nasogastric tube Flashcards
nasogastric tubes
a pliable tube that is inserted into the paitnets stomach
has a hollow lumen that allows for removal of gastric secretions and introduction of soloutions into the stomache
small or large bore
use of ngt tubes
enteral feeding admin medications suctioning lab analysis lavage internal application of press
indications for ngt tubes
post op
impaired peristalsis
abdominal distention
critical illness
client assessment
patency of nares and intactness of nasal tissues
gag reflex
level of conciseness
auscultate abdomen
maintenance of ng tubes
irrigate tube as required verify placement maintain patency asesses abdomnial auscultate bowel sounds/breath sounds
care of client
maintaining comfort assess nares and muscossa freq lubricate nares freq mouth care freq mouth/asess abdominal respiratory
complications
abdominal distention, vomiting absence of drainage throat irritation chronic inflammation erosion of the nares and nasal muscossa fluid volume deficit pulm aspiration
Aspiration immediate
Coughing Dyspenea Cyanosis Crackels and wheezes Decreased o2 says Increased RR
Delayed response
Fever
Development of phenomia
Unexpected outcomes with enteral feeds
Increased gastric residual (more than 200-500) Diahrea N/V Clogged tubes/ fluid overload Dehydration
Guidelines for dietary change
advocate reduced saturated and trans fats, reduced sodium, and reduced refined sugars, as well as an increased intake of complex carbohydrates and fibre.
Importance balanced diet
carbohydrates, fats, proteins, vitamins, and minerals provides the essential nutrients to carry out the body’s normal physiological functioning
Lipid emulsions
provide supplemental kilocalories and prevent deficiencies of essential fatty acids.
These emulsions can be administered through a separate peripheral catheter, through the CVC by Y-connector tubing
Contraindications to giving lipids
are hyperlipidemia, lipid nephrosis, severe liver failure, and egg allergy.
Who benefits from parental feeding
Patients who are unable to digest or absorb enteral nutrition benefit from parenteral nutrition.
Patients in highly stressed physiological states, such as sepsis, head injury, or burns, are also candidates for parenteral nutrition therapy
Enteral nutrition
refers to nutrients given via the gastrointestinal tract
where can you insert a gt tube
(nasogastric-orogastric or
nasointestinal-orointestinal tubes),
surgically through a stoma
jejunum (gastrostomy or jejunostomy tubes)
endoscopically (percutaneous endoscopic gastrostomy
jejunostomy
large bore sump tubing
large bore sump tube is most used for stomache decompression and short term feeding
small bore tubing
small-bore, silastic tubing with insertion stylet is used for longer-term feeding needs.
The small-bore nasogastric or nasojejunal tube is preferred over large-bore tubes as they reduce patient discomfort and gastric erosion
when a nasal feeding tube used
less than 4 weeks, nasoenteral tubes may be used.
surgical placed feeding tube
Surgical or endoscopically placed tubes are preferred for long-term feeding (>4 weeks) to reduce the discomfort of a nasal tube and to provide a more secure, reliable access
Indications for Enteral Nutrition
Cancer (Head and neck Upper gastrointestinal tract)
Critical Illness or Trauma
Neurological and Muscular Disorders
Gastrointestinal Disorders
BMR
basic metabolic rate
This is the energy needed to maintain life-sustaining activities (breathing, circulation, heart rate, and temperature) for a specific period of time.
REE
resting energy expenditure (REE) is a measurement that accounts for BMR plus energy to digest meals and perform mild activity.
REE is a baseline of energy requirement accounting for approximately 60% to 75% of our daily needs.
risk of aspiration
Patients with gastroparesis (decreased or absent innervation) esophageal reflux, those at risk for aspiration, those with a history of aspiration pneumonia
when inserting a feed tube with person who is unconsciousness
or who are intubated and sedated, may also have impaired gag reflex, and their risk of aspiration
For patients who are intubated, sedated, or too ill to participate in the procedure, ensure that the patient’s head is tilted toward the chest for enteral feeding tube insertion.
alert patient inserted into patient
Encourage a patient who is alert and communicating to swallow by giving small sips of water or ice chips when possible.
Advance tube as patient swallows or as patient’s head is tilted toward chest. Rotate tube 180 degrees while inserting.
nutrition guidelines for enteral feeding
Nutrition guideline recommends a range of 250 to 500 mL
Volumes greater than 200 are considered high in critically ill
if residual volume exceeds 500 mL, feedings may be withheld.
Polymeric formulas
(1.0 to 2.0 kcal/mL) include milk-based blenderized foods prepared by hospital dietary staff or in the patient’s home.
Modular formulas
(3.8 to 4.0 kcal/mL) are single-macronutrient (e.g., protein, glucose, polymers, or lipids) preparations and are not nutritionally complete
specialty formulas
(1.0 to 2.0 kcal/mL) are designed to meet specific nutritional needs in certain illnesses (e.g., liver failure, pulmonary disease, or human immunodeficiency virus [HIV] infection).
refeeding syndrome
(metabolic disturbances that occur as a result of reinstituting nutrition) because cations such as potassium, magnesium, and phosphate move intracellularly
