Enteral Nutrition Flashcards
enteral nutrition is
nutrition directly into stomach or small intestine
types of tubes
- NG tube: into nose into stomach, taped onto face
- PEG tube: directly into stomach
- button: more discreet
enteral nutrition
closed system:
- nutrition solution added during manufacturing, system cannot be opened
- can safely hang for 24-36 hours
- some agencies allow 48 hours
- more common
open system:
- nutrition solution prepared by nurse at bedside
- both systems are administered via an enteral pump
(closed is typical in hospital, open is long-term like nursing homes)
types of infusions
- continuous
- cyclic
- intermittent
- bolus
continuous nutrition
- administered over 24-hour period using an enteral pump
- initial dose full strength at slow rate
– rate increased every 8-12 hours until goal reached
– HOB up 30 degrees of at all times
(always hooked up, more likely unconscious patient, critical care,
can flush at any time, but it is never going to be unhooked)
cyclic nutrition
- continuous feeding administered in less than 24 hours
- often administered at night
- patient may eat during the day
- HOB remains at least 30 degrees
- flush with 30 mL of sterile water when finished
(ex: someone with esophageal cancer who can only eat soft foods but that’s not enough for them, so eat soft foods duringday, and hook up to feeding at night,
may be active moving around, eating during day, not unconscious patient)
intermittent nutrition
- feedings usually begin full strength at a specified volume (mL/kg), 5-8 feedings per day
- usually administered over at least 30 minutes via enteric pump or syringe
- goal is to provide needed calories and volume in 4-6 feedings a day
- keep HOB up at least 1 hr after each feeding
(hook themselves up 4-6 times a day so once for each feeding, since it is administered in shorter time, want to keep HOB up at least 1 hr after feeding)
bolus nutrition
- a syringe is used to deliver the formula into the stomach by gravity
– raising or lowering syringe regulates flow - delivered more rapidly than intermittent feeding
- keep HOB 30 degrees for at least 1 hr
- flush w/ 30mL of sterile water
(no pump, you are pouring nutrition into syringe, raising the tubing to make it go faster, lowering tubing will make it slower,
see this more in NICU where babies have NG tube bc only few mL at a time,
have to label tubing with date, time, initials,
have to prime tubing by allowing the nutrition to come into the tube, if not you are just pushing air into patient’s stomach which makes them uncomfortable)
enteral nutrition
high risk for
- diarrhea
- nausea/vomiting
- gas/bloating/cramping
- constipation
- dehydration
- hyperglycemia
- biggest risk - ASPIRATION (tube moved from stomach into lungs)
signs and symptoms of aspiration
- cough
- shortness of breath
- gurgling
- raspy voice
(aspiration = tube slipped into lungs, feeding isn’t going into stomach but into lungs)
aspiration
what should you do if aspiration is suspected?
- stop the feeding
- make sure the bed is elevated
- turn patient on their right side
- notify the physician
- check placement with order (check with x-ray: only way to check placement of tube)
adult tube feeding intolerance algorithm
abdominal signs:
- distention
- firm
- tense
- guarding
- discomfort
nausea:
- antiemetics
- minimize narcotics
- check for constipation
- notify provider
emesis:
- hold feeding
- check for constipation
- notify provider
(nausea alone doesn’t mean you should stop it bc they may always feel nauseous during feeding,
if they’re nauseous, try those things,
if they’re vomiting, do those things)
gastric residual checks may be useful in some patient populations
- critically ill surgery patients
- critically ill trauma patients
- head injury
- postop abdominal surgery
- obtunded/vegetative state
if so, first: put patient on right side for 20 minutes, while maintaining patient’s backrest elevation of greater than 30 degrees
– check GRV per ordered frequency
discontinue order for GRV checks after 48-72 hours if less than 500mL, and no abdominal signs present
(helpful for these patients bc can’t tell you about pain, nausea, etc.,
if you think they’re having intolerance, check residuals by putting syringe on tube and pulling what’s in tube back - if there is nutrition there, it means it didn’t go where it was supposed to,
if pull back more than 500mL, this means nutrition didn’t go where it was supposed to so stop feeding, notify provider)
before proceeding with a feed
- assess the patient’s GI system:
– bowel sounds, presentation of abdomen
– location of enteral tube, correct label? - is the patient in proper position: HOB above 30 degrees
- is prepared feeing room temp? (if cold, will cause stomach cramps)
- is the tubing primed?
checking placement steps
- verify tube placement - x-ray
- aspirate to assess tube patency/ gastric contents (like CVAD) if patient is symptomatic
– exception: not jejunostomy tube, not levine/dobhoff tubes - measure contents and return - see protocol (if less than 500mL, return it to patient stomach, flush, document)
- flush with 30mL sterile water
- document findings
