Enteral Meds Flashcards
different tubes
nares:
- nasogastric (NG) tube - stomach
- Dobhoff (NG) tube - stomach (usually liquid med bc smaller tube)
- nasoduodenal tube - small intestine
- nasojejunal tube - small intestine
surgical:
- gastrostomy (PEG) tube - stomach
- jejunostomy (J) tube - small intestine
Peg tubes rationale for use
for long term use
- dysphagia
- cancer/radiation affecting GI tract
- neurological defects
- bowel disease/dysfunction
- cranio-facial abnormalities, trauma
- malnutrition concerns
(peg tube is better than having NG tube for long time)
comparing tube vs button (dumb slide)
- abdomen and percutaneous endoscopic gastrostomy tube showing catheter fixation
- abdomen and balloon fixation of low-profile gastrostomy device
once a tube has been placed, confirmation is critical
- x-ray: gold standard for initial confirmation
- confirmation is still required after initial confirmation (just not x-ray bc expensive)
- always assess placement by measurement of tube (see how far tube is coming out of nose, mark it on tube, document how many cm coming out of body, this way you know if it has moved out further or out of place)
(could also draw a sample from tube to see if get stomach contents if meant to be stomach (???))
nurse must also assess and document these
- tube length (all nasal tubes): compare every measurement to previous assessments before every administration
- deviations:
– increase in length possibilities
— from intestines into stomach
— from stomach into esophagus
— into lung
– decrease in length possibility
— from stomach into intestines
next steps before administering any medication or feeding
- bowel sounds and GI assessment: to make sure they’re active
- signs and symptoms of intolerance: nauseated, stomach hurts
- document findings
- each healthcare agency will have a policy for when to hold feedings based on residual volume. it is based on evidence based practice. follow the agency policy.
enteral meds must be in
liquid or powder form
- via mortar and pestle
- or pill crusher (aka Silent Knight)
po meds not to crush
- EC: enteric coated
- SR/SA/TR/CR/XL/XR: extended release
- SL: sublingual
- buccal
- know what is on the do not crush list
in preparation
- know your meds
- what, why, how, where is it going: in order for any drug to have bioavailability (be able to be absorbed and used), it must be delivered to the correct part of the gastrointestinal tract
- know whether the tube can be used for all meds - always ask if they have allergies
crush simple tablets to a fine powder
so they don’t clog up the tube, so the powder will dissolve
- if spansule type medications or liquid gelatin capsules are the only form available, open into a medication cup and mix accordingly (if not, they can clog up the tube, don’t recommend this form unless it is absolutely necessary)
how to
- in the med room prepare each crushed/liquid medication in their individual medication pkg (label), sleeve or cup - may have syringe from pharmacy
- take med sleeve and/or pill package, etc. with you for verifying and scanning
- at the bedside, you mix each med individually with 15mL sterile water.
(don’t mix meds all together outside the body bc they could interact, different from inside the body bc there is acid in stomach)
how to
- confirm tube patency by gently flushing the gastric tube with 15mL of sterile water
- pinch or clamp proximal end of the gastric tube each time the syringe is removed to prevent air from entering the stomach
- remove the plunger from the syringe and attach the syringe to the feeding tube
- pour dissolved/diluted medication into the syringe tube, raise syringe and allow to flow by gravity
- flush with 5-10mLs of water between each medication to prevent potential drug interactions and incompatibilities
- after administering the final med, flush the tube with 15-30mL of sterile water
- leave head of bed elevated for 30 minutes to facilitate flow and prevent esophageal reflux
(attach tip of syringe to tube, pour in 15 mL of sterile water, pour in diluted meds one at a time, not pushing anything but allowing gravity to take it down, doing 5-10 mL sterile water in between meds, then give next med (which is diluted in 15 mL sterile water) then after done giving meds, add 15-30mL of sterile water
never give meds with them flat, always have HOB elevated and leave HOB elevated after done)
warning
- don’t mix multiple medications together - bc they will interact outside body
- do not give meds directly into feeding tube
– have to stop feeding, flush with sterile water, and then begin meds
– may have to wait to begin feeding after meds have been given (or wait to give meds after feeding has stopped if meds supposed to be on empty stomach) depending on meds and feeding
before proceeding
- ensure patient in proper position: HOB elevated
- assess the patient’s GI system
– bowel sounds, presentation of abdomen
– location of enteral tube - correct label?
– is there a feeding in progress - place feeding on hold, if in progress, to administer meds
- if a medication supposed to be given on empty stomach, wait in between stopping feeding and starting meds
final
- when all meds are given and the final flush has been administered
– restart meds in a timely manner to avoid compromising the patient’s nutritional status. feeding may be delayed for 30 minutes or longer, when appropriate to avoid altering the bioavailability of the drug - Boullata, 2009
