Nutrition Case Study

Question 1

Pros and cons of a large bore feeding tube

Answer 1

More rigid and cause more discomfort but are less likely to clog than small bore feeding tubes

Question 2

When would you use a small-bore feeding tube?

Answer 2

Physician order dictates which type of tube to be inserted.
Small bore are used for long-term feedings in lower acuity setting

Question 3

When is tube placement checked?

Answer 3

Prior to administration of meds or feedings

Question 4

Why is tube placement checked?

Answer 4

Large-bore feeding tubes that are not in correct position could cause aspiration of the tube feeding

Question 5

Two methods for checking tube placement

Answer 5

Chest x-ray (gold standard)
Auscultation via bulborigmy

Question 6

What are the signs of tube obstruction?

Answer 6

Inability to flush tube with tap water
Inability to draw aspirate via the tube
Feeding tube pump may be alarming “occlusion”

Question 7

How would you prevent an obstructed tube?

Answer 7

Consistent flush of sterile water every 4 hours

Question 8

What are the side effects of enteral nutrition?

Answer 8

Diarrhea
Elevated blood sugar
Abdominal distention
Hyperactive bowel sounds

Question 9

Name at least 3 measures of tube feeding intolerance

Answer 9

Abdominal distention
Hyperactive bowel sounds
Excess residual of > 30 mL

Question 10

Name the most common lab value indicative of acute malnutrition

Answer 10

Pre-albumin

Question 11

What does decreased pre-albumin levels indicate

Answer 11

A lack of protein absorption in the body

Question 12

What are signs and symptoms a critical care patient is malnourished?

Answer 12

Bleeding gums
Poor wound healing
Dry, coarse hair
Dry skin
Brittle nails
Frequent infections