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NRSG 202 > Enteral Feeding > Flashcards

Enteral Feeding Flashcards

1
Q

Enteral Nutrition:

A

The administration of nutrients directly into the gastrointestinal tract.

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2
Q

Which nutritional pathway is preferred:

A

It is the preferred method for providing nutrition and should be used when the patient’s GI tract is functional.

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3
Q

Malnutrition S/S:

A

Mental confusion, irritability; inability to concentrate; apathetic, listless
Lack of appetite and interest in food
Changes in skin color (eg. pale, pigmented)
Dry, scaly skin; brittle, pale nails; dry, dull, sparse hair
Swollen and bleeding gums; decaying teeth
Eyes dry, sunken; cheeks hollow
Fatigue, low energy; muscle weakness
Distended abdomen; enlarged liver
Weight loss, muscle wasting
Poor immune function; infections; poor wound healing

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4
Q

Abnormal Blood Results in Malnutrition:

A

Decreased albumin/pre-albumin and total protein
Decreased Hgb/Hct (if anemic)
Decreased Iron/components
Decreased lymphocytes (or increased if infection)
Decreased blood glucose
Decreased K+ and calcium (and other electrolyte imbalances)
Decreased BUN and CR (but increased if hypovolemic from dehydration eg. renal failure)
Decreased serum vitamin and mineral levels

Increased liver enzymes (eg. liver damage)

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5
Q

Parental Nutrition and the gut:

A

parenteral nutrition fails to stimulate the gut resulting in:
villous atrophy
loss of gut mass
compromising the physical barrier (decreased surface area)

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6
Q

Enteral nutrition and the gut:

A

maintains gut mass, function and integrity

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7
Q

PARENTERAL Feeding

A

Feeding via an IV through a central vein

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8
Q

ENTERAL Feeding

A

Feeding via the stomach or intestine

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9
Q

Indications for an Enteral Feeding

A

Need a functioning and accessible GI tract
Malnourished or at risk of malnutrition
To supplement food intake when it is insufficient to meet daily needs
Unable to ingest oral foods
Unwilling to take oral feeds
Dysphagia
Upper GI tract is impaired

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10
Q

Indications for a Parenteral Feed

A

Indicated for patient’s with a non-functioning GI tract
Administered through a central vascular access device (CVAD) (ie: PICC) – preferred route

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11
Q

Contraindications for Enteral Feeding

A

If no gag reflex- can aspirate food
GI tract not functioning (eg. intestinal obstruction
Must be able to elevate HOB during feeds

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12
Q

Complications of Enteral Feeding

A

*Refeeding syndrome
*Aspiration
Metabolic problems

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13
Q

Re-feeding Syndrome

A

occurs in previously malnourished patients
This results in a rapid and dramatic fall in phosphate, potassium and magnesium
As the body tries to switch from catabolic (starvation mode) to using exogenous fuel sources, there is an increase in oxygen consumption, increased respiratory and cardiac workload

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14
Q

How should feeds be started?

A

Feeds should be started slowly and the electrolytes closely monitored and adequately replaced to avoid these problems developing.

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15
Q

How to prevent aspiration?

A

Ensure head of bed elevated while a continuous tube feeding is running and for 1 hour following intermittent feeds
Assess gag reflex

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16
Q

Nasogastric Tubes

A

Inserted into nostril down into the stomach
*Requires intact gag and cough reflex (or airway protected)

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17
Q

Anti-Reflux Valve:

A

prevents gastricrefluxor leakage through the vent lumen of a double-lumennasogastric tube

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18
Q

What does the stylet do in Small Bore NG tube?

A

Have stylet to assist insert
Remove before feeding

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19
Q

When do you change small bore NG tube?

A

Need to be changed monthly

20
Q

When do you change Large Bore NG Tube?

A

Need to be changed weekly

21
Q

Aspiration Treatment

A

STOP FEEDS
Lower head of bed and put client on left side to prevent further seepage of formula into lungs
Suction as necessary
Administer oxygen as needed
Notify MD immediately (to plan further care)
Continue suctioning PRN

22
Q

Aspiration Risk Factors

A

Head of bed less than 30 degree angle
Impaired level of consciousness (eg. sedation)
Neurological deficits
Poor oral health
Mal-positioned feeding tube
Gastroesophageal reflex
Age over 60 years
Delayed gastric emptying

23
Q

Labeling Feeding Systems:

A

All feeding systems need to be labelled with:
Client Information
Date/time
Preparer’s initials
Enteral feeding formula type, rate, strength, and amount
Label the tubing close to the client and at the site close to the source when there are different access sites or several bags
Label the the administration set: “Tube feeding only”

24
Q

Open System/Bolus or Intermittent Feed:

