity
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
Pump
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
Nursing Interventions/Care (Monitor)
monitor constantly for signs of intolerance
intake and output
daily weight
oral care
monitor accu-checks carefully
Nursing Interventions/Care
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
Skin Irritation and Infection Prevention
thin gauze or external disk
clean site regularly
monitor skin for: irritation/breakdown, drainage/bleeding, yeast infection, need to rotate/replace bumper
