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Exam 5 > Enteral Nutrition/ Feeding > Flashcards

Enteral Nutrition/ Feeding Flashcards

1
Q

Different types of tubes

  • NG Tube
  • PEG Tube
  • Button
  • Oreo
A

NG Tube
PEG Tube
Button

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2
Q

2 types of systems in enteral feeding

A

closed and open system

Both systems are administered via an Enteral Pump

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3
Q

Enteral Feeding: Closed System

A

Closed system can safely hang for 24 to 36 hours

Some agencies allow 48 hrs

System cannot be opened

More common

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4
Q

Enteral Feeding: Open System

A

Nutrition solution prepared by nurse at the bedside

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5
Q

4 types of Infusions

  • Continuous
  • Cyclic
  • Intermittent
  • Bolus
  • Open
A

Continuous
Cyclic
Intermittent
Bolus

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6
Q

What is Continuous Nutrition?

Used for unconscious PT or a PT can’t eat

A

Given over 24 hr 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 AT ALL TIMES
  • NOT FLAT BC PT COULD CHOKE
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7
Q

What is Cyclic Nutrition?

Nutrition at NIGHT

A

Continuous Feeding given in LESS THAN 24 HRS

Patient may eat during day

HOB REMAINS AT LEAST 30 DEGREES

Flush with 30 mL of sterile water when done

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8
Q

What is Intermittent Nutrition?

Patients who eat like we do

A

Feedings usually begin full strength at a specified volume (mL)/ kg, 5-8 feedings per day

Given over at least 30 minutes through enteric pump or syringe

Goal is to provide needed calories and volume in 4 - 6 feedings a day

HOB UP AT LEAST 1 HOUR AFTER EACH FEEDING

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9
Q

What is Bolus Nutrition?

A

A syringe is used to deliver the formula into the stomach by gravity
( the higher the syringe the faster the rate )

Delivered more RAPIDLY than intermittent feeding

KEEP HOB 30 DEGREE FOR AT LEAST 1 HR

Flush with 30 mL of sterile water

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10
Q

Risks for Enteral Feedings

  • Diarrhea
  • Nausea/ vomiting
  • Gas/ Bloating/ Cramping
  • Constipation
  • Dehydration
  • Hyperglycemia
  • ASPIRATION
A

Diarrhea
Nausea/ Vomiting
Gas/ Bloating/ Cramping
Constipation
Dehydration
Hyperglycemia ( high blood sugar )
Aspiration ( drowning from inside out )

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11
Q

Signs and symptoms of Aspiration

A

Cough
Shortness of breath
Gurgling
Raspy Voice

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12
Q

What should YOU do if aspiration is suspected?

  • Stop the feeding
  • Make sure the bed is elevated
  • Turn PT on their right side
  • Notify the physician
  • Check placement with order
  • None of the above
A

Stop the feeding
make sure the bed is elevated
turn pt on their right side
notify the physician
check placement with order

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13
Q

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
A

things you can do to check if they’re getting their feedings

If so, first: put patient on right side for 20 minutes, WHILE maintaining patient’s backrest elevation of >30 degrees
- check GRV per ordered frequency

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14
Q

Discontinue order for GRV checks after 48-72 hrs if <500 mL, and no abdominal signs present

T/F

A

TRUE

GRV - Gastric Residual Volume

if its always above 500 mL -> no absorption is happening

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15
Q

Before proceeding with a feed

  • assess the pt GI system
  • pts proper position
  • is prepared feeding room temp
  • is the tube PRIMED?
A

assess the pt GI system
- bowel sound, presentation of abdomen
- location of enteral tube - correct label?

pt proper position
- HOB 30 degree

room temp
- cold feeding -> vasoconstrict (cramping)
- too hot -> diarrhea

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16
Q

Checking placement steps

  1. verify tube placement
  2. aspirate to assess tube patency/ gastric contents (like cvad) if pt is symptomatic
  3. measure contents and return - see protocol
  4. flush with 30 mL sterile water
  5. document findings
A
  1. verify tube placement through xray
  2. aspirate to assess tube patency/ gastric contents like cvad if pt is symptomatic
    - exception: NOT jejunostomy tube
    - NOT Levine/ Dobhoff tubes
  3. measure contents and return - see protocol
  4. flush with 30mL sterile water
  5. document findings
17
Q

