Enteral Nutrition Flashcards
how long can a closed feeding system be used?
for up to 48 hrs
Enteral nutritional formula containing intact protein, carb and fat molecules that requires pt to have normal digestion and absorption.
Standard formula
Low profile device used for long term feeding in kids and active patients because of minimal external apparatus
LPGD (low profile gastrostomy device)
high residual volumes are known to increase what risk
residual volumes greater than 200-250 mL are associated with increased aspiration risk
When pt is in need of long term nutritional support a tube may be placed directly into the ____ or the ____.
Stomach (g-tube)
Jejunum (j-tube)
How to measure for NI tube placement
Measure just like an NG tube (nostril to ear lobe to iPhone process) and then add 8”-10”
Always check ___ ___ before giving meds or feeding down tube
Tube placement
Use of a g-tube or PEG tube requires a…
Intact, fully functioning GI tract
pH of stomach
Less than 5.5
Starting feeding at a slower rate and advancing improves…
Pt tolerance
during feedings, pt should be positioned how?
with their head as upright as possible during feeding and for at least an hour after feeding
Normal airway ETCO2
35-45 mmHg
NI tube
Nasointestinal tube
Intestinal feedings are continuous to prevent…
Dumping syndrome
Flush tube regularly with ___ after checking residual to prevent occlusion.
Warm water
Hydrolyzed enteral formula
Macronutrients are already broken down into simpler forms that require little or no digestion.
Consult the physician of residual is greater than
400 mL
Residual
Amount of feeding still in the stomach
can you add meds to formula?
no
NG tube placement confirmation techniques
- radiograph (X-Ray)
- visual assmt of aspirate
- pH of aspirate
Prior to aspirating GI contents you should…
Insert 30 mL of air into the tube
Pt position while inserting NI tube
pt should be on right side
when giving meds, when do you flush with water?
before given meds, between meds and after giving meds
how to measure NG tube for insertion
measure tube from nostril to ear lobe to tip of xiphoid process. Mark the tube with a permanent marker.
Continuous feeding for a portion of a 24 hour period (i.e. Overnight)
Cyclic feeding
Why do you never use the plunger when you’re when feeding patient using a large syringe?
Because administering a feeding too fast can cause G.I. distress
pH of airway
6.0 or higher
can meds be given through NG tubes?
yes, but not during feedings
Research recommendations for tube feeding in pts with dementia
Research recommends tube feedings not be used for this population because they do not increase survival or decrease aspiration risk or prevent malnutrition
during insertion, if there are signs of resp distress, excessive gagging, coughing, cyanosis, inability to speak or hum, etc, you should…
discontinue procedure and remove tube because it may be in the airway
Type of enteral feeding utilizing a gradual introduction of food for maximum apportion.
Continuous feeding
When using a feeding pump how often should you check tube placement and measure residual?
q 4-6 hrs
when advancing the tube past the pharynx, you should temporarily stop advancing when the pt ___ to avoid the airway
breathes
If there is a long term feeding situation and a G tube or PEG tube can’t be used because GI tract is not fully functioning, you would place a ____
J-tube
Jejunostomy
Measurement for NI tube placement
measure just like an NG tube (nostril to ear lobe to xiphoid process) and then add 8”-10”
If CO2 is present, NG tube is in the ____.
Airway
Can be used to place a tube in the stomach without the use of general anesthesia.
PEG
percutaneous, endoscopic gastrostomy
Parenteral nutrition
Nutrition via IV therapy
Since infants are obligate nose-breathers, you may use what kind of tube instead of an NG tube?
OG tube (orogastric tube) through the mouth
preferred type of meds to give through NG tube
liquid whenever possible
common complications of enteral feedings
clogged tube aspiration nasal erosion (with NG or NI tubes) diarrhea, nausea, vomiting, distention unplanned extubation stoma infection
Jejunum
The part of the small intestine between the duodenum and the ileum.
Before beginning feeding, you should always…
Verify tube placement with multiple techniques, aspirate all gastric contents to measure residual, push residual back through tube and flush with 30 mL of water
NG feeding contraindications
Dysfunctional gag reflex Aspiration risk GERD Nasal injuries Unable to sit with head elevated at meal time
to secure tube…
tape tube to nostril and cheek and then have pt turn head to opposite side from tube and secure tube to gown.
Pt position for NI tube insertion
Position pt on right side
Med that increases GI motility
Reglan (metoclopramide)
How long should patient remain sitting upright after tube feeding?
At least one hour
if you meet resistance while advancing the tube…
do not force the tube and rotate it back and forth while gently trying to advance it.
Research recommendations on what therapies to use with dementia pts instead of tube feeding
Increased feeding assistance
Changing food consistency
reusable feeding systems should be cleaned how often?
every 24 hours with soap and hot water
NG tube
Nasogastric tube
Preferred and most effective method of feeding pts?
Oral feeding
after checking residual, you should do what to prevent tube occlusion?
flush with water
Next best thing if oral feeding is not possible
Enteral nutrition/feeding
Best check for G tube or J tube placement
Measurement of excess tube length
Enteral feedings preferred for feedings into the intestine
Continuous feedings
Syndrome caused by introducing too much food into the intestine at once. Causes nausea, distention, diarrhea, cramping and lightheadedness.
Dumping syndrome
before opening a can of fluid you should always…
check the expiration date and disinfect the rim
pH of intestines
7.0 or higher
“Gold standard” of NG verification
X-Ray (radiograph)
when inserting an NG and the tube reaches the pharynx, you should have pt…
touch chin to chest and sip water through a straw or swallow if NPO
In what way does continuous feeding alter the pH of the stomach?
Nutritional formula acts as a buffer and can make GI readings higher on the pH scale (alkalodic)
When using a large syringe (open system) how can you control the speed of the flow?
Since there is no plunger and the system is open, use gravity to adjust the flow rate by raising or lowering the syringe
when NG or NI tube is in place, perform oral hygiene every…
2-4 hrs
During, and for one hour after feeding, pt should remain as upright as possible, at what minimum angle?
Pt should sit up to at least a 30-45 degree angle
How is an NI tube inserted?
It’s usually placed in the stomach and allowed to advance via peristalsis through the pyloric sphincter into the intestines
other uses for NG tube besides feeding
decompression of stomach drain fluid remove poison or meds from stomach monitor GI bleeding prevent intestinal obstruction
An ____ in excess tube length could mean the tube is dislodged
Increase
Check residual…
before feedings and every four to six hours during continuous feedings
ways to confirm NG/NI tube placement
X-ray, visualize aspirate, test pH of aspirate, check for presence of CO2. Make sure pre-measured mark is at the nostril.
If inserting an NG tube and coughing and gagging persist you should…
stop advancing and check placement with a tongue blade and flashlight
Enteral nutrition
Putting nutrients directly into the stomach
when pt has an NG tube in place, perform oral hygiene how often?
q 2-4 hrs
