Nutrition Flashcards
enteral nutrition
*nutrition that’s provided via the GI tract as a liquid
*it can include a normal oral diet, the use of liquid supplements or delivery by use of a tube (tube feeding)
parenteral nutrition
nutrition that’s provided through a central IV route
nasogastric tube
inserted through the nose into the stomach
nasoenteric or nasointestinal
inserted through the nose into the small intestine
gastrostomy tube
*tube that’s surgically inserted into a patient’s stomach through the abdominal wall
*most common is a PEG
PEG tube
percutaneously endoscopically placed gastronomy tube - placed into stomach using an endoscope
PEJ tube
percutaneously endoscopically placed jejunostomy tube - placed in jejunum using an endoscope
whats the most reliable method for confirming INITIAL tube placement is using _____________
radiographic verification (aka xray)
two other methods to confirm initial tube placement
- aspirate and inspect contents
- measure the volume and pH (Generally, a pH of 1 to 5.5 indicates gastric placement, a pH higher than 6 indicates that the tube is in the jejunum, while a pH of 7 or higher might indicate respiratory placement)
the most common way to confirm ongoing tube placement
observe length of tube that extends from body
capnography
tests for CO2 to see if it’s in the lungs (client will also be in respiratory distress….)
gravity flow
method to administer feedings - patient at risk of GI reflux, diarrhea, and aspiration
pump controlled infusions
recommended for jejunal and gastrostomy feedings
cyclic : schedule to administer feedings
Feed over a set period of time each day, generally evening and night (AKA nocturnal feedings)
intermittent : schedule to administer feedings
Feedings given every so many hours. (Ex: Give 480ml of formula every 6 hours)
bolus : method to administer feedings
*Feedings administered with a syringe at ordered intervals.
*Can only do with gastric tubes NOT intestinal tubes.
*Easiest method to teach family members.
continuous : schedule to administer feedings
Feeding runs around the clock or continuously
*** Regardless of method the patient’s head of bed must be elevated _____ degrees to prevent aspiration during feedings and keep elevated for _______ after administering the feeding
*30-45 degrees
*1 hour
When administering feeding the nurse needs to assess for tolerance - watching for signs of discomfort such as _______________ ____________________________________________
cramping, flatus, pain, vomiting, or diarrhea; respiratory status, ability to speak, amount of residual volume
open system enteral feeding
*It is exposed to the environment during administration (usually syringe method or bag method.
*Limit exposure to 4 hours.
*Flush system with water to clean after each delivery or 4 hours worth of time.
closed system enteral feeding
*Is a prefilled system (usually bag or bottle)
*Decreases risk of contamination
*Formula can hang for 24 - 48 hours if sterile technique is used
assess the residual amount how often?
every 4 hours with continuous feedings or prior to intermittent feedings
if the residual is less than 150 ml for gastric or 10 ml for intestinal OR equal to 1 hour’s worth of feeding, what would you do?
put the residual back in (with a syringe and graduated container) - flush - and continue to administer the feeding
if the residual is more than 150 ml for gastric or 10 ml for intestinal OR 1 hour’s worth of feeding, what would you do?
hold feeding - follow orders (maybe the order is to wait 1 hour and reassess, or to call the provider, or to reinstall the residual contents over a period of time) BUT TO HOLD OFF ON ANY FEEDING AT THAT TIME
STEPS TO GIVE FORMULA
- flush tube with 1/2 the “free” (= warm tap water) water in the order
- administer the feeding by the correct method and at the correct rate
- flush tube with the 1/2 remaining water
- close and secure end of feeding tube
- if an open system, after feeding is complete run 15-50 ml of water through the bag and tubing
- dispose of equipment, if appropriate (bags and syringes should be labeled with date and time b/c they’re good for 24 hours)
- document
- observe patient for any problems
administering medication via a tube
- 5 rights, verify orders, check for allergies
- is the med available in liquid form?
- if not, can the med be opened/crushed?
- dissolve med in warm water (~20ml)
DO NOT ADMINISTER WHOLE MEDS - label each med cup
- go to patient’s room (introduce self, provide privacy, explain med, etc)
- hand hygiene
- confirm tube placement and check residual to ensure you are able to go ahead and administer meds
- flush tube with 20-30 mls (or 5-10 ml for kids) with water
- administer med ONE AT A TIME (they each have their OWN cup to prevent congealing)
- after each med flush tube with 20-30 ml of water, including at the very end
- clamp tube or reestablish tube feeding
- keep head of bed up 30-45 degrees for one hour
- hand hygiene
- document
- observe patient for desired effect and any potential undesired effects of meds
decompression (AKA gastrointestinal suction) is used to: _______________
keep the stomach empty of gas or fluid content/gastric content
modular formulas
single-nutrient formulas that require a functioning GI tract that can absorb whole nutrients
elemental formulas
contain predigested nutrients that are easy for a partially functional GI tract to absorb
polymeric formula
whole-nutrient formula that require a functioning GI tract that can absorb whole nutrients
specialty formula
meet specific nutritional needs for clients who have conditions such as HIV, liver failure, or clients who have pulmonary disease
to determine the length of a nasointestinal tube to insert, a nurse should measure what?
Measuring from the tip of the nose to the earlobe to the xiphoid process approximates the distance from the nose to the stomach for 98% of clients. For duodenal or jejunal placement, an additional 20 to 30 cm is required
Nasogastric tubes are contraindicated for __________
clients at high risk of aspiration
What kind of feeding tube is recommended for clients at a high risk of aspiration who require short-term feedings of less than 4 weeks
nasointestinal tube
