enteral nutrition Flashcards
enteral nutrition
- aka tube feeding.
- provides nutrients into the GI tract.
- it is physiological, safe, and economical nutritional support.
- preffered over parenteral nutrition
- must have a funtioning GI tract.
who should recive nutrients this way?
- clients who cannot eat
stroke
coma
venelated
impaired swallowing - clients who will not eat
eating disorders
dementia
failure to thrive (peds) (elderly) - clients who cant maintain adequate nutrition
- cystic fibrosis
- chemo patients
decesions will typically be made after five days of inadequate nutritiion
3 main types of formulas
- intact
- hydrolyzed
- modular
- special formulas for patients with diabetes, liver, lung, kidney, and lung disease
- osmolarity, amount of protein, sodium, and fat vary
- decide by medical condition, protein requirements, and digestive ability
- 1,000 - 2,000 calories
free water flushes
q 4-6 hours
complications
- vomiting
- dehydration
more calorically dense, less water formula.
check for high protein content. - diarrhea
- constipation
monitor labs;
common for BSFS q 6 when all patients begin enteral nutrition
dumping syndrome
a potential complication that results in diarhhea
what temp should formula be given to the patient?
room temperature
closed feedings vs open feedings
closed feedings have a lower chance of bacteria growth
change pump tubing, feeding bags, and piston syringe q 24 hours
general nursing considerations for enteral nutrition
- Daily weights
1-2 lbs a week is goal; greater is abnormal and could mean fluid volume excess - Assess for bowel sounds before feedings
- Accurate I&O
30 ml/hr is minimum, if less pt may be dehydrated - Label with date and time started
- Pump tubing changed q24h
what labs are important to review?
renal fxn
liver fxn
…..
tube feeding patency
- flush tube every 4-6 hours
- continuous feeding administered on feeding pump with occlusion alarm
usually during matenince
what should the HOB be raised to during feedings?
30 degrees
even durning continuous feedings
intermitent feedings
- patients need to stay upright 45- 60 minutes after feedings
checking gastric residual volumes:
- the amount of food contents still within the tube after 4-6 hours of feedings
- we typically do not want any residuals, but bc of the pt states
GVR less than 250 mL = give it back to the patient
because it containes nutrients and electrolytes
- watch pt; HOB raised: turn patient to their right side: recheck after an hour
GVR greater than 250-500 mL = give it back to the pt and contact HCP
site care
- assess the nose and nares around the tube daily or
- Assess the skin around tube daily
- Monitor bumper tension (G-tube/J-tubes) it should not sit flush against the skin; wash with mild soap and water and dry well
- Apply a dressing only until site is healed
- After healed, wash with soap and water
- Protective ointment or skin barrier
misconnections
- always trace tubes from content to site of insertion
- Inadvertent connection between an enteral feeding system and a nonenteral feeding system
- Severe patient injury or death can result
gerontologic considerations
More vulnerable to complications
- Fluid and electrolyte balances
- Glucose intolerance
- Decreased ability to handle large volumes
- Increased risk of aspiration
decreased LOC, slow GI motility
pediatrics
Breast milk preferred over formula
Continuous feeding must be delivered on infusion pump
May be feed intermittently/bolus
Smaller volumes of nutrition and flush
Burp afterwards
holding the baby close in an upright position when feeding use a pacifier the preserve the sucking reflex
1-5 ml for air insulflation when checking gvr
1-2 ml flush
5-15 ml flush for toddlers
immunocomprimised pts - sterile water flush
think about the effects of tube feedings can have on a pt
Many social, religious, and cultural events involve food; patients requiring long-term tube feeding may feel a sense of loss regarding their ability to participate in life activities
enteral medications
- medications should be mixed with sterile water
- HOB elevated 30 -45 degrees
- check tube placement before administration
- flush to ensure patency
- Liquid preparations are preferred
- Gravity method preferred
- Tablets must be crushed
- Capsules opened/emptied
- Gel caps pierced/dissolved in warm water
if a pt is on continous feedings and need meds on an empty stomach; you need to stop the feedings for thirty minutes, administer the meds, then leave the suction off for an hour or long enough to digest.
crush pills with 10 ml, flush with 30 ml admin meds, flus with 30-60 ml