NUR 144 - Week 3 Contd. Alternate Nutrition

Question 1

List Enteral feeding routes

Answer 1

Temporary:
- Nasogastric
- Nasoduodenal, nasojejunal: Used when stomach needs to be bypassed for a short time (<4 weeks) or if patient has high risk of aspiration

Long-term:
- Gastrostomy (G-Tube); Percutaneous endoscopic gastrostomy (PEG)
- Jejunostomy (J-Tube)

Question 2

Bolus vs. Continuous Feeding

How are they administered?

Answer 2

Bolus
- Divide total daily intake in 4-6 feeds (typically 400mL)
- Given by syringe via gravity
- Relatively quick; 15-60 minutes
- Start feeding slowly
- Raise/lower syringe to control rate

Continuous/Cyclic
- For critically ill patients, high aspiration risk, risk for intolerance
- Pump used to control rate

Question 3

Administering Tube Feedings:

Things to ensure

Answer 3

• Dependent on location
• Patient education & pre
• Tube insertion and placement properly
• Clear tube obstruction
• Maintain tube function
• ## Oral and nasal care

Question 4

Things to assess on patient receiving Enteral Feeding:

Answer 4

• Tube placement
• Tolerance of formula and amount
• Clinical response
• Signs of dehydration
• Elevated blood glucose, decreased urinary output, sudden weight gain, preorbital or dependent edema
• Signs of infection
• Gastric residual volume (maybe not? check w/ agency)
• I/O, weekly weights
• Dietician consult

Question 5

Procedure for Enteral Feeding

Answer 5

• Administer at prescribed rate and method, according to patient tolerance
• Administer water: 1) before and after medication/feeding, 2) every 4-6 hours, 3) whenever tube feeding is discontinued or interrupted
• DO NOT MIX MEDICATION & FEEDING
• Maintain delivery system as necessary; do not hang more than 4-8 hours of feeding in an open system
• Maintain normal bowel elimination
• Maintain hydration by giving additional water and assessing for dehydration
• Promote coping by support and encouragement
• Patient education

Question 6

What position should the patient’s head be in when receiving a tube feeding to prevent aspiration?

Answer 6

At least 30 degrees of elevation

Question 7

Parenteral Nutrition

Which patients are candidates for Parenteral Nutrition?

Answer 7

• Nutrition status; decreased oral intake >1 week
• Weight loss of 10% or more
• Muscle wasting, decreased tissue healing
• Frequent nausea and vomiting

Question 8

Parenteral Nutrition

What to monitor on patients receiving PN?

Answer 8

• Hydration Status
• Electrolytes
• Caloric Intake

Question 9

Parenteral Nutrition

What are potential complications from PN?

Answer 9

• Pneumothorax, air embolism
• Clotted or displaced catheter
• Sepsis
• Hyperglycemia
• Rebound hypoglycemia; “Body adjusts to high glucose from PN. But as a result, hypoglycemia occurs if PN is abruptly stopped, or if glucose is lowered”
• Fluid Overload

Question 10

Parenteral Nutrition

Main goals in parenteral nutrition

Answer 10

• Attaining an optimal level of nutrition
• Preventing infecting
• Adequate fluid volume
• Optimal activity levels
• Pt education on self care
• Preventing complications

Question 11

Parenteral Nutrition

Nursing Interventions for parenteral nutrition

Answer 11

Maintaining optimal nutrition:
- Daily weight at same time
- Accurate I&O
- Caloric count
- Trace elements included in solution

Preventing infection:
- Catheter and IV site care
- Sterile technique & wear a maskf or dressing changes
- Assess insertion site; assess indications for infection

Maintaining Fluid Balance:
- Infusion Pump
- Do not increase or decrease rate abruptly
- I&O
- Daily weight
- Monitor blood glucose