A

Used when client able to tolerate bolus feeds
250 mL tetra packs or cans; or dry powder
Usually 300 – 500 mL given several times per day (eg. breakfast, lunch, supper, and bedtime)
Administered usually over at least 30 minutes
Must be given only in the stomach

25
Q

Closed System/Continuous Drip

A

Usually used initially when client does not tolerate bolus
1000 - 1500 mL container
Hang-time up to 48 hours (if sterile technique used)
May be administered at night (nocturnal feeds) so patients can attempt to eat during the day
Are essential when feedings are administered into the small bowel
Tubing change with bag change; up to q48 hours
Usually run using a pump
Always started at a slow rate and increased as tolerated

26
Q

Available formulas

A

Low volume
High fiber
High protein
Low sugar/CHO
High nitrogen
With fiber for treatment of diarrhea
Predigested and easy to absorb (eg. Osmolite HN)
Natural formula (new

27
Q

Enteral Formula Hang Times:

A

Tetra pack (ready to use) formula - 8 hours
Reconstituted powder formula - 4 hours
Closed system formula bottles – 48 hours

28
Q

What do you need prior to initiating a feed?

A

A doctor’s order
An xray confirming tube placement
documentation of confirmation of tube placement by the MRP

29
Q

What is total free water?

A

Amount of fluid client needs in a 24 hour period to sustain life

30
Q

How do you administer enteral feeding>

A

Enteral feedings are always started slowly and gradually increased as tolerated

31
Q

How often do you flush a continuous feeding tube?

A

Q4H

32
Q

What do you flush a tube with?

A

Clean water

33
Q

What do you flush a card with if a person is immunocomprimsed?

A

Sterile water

34
Q

How do you prevent an occlusion?

A

Flush with a minimum of 30 mL water q4h when feeds are stopped for any reason

35
Q

Assessments before administration

A

respiratory
CNS
GI initially then q4 hours and prn or prior to each bolus feed
Hydration
Weight if needed (usually 2X/week)
Assess tube site (nasal or abdomen)
Eg. redness, warmth, bleeding/irritation, drainage, dressing (if used)
Assess feeding solution, expiry date, and check rate of administration

36
Q

What assessments need to be done to assess feeding tube placement

A
  • NG external length
  • Aspirate stomach contents
  • Measure pH
  • Ascultate over the stomach
37
Q

When do NOT you check residuals?

A

Do NOT check residuals on tubes past the stomach
Do NOT check residuals for small bore NG

38
Q

When do you check residuals

A

Gastric Tubes – check q 4 hours for first 48 hours of feeding and prn if warranted
If the person is unconscious – continue to check and record residuals q 4 hrs
Check residuals if unable to assess for signs of intolerance in a client
Return gastric residuals (back into stomach) according to orders

39
Q

How do you assess residuals?

A

Check residual with a 60 mL syringe

Put 10 - 20 mL of air into tube initially to release tube from stomach wall

Aspirate all fluid in stomach and measure

Flush tube with 10 - 30mls of water following residual checks

40
Q

What are you going to monitor during an Enteral Feeding?

A

Ensure the HOB is elevated 30 - 45 degrees (or higher) during all feeds (eg. do not lower bed for nocturnal feeds)
*NB: Remember to keep HOB elevated for one hour after a bolus feeding
Monitor breathing especially in those at risk for aspiration
Monitor for discomfort/tolerance (nausea, bloating, abdominal pain)

41
Q

What do you need to do following a Bolus Enteral Feeding?

A

Ensure/teach client to sit upright for one hour post-intermittent feeding
Perform GI reassessment
Evaluate effects/tolerance of feeding (eg. severe diarrhea > than 3-4 times in 24 hours should notify MD/dietician)
Perform mouth care q4 hours and prn
Perform nasal site care prn (NG)

42
Q

When do you rotate PEG?

A

Daily rotation of skin disc or cross bar to prevent skin breakdown
Daily rotation of a gastrostomy tube (90 – 360 degrees) to release any sticking and promote tract formation (after stoma healed).

43
Q

When do you rotate a J-PEG?

A

Never! too long, could twist and become blocked

44
Q

How often do you have to assess position?

A

Every shift

45
Q

When do you hold a tube feed?

A

Do not stop tube feeds during routine nursing care, client positioning when HOB is temporarily lowered, or during bedside procedures unless specifically ordered by the physician. HOB should be returned to greater than 30 degrees as soon as possible

Do not stop feeds or decrease rate for a single elevated GRV, absent BS, diarrhea, or emesis related to suctioning

46
Q

What do you do if you stop feed and restart it?

A

If feeding is interrupted (eg. test, surgery), resume feeding at same rate prior unless ordered otherwise

NRSG 202 (4 decks)

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