MALNUTRITION & ENTERAL NUTRITION

Question 1

Types of enteral nutrition

Answer 1

Complete formula, modular feedings, isotonic formulas, and hypertonic formulas

Question 2

Whole nutrient formula

Answer 2

Complete formula

Question 3

Single macronutrient formula, supplements

Answer 3

Modular feedings

Question 4

Used for pts with tolerance issues

Answer 4

Isotonic formulas

Question 5

Attracts water from the body into the lumen of the GI tract May cause diarrhea. Watch for fluid & electrolyte imbalances.

Answer 5

Hypertonic formulas

Question 6

Parenteral vs enteral nutrition

Answer 6

Enteral feeding- through a tube placed into the stomach or small intestine

Parenteral feeding- through a tube inserted into a vein whereby nutrients enter the bloodstream directly

Question 7

Types of tubes

Answer 7

NG tube
Nasoduodena (Dubhoff)
Nasojejunal (Romsons)
G-tube (Gastrostomy)
J-tube (Jejunostomy)

Question 8

What tubes are surgically placed?

Answer 8

G-tubes
J-tubes

Question 9

What type of tube is used for short term feedings or suctioning?

Answer 9

NG tubes

Question 10

S/sx of leaking into mediastinum

Answer 10

pain, SOB, and increased temperature

Question 11

Administration of feedings

Answer 11

-bolus feeding for large feedings at a time
-Intermittent or continuous

Question 12

Reminders for intermittent or continuous feedings

Answer 12

HOB 30-45 degrees
Pause feeding for repositioning and care

Question 13

Nursing responsibilities

Answer 13

-oral and nasal care
-assessing drainage
-positioning is important (contact provider if suspected dislodgment)
-postop danger of perforation or suture disruption

Question 14

What is needed in order to reposition or irrigate?

Answer 14

provider orders

Question 15

pH should be 0-4

What does it mean if pH is greater than 6?

Answer 15

tube may be dislodged into the lung

Question 16

Hold for residual if greater than ___ mL on two assessments

Answer 16

200 mL

Question 17

Complications

Answer 17

-Overfeeding
-Diarrhea
-Aspiration pneumonia
-Refeeding syndrome

Question 18

Complication

Abd. distention & NV

Check residual and rate at which you are infusing

Answer 18

Overfeeding

Question 19

Complication

Possibly due to concentration of formula. Evaluate for C. Diff and walk with dietician.

Answer 19

Diarrhea

Question 20

Complication

Can be life threatening. Tube displacement is primary cause. Stop feeding, turn client to side, and stop suctioning. Administer oxygen. Increased HR and temp. Call physician & get Xray.

Answer 20

Aspiration pneumonia

Question 21

Life threatening complication

When feeding is started in a patient who is in a starvation state & whose body begun to catabolize protein and fat for energy.

Monitor for electrolyte imbalance, new onset confusion or seizures, increased muscular weakness, etc.

Answer 21

Refeeding syndrome

Question 22

Should you verify whether meds can be crushed?

Answer 22

Yes

Question 22

To prevent aspiration ..

Answer 22

Keep HOB elevated at least 30 degrees during the feeding and for at least 1 hr after the feeding for bolus feedings

Continuously maintain semi-Fowler’s position for pts receiving cyclic or continuous feeding.

Question 23

Residual volume should be checked and recorded every

Answer 23

4 to 6 hrs

Question 24

Per Joint commission, if G-tube or J-tube is used, assess insertion site for signs of infection or excoriation (redness, drainage).

Answer 24

Rotate tube 360° each day and check for in-and-out play of about ¼ inches (0.6cm).

If the tube cannot be moved, notify physician ASAP because it can mean the retention disk is embedded in the tissue.

Cover the site with a dry, sterile dressing and change the dressing daily.