Enternal Feeding, Supplementary Feeding, and Complications of Breastfeeding

Question 1

indications for enteral feeding

Answer 1

intubation, inability to suck, swallow, or gag or coordinate these actives (34-36 weeks or less)

Question 2

how is a enteral feeding tube measured and marked

Answer 2

tip of eat to midpoint between xiphoid process and umbilicus and marked before insertion

Question 3

how to choose between oral or nasal tube

Answer 3

-oral tubes are used for infants less then 1kg, those on NCPAP, ventilator or high 02 needs
-nasal tubes are used for greater then 1kg, taking oral feeding and has a strong gag reflex

Question 4

what are short term enteral tubes made out and how long are they good for?

Answer 4

polyvinyl chloride - changed a 24-72 hours

Question 5

what are long term enteral tube made out of and how long are they good for?

Answer 5

polyurethane; every month

Question 6

ideal enteral feeding position during enteral feeding and after

Answer 6

skin to skin with mother is preferred; prone or left lateral position with head elevated to 30 degrees; additionally place infant in right lateral one hour after feeding, followed by one hour of left lateral for best digestion

Question 7

bolus vs continuous feedings

Answer 7

bolus feeding are administered over 15-30 min; continuous feedings are administered over a number of hours; no consensus on which method is better.

Question 8

benefits on bolus feeding (2)

Answer 8

stimulates normal feeding pattern; may improve sphanchnic oxygenation

Question 9

disadvantages of bolus feedings (4)

Answer 9

-direct nursing care required
-make care metabolic instability
-increased risk of GI reflux
-may overwhelm immature GI system

Question 10

continuous feeding benefits

Answer 10

-improves feeding tolerance
-promotes metabolic stability
-decreased risk of acid reflex
-may result in increased weight gain

Question 11

continuous feeding disadvantages

Answer 11

may increases bacterial contamination; may result in fat separation and decreased fat intake

Question 12

what are trophic feedings?

Answer 12

very small enteral feeds given soon after birth for a extremely premature infants not expected to tolerate enteral feeds for several weeks; 1-2ml/kg per feeding, does not exceed 15ml/kg/day; starts at 24-48 hours of birth of stable neonates and colostrum, breastmilk and preterm infant formula is preferred

Question 13

what are the advantages of trophic feeds?

Answer 13

prevent atrophy of the gut, enhance GI maturation and small intestine motility; also protects the neonate for development necrotizing enterocolitis

Question 14

how long can TPN be given through a PIV?

Answer 14

less then one week

Question 15

what do you need to monitor closely if any neonate is on TPN?

Answer 15

glucose

Question 16

what are the main componates of TPN

Answer 16

glucose, protein, lipids, sodium, potassium, calcium, phosphorus, magnesium, trace elements and vitamins

Question 17

guidelines for IV lipid administration

Answer 17

start w 0.5g/kg on the day 3rd day and slow increase to 3-3.5g/kg/day by day 7-10. lipids are to be delivered slowly over 18-24 hours a day

Question 18

risk of IV lipids in neonates (3)

Answer 18

-elevated unconjugated bilirubin
-exacerbation of chronic lung disease
-exacerbation of persistent pulmonary hypertension

Question 19

complications of TPN

Answer 19

-development of cholestasis
-problems at the IV site including sepsis originating from site, thrombophlebitis, and infiltration w possible tissue necrosis

Question 20

why do preterm infants have need iron supplementation

Answer 20

preterm infants are at risk for low iron because of the lack of iron transferred from mother during third trimester; all formula is iron fortified; if breastfed infants need to be given iron supplementation until they are several months old

Question 21

ways to assist with clogged milk duct

Answer 21

massaging affected area while breastfeeding, increased breastfeeding on that side, manually expressing breastmilk in hot shower, applying heat to the area, using a breast pump; position infants so the chin points to the blocked area

Question 22

signs of mastitis

Answer 22

induration, swelling, erythema, increasing fever, acute pain; mother may have flu like symptoms prior to inflammation of breast