Do Not Proceed if…

  • if > 500mL residual
  • return residual & flush 30mL sterile water
  • recheck in about 4 hrs
  • if still >500mL, hold tube feedings - notify dietician and primary care physician (PCP)
    ALWAYS REFER TO AGENCY OR HOSPITAL POLICY
A

if >500mL residual
return residual & flush 30mL sterile water
recheck in about 4 hrs
if still >500mL, hold tube feedings - notify dietician and primary care physician (PCP)
ALWAYS REFER TO AGENCY OR HOSPITAL POLICY

18
Q

Administration of Feedings: Gravity

  • ensure HOB 30 degree
  • connect device and administer via gravity flow - SLOWLY
  • flush with 30mL sterile water
  • keep HOB up at least 1 hr
A

ensure HOB 30 degree
connect device and administer via gravity flow - SLOWLY
flush with 30mL sterile water
keep HOB up at least 1 hr

19
Q

Administration of Feedings: Pump

  • ensure HOB almost 30 degree at all times
  • connect primed pump tubing
  • ensure pump rate as ordered
  • open clamp and start infusion
  • monitor gastric residual every 4 hrs
  • flush per protocol ( common 30mL)
A

ensure HOB greater than or equal to 30 degree at all times
connect primed pumo tubing
ensure pump rate as ordered
open clamp and start infusion
monitor gastric residual every 4 hrs (IF THERE ARE SIGNS OF INTOLERANCE)
flush per protocol (common 30mL)

20
Q

Metoclopramide/ Reglan

  • Gastoporesis
  • GERD
  • nausea and vomiting
A

Gastoporesis
GERD
nausea and vomiting

21
Q

Ondensetron / Zofran

  • nausea and vomiting
A

nausea and vomiting

22
Q

Nursing Interventions/ Care

  • monitor constantly for S/S
  • I & O
  • daily weight
  • oral care
  • monitor accu-checks carefully
A

monitor constantly for S/S
I&O (input and output)
Daily weight ( is the pt absorbing it )
Oral care
Monitor accu-checks carefully

23
Q

Nursing Interventions/ Care

always assess tubes for correct placement and properly labeled
Change prepared feedings every 8 hrs and closed enteral feedings every 24 hrs or when empty - NEVER let tubing run dry!!!
Be aware of tubes when transferring or changing pt position

A

always assess tubes for correct placement and properly labeled
Change prepared feedings for 8 hrs and closed enteral feedings every 24 hrs or when empty - NEVER LET TUBING RUN DRY
Be aware of tubing when transferring or changing pt position

24
Q

Skin irritation and infection prevention

  • thin guaze or externall disk ( bumper )
  • clean site regularly
  • monitor skin for
  • irritation/ breakdown
  • drainage/ bleeding
  • candida ( yeast ) infection
  • need to rotate/ replace bumper
A

Thin guaze or externall disk ( bumper )
Clean site regularly
Monitor skin for
- irritation/ breakdown
- drainage/ bleeding
- candida ( yeast ) infection
- need to rotate/ replace bumper

25
Q

KEY POINTS

  • ALWAYS look for S/S aspiration
  • ALWAYS look for S/S intolerance
  • ALWAYS keep pt properly positioned (30 DEGREES)
  • hold feeding if residual is > 500mL after 2 consecutive checks at least 4 hrs apart and contact dietician & physician
    (RETURN CONTENTS AND FLUSH)
A

ALWAYS look for S/S aspiration
ALWAYS look for S/S intolerance
LWAYS keep pt properly positioned (30 DEGREES)
Hold feeding if residual is > 500mL after 2 consecutive checks at least 4 hrs apart and contact dietician & physician
(RETURN CONTENTS AND FLUSH)

Exam 5 (4 decks)

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