neonate enteral nutrition: lab Flashcards
assess before
- Review the current anthropometric measurements, including admission weight, length or height, head
circumference, skin folds (if available), and plots of these values on appropriate age and gender charts. - Review the neonate’s medications.
- Assess GI tract function.
- Assess fluid balance to determine enteral nutrition requirements.
Prepare
appropriate amount of room-temperature formula or breast milk in an appropriate-size oral
syringe and label it.
For intermittent feedings, (amount of formula/BM to prepare)
the ordered amount.
For continuous feedings, (amount of formula/BM to prepare)
use up to 4 hours’ worth of the feeding.
Immediately before every feeding, monitor
oxygen and ventilation indices. Notify the practitioner if the neonate
shows changes in the work of breathing (changes in respiratory rate and effort and lung sounds), blood gas
values, or oxygenation.
2. verify the tube placement and gastric residue
place on a ___ monitor during feedings
Place the neonate on a cardiac respiratory monitor during the tube feeding. Immediately stop the feeding
infusion in the event of apnea or bradycardia. Assess the neonate for adequate respirations and heart rate
and evaluate the need for resuscitation. If the neonate recovers quickly, resume the feeding slowly after a
brief pause and observe the neonate carefully. If apnea or bradycardia continues or recurs, stop the feeding.
Check the airway for patency by clearing the mouth and then nose with suction. Notify the practitioner.
Check for any residual gastric contents by gently aspirating stomach contents.
a. Use additional syringes as necessary to obtain the full amount of stomach contents.
b. If attempts to obtain an aspirate are unsuccessful (no air or residual), use a larger syringe to decrease the
pressure created by the plunger. Consider repositioning the neonate to move the tube tip away from the
stomach wall.
c. Return the gastric residual and subtract that amount from the volume of the feeding, as appropriate. A
partially digested aspirate of less than half of the previous feeding or a 1-hour volume of continuous infusion
is typically considered normal in the absence of illness. If the gastric residual is bloody or has the
appearance of coffee grounds, is green or bright yellow or has the appearance of fecal matter, or contains
thick mucus, do not refeed it. Notify the practitioner immediately if the gastric aspirate contains bile or blood
or has the appearance of coffee grounds.
Determine the need for an
an indwelling feeding tube or an intermittently placed feeding tube. Ensure that an
indwelling feeding tube is secured to the neonate’s face. Change the adhesive dressing if necessary.
Assess
neonate’s abdomen for distention, discoloration, and loops of bowel before every bolus or
intermittent feeding or every 4 to 8 hours with a continuous infusion. Include abdominal girth in the
assessment by measuring around the neonate’s abdomen over the umbilicus. Notify the practitioner
immediately of persistent distention, pain with palpation, discoloration, and visible loops of bowel.
actual procedure
- Match the two patient identifiers on the breast milk container to the neonate’s identification band. Scan
barcoded labels to match the neonate’s identification bar code or have a qualified individual verify that the two
patient identifiers on the container match the two patient identifiers on the neonate’s identification band. - Add medications to the formula or breast milk (if needed) at the beginning of the feeding, after checking for
compatibility. - If medication is needed, ensure the six rights of medication safety: right medication, right dose, right time, right
route, right patient, and right documentation before adding medication to the feeding. - Label the feeding bag and administration set or oral syringe with the date and time prepared, type of formula
or breast milk, and amount. - Initiate the enteral feeding as ordered.
Bolus Feeding by Gravity Via Oral Syringe Method
- Attach the syringe to the distal end of the feeding tube.
- Remove the plunger from the oral syringe.
- Allow the room-temperature enteral formula or breast milk in the syringe to run in slowly by gravity. If the flow
does not begin spontaneously, gently push the feeding, using the syringe plunger to establish flow. - Position the syringe about 20 cm (8 inches) above the neonate’s abdomen to allow the feeding to run in
slowly, ideally during the course of 30 minutes.
Intermittent or Continuous Tube Feeding Via Syringe Pump
- Attach the feeding extension tubing to the syringe and prime to expel air.
- Place the syringe on the pump.
- Program the syringe pump.
a. For intermittent feeding, enter the ordered volume and infusion time.
b. For continuous feeding, enter the hourly rate. - Connect the tubing to the distal end of the indwelling feeding tube.
- Begin the infusion.
Intermittent or Continuous Tube Feeding Via Feeding Pump
- Close the clamp on the enteral feeding bag and pour the appropriate amount of room-temperature formula or
breast milk into the bag.
a. For intermittent feedings, use the ordered amount.
b. For continuous feedings, use up to 4 hours’ worth of feeding. - Hang the feeding bag on the IV pole and prime the tubing to purge the system of air.
- Load the administration set into the enteral feeding pump.
- Program the pump.
a. For intermittent feeding, enter the ordered volume and infusion time.
b. For continuous feeding, enter the hourly rate. - Connect the tubing to the distal end of the indwelling feeding tube.
- Begin the infusion.
Bolus, Intermittent, or Continuous Tube Feeding
- Give the neonate a pacifier to satisfy oral needs.
- When the feeding is complete, clear the feeding tube with a small amount of air. Maintain the neonate’s
elevated position for 30 minutes. - Discard supplies, remove gloves, and perform hand hygiene.
- Document the procedure in the neonate’s record.
