Topic 7: Specialized Nutritional Support Flashcards
oral feeding
used as an adjunct to meals and fluid intake in the patient whose nutritional intake is deficient
what does oral feeding include
milkshakes, puddings, or commercial products (Carnation Instant Breakfast, Ensure, Boost)
enteral nutrition
tube feeding delivered directly into the GI tract. Used in patients who has a functioning and unobstructed GI tract but is unable to take any or enough oral nourishment or when it is unsafe to do so
Parenteral Nutrition
administration of nutrients directly into the bloodstream. Used when GI tract cannot be used for indigestion, digestion or absorption of essential nutrients
Central PN
indicated for long-term support, the tip of the central catheter lies in the superior vena cava
what solutions are given in central PN but not peripheral PN
hypertonic for central (if this was given peripheral PN it would cause irritation and thrombophlebitis)
Peripheral PN
a peripherally inserted catheter into a large vein used for a short time, but there is an increased risk of phlebitis
· Common enteral feeding locations
o Nasogastric
o Esophagostomy
o Gastrostomy
o Nasoduodenal
o Nasojejunal
o Jejunostomy
Percutaneous Endoscopy Gastrostomy (PEG) tube
-Using endoscopy, a gastrostomy tube is inserted through the esophagus into the stomach and then is pulled through a stab wound made in the abdominal wall.
-A retention disk and bumper secure the tube.
you need to assess for risk of what when using parenteral nutrition
hyper/hypoglycemia (assessed with a glucometer)
· Assessing for effectiveness of parenteral nutrition
o Monitor initial VS Q4-8 hours
o Weigh patient daily as a measure of the patient’s hydration status
o I&Os
o Determine cause of any weight changes
o Assess blood glucose, electrolytes and urea nitrogen
o CBC and hepatic enzyme studies are obtained a minimum of 3 times per week until stable
· Fat emulsion may cause SE
o Vomiting
o Shivering
o Fever
o Chills
Lipids need to be used with caution in clients with…
disturbance in fat metabolism, in danger of fat embolism, and allergic to eggs
enteral nutrition indication includes those with…
o Any condition that impacts ability to safely swallow
o Anorexia
o Facial fractures
o Head/neck cancer
o Neurologic or psychiatric conditions
how often does pump tubing need to be changes
every 24 hours
General nursing considerations for enteral nutrition
· Daily weights
· Assess for bowel sounds before feedings
· Accurate I&O
· Initial glucose checks
· Label with date and time started
· Pump tubing changed q24h
when should tubes be flushed
o Flush tube before and after drug administration
Feedings can be started when
bowel sounds are present, usually 24 hours after placement
Most PEG tube feedings can start within
· within 2 hours of insertion
EN and Safety
· Do not add medications to enteral feeding formula
· Crush drugs to a fine powder and dissolve in 30-60 mL of purified water
· Keep HOB at 30-45 degrees
· Check for Gastric Residual Volume (GVR) per agency policy (every 6-8 hours)
With bolus feedings, the head should remain elevated for
30-60 minutes after feeding
Maintaining EN Infusions
· Check tube placement before feeding and before each medication administration
· Assess bowel sounds before feeding
· Flush NG or G tubes as needed
· Evaluate nutritional status of patient receiving enteral feedings
Tube Position is checked by
· x-ray of newly inserted tubes to confirm proper position before starting feedings or medications
· Mark exit site of tube
· Check placement before each feeding/drug administration or every 8 hours with continuous feeds
· Check insertion length regularly
· Aspiration of stomach contents
· pH check
which pH is indicative of stomach contents
<5
what is the most accurate assessment for tube placement
x-ray
· Check gastric residual volumes…
o Every 4 hours during first 48 hours
o ↑ Volume leads to aspiration
Site Care
· Assess skin around the feeding tube daily for signs of redness and maceration (digestive juices can irritate the skin)
· Keep it clean and dry, rinse it with sterile water and dry it
· Apply a dressing until the site is healed
· After healed, wash with soap and water
· Protective ointment or skin barrier
Tube Patency
· Flush with 30mL of warm tap water every 4 hours during continuous feeding or before and after each bolus feeding, and before and after each medication given
Refeeding syndrome
can occur any time a malnourished patient starts aggressive nutritional support.
what is the hallmark sign for refeeding syndrome
o Hypophosphatemia is hallmark
-Characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia)
what can refeeding syndrome result in
dysrhythmias, respiratory arrest and neurologic problems (paresthesias)
Catheter-Related Infections
· Assess for signs of inflammation or infection. Phlebitis can occur with infusion of hypertonic solution.
Local IV infection manifestations:
erythema, tenderness, exudate at the catheter insertion site
systemic IV infection manifestations:
fever, chills, nausea, vomiting, malaise
feeding bad must be refrigerated until
30 minutes before use
what must be labeled on bag
· nutrient content, all additives, time mixed, and date and time of expiration
