Enteral feeding Flashcards
What would you monitor with NG feeding
Tube misplacement/ displacement:
- First risk is the tube being misplaced, can occurs when being inserted wrong. There is a risk that the tube has entered the lung instead of the stomach. Can be checked by testing pH levels, or chest x-ray to identify placement. Can also tell by length of tube not being correct
- Displacement is movement of tube once it has been inserted, can occur with vomiting
- pH levels continuously checked to ensure displacement has not occurred.
Re-feeding syndrome:
- Blood tests to monitor electrolytes (potassium, magnesium and phosphate), pre and post feeding
Progress
- Regular weighing
- Review feeding regime
Other considerations:
- Monitoring blood sugar levels regularly in diabetic patients
- Monitoring the position of the tube especially if coughing, retching or vomiting
- Reviewing any stomach or bowel problems that occurs such as nausea, vomiting, diarrhoea or constipation
- The maintenance of oral hygiene even if no food is being consumed whilst on NG feeding
- Monitoring the nose. mouth area for any dryness, redness or soreness
- Monitoring the tube for any blockages. It is advised that tubes are flushed with water before and after feed and medications to prevent blockages from occuring.
When would a PEG be considered over a NG tube for feeding?
PEG are generally used when there is a need for enteral nutrition for a longer time period as opposed to an NG tube which is designed to be used for 4-6 weeks.
Patients at a high pneumonia risk
What are the ethical issues surrounding enteral feeding?
Patients may refuse
The ethical principles “autonomy, beneficence, non-maleficence and justice” are internationally recognized. They are interrelated and have to be applied in the act of medical decision making.
Autonomy does not mean that a patient has the right to obtain every treatment him or her wishes or requests, if this particular treatment would not be medically indicated.
A competent patient has the right to refuse a treatment after adequate information even when this refusal would lead to his or her death.
If the risks and burdens of a given therapy for a specific patient outweigh the potential benefits, then the physician has the obligation of not providing (withholding) the therapy.
Even when artificial nutrition and hydration will be stopped, standard care to maintain a best possible quality of life to the patient has to be maintained
Artificial nutrition is used in accordance with a realistic goal of individual treatment, and the wishes of the patient himself/herself, and based on assessment of the situation by the doctor and other healthcare professionals.
Medical treatment is administered for the purpose of prolonging or preserving life (if necessary by accepting a transient deterioration in quality of life), or for the purpose of enhancing or preserving quality of life (if necessary by accepting a shortening the time left to live)
In case the feasibility or efficacy of artificial nutrition is uncertain it is advisable to administer the therapy on a trial basis. In the event of complications or if the desired success is not achieved, the attempt should be discontinued
The continued medical justification for artificial nutrition must be reviewed at regular intervals, determined in accordance with the patient’s condition.
Every individual is entitled to obtain the best care available. Resources have to be distributed fairly without any discrimination. On the other hand treatments which are futile and do only prolong the suffering or the dying phase, have to be avoided. In regard to limited resources there has to be proper use of ethically appropriate and transparent criteria
Other Ethical Considerations:
Trauma
Quality of day-to-day life
Ensuring bags and tubes are sufficiently cleaned to avoid infections
What is aspiration pneumonia?
Causes and risks of aspiration?
Aspiration pneumonia - results from inhalation of oropharyngeal contents into the lower airways that leads to chemical pneumonitis, lung injury and resultant bacterial infection.
Risk factors:
- Sputum suctioning –> sputum is produced by cells lining the respiratory tract
- Deterioration of swallowing function or something have affected the swallowing reflex
- Dehydration
- Brain injury
- Stroke
- Unconsciousness
- Sedatives/ hypnotics
- Dementia
NG feeding is a significant cause of aspiration in stroke patients
How can you safeguard aspiration in patients with swallowing difficulties?
Swallowing rehabilitation can reduce the risk of aspiration with help of SALT.
Following the IDDSI framework can help match specific food textures the patient.
