Enteral Nutrition Safety Flashcards
the agency that regulates medical foods
the Food and Drug Administration (FDA)
when should blue dye/blue food coloring be used in enteral tubes
NEVER
what is not a nursing responsibility for monitoring jejunal tube feeding
measurement of residuals
how can clogging of a feeding tube be prevented when checking residuals
flush the tube with 20-30 mL of water before checking a GRV to prevent clogging
which patients are at risk for formula related contamination
neonates, critically ill, immunosuppressed, compromised gastric acid microbial barrier
what are the 3 chances of contamination in EN formulas
storage
preparation
administration
which type of Enteral Feeding has the lowest chances of contamination
sterile/closed system feedings
which type of EN formula has the highest risk of contamination
mixing, dilution, reconstitution (powder)
hang time for open systems
4-12 hours
hang time for reconstituted formulas
4 hours, room temperature
powdered enteral formulas are ____ sterilized
NOT
___ water should be used to reconstitute powdered formula
sterile
closed enteral systems can hang for ____ hours
24-48 hours
formulas should be used ____ after opening which reconstitution with ____ water
immediately, sterile
what should be referenced for recommended room temperature and hang time of specific formulas
manufacturer recommendations
should a blender be used to mix powders
no, high risk of contamination
clean the lids of enteral feeding products with ____ and dry
isopropyl alcohol
how often should feeding bags be changed
every 24 hours
when material from the lungs, stomach, and throat back up into the feeding tube, where they can proliferate and be re-infused in greater numbers is considered _____ contamination
retrograde
most gravity drips have a ____ that decreases the risk of retrograde contamination
drip chamber
checking ____ can also lead to contamination of enteral feeding by pulling back gastric contents and infecting the tube feed hub
gastric residuals
what is one example of prevention policy for enteral feeding to reduce chance of contamination
enteral quality control programs/institutional protocols
what is another example of prevention of EN contamination
define the process for receiving, distributing, storing, preparing, handling and administering EN
To ensure safety during EN feedings, visually inspect each TF bottle for ___ and ___
damage
expiration date
use proper _____ before feeding administration, and formula handling
hand washing/clean gloves
flip top enteral feeding cans should be wiped with _______
isopropyl alcohol
visually inspect EN formulas for
separation, thickening, clumping or curdling
inhalation of material into the airway is known as
aspiration
aspiration PNA can be caused when _____are in the wrong place or inhaled ____ contents
feeding tubes , gastric contents
asymptomatic aspiration of saliva is called
silent aspiration
dyspnea, wheezing, frothy/purulent sputum, cyanosis, anxiety, fever, tachycardia, rhonchi/rales, leukocytosis, leukopenia or a new / progressing infiltrate are symptoms of
aspiration pneumonia
when aspiration occurs from a ventilator it is known as
ventilator associated PNA
_____ is one of the most feared complications of EN and can lead to acute pulmonary pathology
aspiration PNA
patients with dysphagia may aspirate saliva regardless of enteral feedings, true or false
true
what are the steps to reduce aspiration risk during enteral feeding
- elevated HOB 30-45 degrees
- sit patient upright or reverse Trendelenburg position
- good oral care BID with chlorhexidine
- continuous tube feeding,
- minimal sedation, suction prior to lying down,
to decrease risk of aspiration check GRV’s every ___ hours if they are part of your hospital protocol. Start _____ in setting of elevated GRV’s in the critically ill and use ___ trees for actions depending on the GRV
4 hours
pro-kinetic
decision
per ASPEN, GRV’s should ____ be used routinely to monitor ICU patients with enteral nutrition
NOT
if your ICU still uses GRVs, avoid holding EN for GRVs < ____mL in the absence of other signs of feeding intolerance
500mL
what methods should be used to check TF placement to decrease the risk of aspiration PNA and tube feeding
- check visible tube length
2. routinely check CXR especially if migration is suspected
to avoid hypertonic dehydration in EN what should be monitored
daily fluid I/O daily body weight serum electrolytes urine specific gravity BUN/Cr raio enteral/IV fluid provision
excessive fluid intake, rapid feeding, catabolism of LBM tissue with potassium loss, cardiac insufficiencyy/renal/hepatic insufficiency/refeeding syndrome are all causes of
overhydration
if a patient is experiencing overhydration during enteral feeding , what can be done/monitored
I/O
body weight/fluid status
check aldosterone (increases Na retention)
diuretic therapy
refeeding syndrome, catabolic stress, high ADH/aldosterone, diuretics, diarrhea/NGT loss, metabolic alkalosis, insulin and dilution can all cause _____
hypokalemia
if hypercapnia from overfeeding is suspected during enteral feeding what can be done
- lower phosphorous
- measure EEN with IC
provide balance of CHO, fat and protein
if a patient on EN develops low levels of serum zinc what can be done
supplement zinc in EN
per ASPEN when EN is being provided in a patient suspected to be at risk for refeeding syndrome provide ____% of energy goal on Day 1 with attention to energy contribution from ____then cautiously advance toward energy goal within ____ to ___ days pending clinical status/electrolyte levels.
25% on day 1
dextrose from IV
3-5 days
hyperglycemia is more common in EN Or PN
PN
when a patient on Enteral Nutrition experiences hyperglycemia what can be done
- use EN formula high in fat/fiber
- manage with insulin
- advance TF slowly toward goal
a BUN/Cr ration over > can indicate dehydration
20:1
a patient with renal failure/malnutrition with a BUN of 100 and Cr of 1 with a ratio of 100:1 may still be _____
adequately hydrated
typical urine output range
0.5-2 mL/kg/hour
1 liter of fluid = ___ kg of weight
1
