enteral nutrition

Question 1

enteral nutrition

Answer 1

• 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.

Question 2

who should recive nutrients this way?

Answer 2

• 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

Question 3

3 main types of formulas

Answer 3

• 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

Question 4

free water flushes

Answer 4

q 4-6 hours

Question 5

complications

Answer 5

• 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

Question 6

dumping syndrome

Answer 6

a potential complication that results in diarhhea

Question 7

what temp should formula be given to the patient?

Answer 7

room temperature

Question 8

closed feedings vs open feedings

Answer 8

closed feedings have a lower chance of bacteria growth

change pump tubing, feeding bags, and piston syringe q 24 hours

Question 9

general nursing considerations for enteral nutrition

Answer 9

• 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

Question 10

what labs are important to review?

Answer 10

renal fxn
liver fxn
…..

Question 11

tube feeding patency

Answer 11

- flush tube every 4-6 hours
- continuous feeding administered on feeding pump with occlusion alarm

usually during matenince

Question 12

what should the HOB be raised to during feedings?

Answer 12

30 degrees

even durning continuous feedings

Question 13

intermitent feedings

Answer 13

• patients need to stay upright 45- 60 minutes after feedings

Question 14

checking gastric residual volumes:

Answer 14

• 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

Question 15

site care

Answer 15

• 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

Question 16

misconnections

Answer 16

• 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

Question 17

gerontologic considerations

Answer 17

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

Question 18

pediatrics

Answer 18

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

Question 19

think about the effects of tube feedings can have on a pt

Answer 19

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

Question 20

enteral medications

Answer 20

• 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