Enternal feeding

Question 1

Identify indications for enteral nutrition

Answer 1

To provide nutritional support
To prevent/treat malnutrition

-NPO

Question 2

Explain the advantages and disadvantages of various enteral feeding routes

Answer 2

Advantages of Enteral Feeding over Parenteral Feeding (IV or Central line)
-Feeding via GI route is easier, safer, less expensive, and more physiologic.
Better utilized by the body.
Maintains the structure and functional capacity of the GI tract
Prevents cholestasis by stimulating bile flow.
Improves systemic immunity and lowers risk for infection

Question 3

Identify methods for confirming feeding tube placement

Answer 3

Initial placement requires radiographic verification
Before each intermittent feeding
Every shift for continuous feeding

Measure external length of tube
Aspirate gastric or intestinal contents
Observe color
Measure pH of aspirated contents
Consider results from pH testing & the aspirate’s appearance
When in doubt, hold feeding and x-ray
-aspirate to check for pH, placement, if it is NG tube

Question 4

Discuss selected types of enteral feeding products

Answer 4

Open system
-Reconstitute formula from powder with milk or water
Once mixed, refrigerate
Allow to stand at room temperature for at lest 20 minutes to warm
Unused quantities discarded after 24 hrs.
Hang only 4 hours worth of formula

Closed system
-Ready for immediate use
Unopened, stable at room temperature
Stable for 48 hours once hung
Always include date and time when starting the feed. 

Polymeric- an enteral formula composed of intact macronutrients.
Modular- a formula consisting of a singular macronutrient. A complete diet can be formulated by mixing modular formulations.
Elemental- is a type of hypoallergenic formula made from individual amino acids.
Specialty- renal, liver patients

Question 5

Explore the types of enterostomal devices and insertion site care required

Answer 5

• Gastrostomy Tube
• PEG tube-Percutaneous endoscopic gastrostomy
• PEG/J tube-Percutaneous endoscopic gastrostomy-jejunostomy tube

-LPGD device-low-profile gastrostomy device
Jejunostomy tube

SKIN CARE
-Inspect skin around site daily

Cleanse site daily using sterile cotton-tipped applicators (normal saline unless antibiotic ordered)

Rotate gastrostomy tube 360 degrees daily if not sutured in place (if newly inserted)

Check for in-and-out play of 0.5 cm

Leave stoma site open to air (unless draining)

Teach the patient to avoid tugging on the tube or lying on left side after feedings.

Question 6

Explain the procedure for administering nasogastric, nasointestinal, gastrostomy, and jejunostomy tube feeding including: intermittent, continuous, by gravity and using a pump

Answer 6

Intermittent
-Pinch proximal end of feeding tube
(a) Infants-children
Remove plunger from syringe & attach barrel to end of tube. Fill syringe with measured amount of formula. Release tube & hold syringe high enough to allow it to empty gradually by gravity; refill

(b) Children-adult
- Hang feeding bag of prescribed amount of formula on IV pole, purge tubing, connect distal end of tubing to proximal end of feeding tube. Connect tubing through infusion pump and set rate.

Continuous
-Fill feeding bag with enough formula for 4 hrs. or use closed system (good for 48 hours)
Hang bag and tubing on IV pole and purge tubing
Connect distal end of tubing to proximal end of feeding tube
Connect tubing through infusion pump and set rate

Question 7

Identify complications of enteral feedings and how to prevent them

Answer 7

Aspiration
Diarrhea –if feed is hypertonic formula, or fed too fast (ensure feed are not contaminated, or past due date
Clogged feeding tube
N/V, abdominal distention, cramping (check pt position, decrease volume/rate, lactose intolerace
Dehydration
Hyperglycemia
Electrolyte imbalance

Refeeding syndrome occurs when previously malnourished patients are fed with high carbohydrate loads, the result is a drastic decrease in phosphate, magnesium and potassium, along with an increasing ECF volume, leading to a variety of complications
-The most effective way to treat refeeding is to be aware of it. One should start feeds slowly and aggressively supplement magnesium, phosphate and potassium

Question 8

How to administer medications via enteral tubes

Answer 8

Preferred form-liquid
Tablet-crushed to fine powder, mixed with warm water
Administer 1 hr. before or 2 hrs. post feeding
Give meds separately
Flush tube with water before & after