Enteral Feedings Flashcards
Enteral Nutrition is also called-
Total Enteral Nutrition (TEN)
Whenever a pt is unable to use the GI route, what could be beneficial for them?
TEN
Enteral Access is achieved by what?
Nasogastric tubes
Nasointestinal (nasoenteric) tubes
Gastrostomy tubes
Jejunostomy tubes
Inserted through nostril, advanced down through the nasopharynx, and into the alimentary tract =
Nasogastric Tubes
Are NG Tubes for short or long term therapy (Feedings)?
Short term therapy
What size catheter is used for a nasogastric tube?
Traditional Large-Bore (Larger than 12 Fr)
NG Tubes are not advised for feeding if-
The gag reflex is not intact
Why are NG Tubes not recommended if the pt’s gag reflex isn’t intact?
Because of the risk of accidental placement in the lungs
What are the purposes of an NG Tube?
Tube feedings and med administration
For stomach lavage following poisoning or overdose
For prevention of N/V & gastric distention postoperatively
To obtain stomach contents for diagnostic analysis
Inserted through a nostril and goes down into the upper small intestine =
Nasointestinal Tubes
Used when clients are at risk for aspiration. May need specialized training to insert =
Nasointestinal Tube
How long are Nasointestinal Tubes?
Longer than NG tubes (~ 40 cm)
What are Nasointestinal Tubes used for?
Pt’s at risk for Aspiration
Clients who are at risk of aspiration during a tube feeding are those with:
Decreased LOC
Poor cough or gag reflexes
Inability to participate in the procedure
Restlessness or agitation
How are Gastrostomy Tubes inserted?
Surgically inserted by surgeon through surgery or by laparoscopy through abdominal wall into stomach
What are Gastrostomy Tubes used for?
Long term nutritional support (More than 6-
8 weeks)
How are Jejunostomy Tubes inserted?
Surgically implanted through abdominal wall into jejunum
What are Jejunostomy Tubes used for?
Long term nutritional support
What are some things that you’d do for a NG Tube insertion?
Explain procedure
Position in high fowler’s position
Assess nostril patency
NEX Measurement
Lubricate tube (water soluble jelly)
Insert tube
Check placement
Secure tube
Document
What should you lubricate a NG Tube with?
Water soluble jelly
What position should you put a pt in when inserting an NG Tube?
High Fowler’s
How should you care for a NG Tube on the daily?
Inspect nostril for discharge or irritation
Clean nostril and tube with moist cotton-tipped applicator
Apply water soluble lubricant if nostril dry or encrusted
Remove tape daily; clean & dry skin; assess skin; re-tape
Frequent oral care; mouth breather possibly due to tube presence
Methods for checking NG Tube placement include:
X-ray
Aspirate gastric contents
Measure pH
Confirm tube length with insertion mark
Which is the best indication of proper nasogastric
tube placement?
A.) pH of contents
B.) Gastric content aspiration
C.) Air auscultation
D.) X-ray
D
What should you always do during NG Tube removal to prevent fluids from draining into the throat?
Pinch the tube
What are some things that you should do during NG Tube removal?
Explain procedure
Wash hands
Sitting position if able
Pad or towel across chest
Detach tube
Have client take a deep breath and hold it
Pinch tube to prevent contents from draining into throat
Remove tube slowly and evenly over 3 – 6 seconds
Coil tube around hand while removing
Place tube into trash bag
Provide oral care & allow to blow nose following removal
Dispose of correctly
Document
What should you always do before NG Tube irrigation?
Check Placement
How often should you irrigate an NG Tube, why?
Irrigate every 4 hours to check placement and to maintain patency of tube
How many mL of water should you instill when irrigating an NG Tube? How should you irrigate one?
Gently instill 30-50 mL of water or NS with irrigation syringe per agency policy
Pull back into syringe to check patency; repeat if tube flow sluggish
How many mL of food are usually given during an NG Tube feeding?
Less than 100 mL
Hold/delayed feedings may be warranted whenever giving how many mL of food?
Over 100 mL
When doing an NG Tube feeding, what should you do?
Assess bowel sounds; absent (hold feeding and contact HCP)
Assess tube placement (check pH)
Check residual and return contents
Warm feedings to room temperature to prevent cramping and diarrhea
Use feeding pump for cyclic or continuous feedings
Keep HOB elevated
Check expiration date of formula
During an NG Tube feeding, you shouldn’t leave solutions hanging for any more than how long? Why?
8-12 hours. Prevents microbial growth
What are some precautions to keep in mind whenever it comes to NG Tubes?
Check placement before feedings & meds
Change tubing and container every 24 hours
Do not hang more than 8-12 hours worth of solution at a time in open systems (prevents bacterial growth)
Check expiration date
Check formula type
Shake formula well before pouring
Assess bowel sounds
Administer feeding per prescriptions
Flush with 30-50 mL after feeding complete
You have a pt who is getting a feeding via a NG Tube. What should you assess about your pt?
Assess bowel sounds + Placement of tube + Abdominal distention + Urine for sugar and acetone + Hematocrit + Urine specific gravity + BUN + Sodium level
What are some potential GI Complications from NG Tube Feedings?
Diarrhea
Vomiting
Constipation
What are some potential non-GI Complications from NG Tube Feedings?
Tube displacement
Delayed gastric emptying
Fluid overload
Aspiration
Clogged tube
How should you administer meds via an NG Tube?
Make sure med can be crushed or capsule opened
Crush meds and dissolve in 15-30 mL water
Check placement and residual prior to administration
Assess bowel sounds
Draw medication up into catheter tip syringe
Administer medication into tube
Flush tube with 30-50 mL water or NS
Clamp tube for 30-60 minutes depending on agency policy
Low continuous suction or high intermittent may be used with this kind’ve tube =
Salem Sump
Low intermittent suction is recommended with this kind’ve tube =
Levin Tube
Why is it important to have a client take a deep breath and hold it during NG tube removal?
A.) To prevent client from gagging
B.) Prevents accidental aspiration of contents
C.) Prevents contents from draining in throat
D.) Prevents transmission of microorganisms
B
Nurses should assess placement of any gastrointestinal tube before performing which actions?
Select all that apply:
A.) Instilling feedings
B.) Administering medications
C.) Irrigation of tube
D.) Lung auscultation
E.) Assessing bowel sounds
A, B, C
