Topic 7: Specialized Nutritional Support

Question 1

oral feeding

Answer 1

used as an adjunct to meals and fluid intake in the patient whose nutritional intake is deficient

Question 2

what does oral feeding include

Answer 2

milkshakes, puddings, or commercial products (Carnation Instant Breakfast, Ensure, Boost)

Question 3

enteral nutrition

Answer 3

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

Question 4

Parenteral Nutrition

Answer 4

administration of nutrients directly into the bloodstream. Used when GI tract cannot be used for indigestion, digestion or absorption of essential nutrients

Question 5

Central PN

Answer 5

indicated for long-term support, the tip of the central catheter lies in the superior vena cava

Question 6

what solutions are given in central PN but not peripheral PN

Answer 6

hypertonic for central (if this was given peripheral PN it would cause irritation and thrombophlebitis)

Question 7

Peripheral PN

Answer 7

a peripherally inserted catheter into a large vein used for a short time, but there is an increased risk of phlebitis

Question 8

· Common enteral feeding locations

Answer 8

o Nasogastric
o Esophagostomy
o Gastrostomy
o Nasoduodenal
o Nasojejunal
o Jejunostomy

Question 9

Percutaneous Endoscopy Gastrostomy (PEG) tube

Answer 9

-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.

Question 10

you need to assess for risk of what when using parenteral nutrition

Answer 10

hyper/hypoglycemia (assessed with a glucometer)

Question 11

· Assessing for effectiveness of parenteral nutrition

Answer 11

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

Question 12

· Fat emulsion may cause SE

Answer 12

o Vomiting
o Shivering
o Fever
o Chills

Question 13

Lipids need to be used with caution in clients with…

Answer 13

disturbance in fat metabolism, in danger of fat embolism, and allergic to eggs

Question 14

enteral nutrition indication includes those with…

Answer 14

o Any condition that impacts ability to safely swallow
o Anorexia
o Facial fractures
o Head/neck cancer
o Neurologic or psychiatric conditions

Question 15

how often does pump tubing need to be changes

Answer 15

every 24 hours

Question 16

General nursing considerations for enteral nutrition

Answer 16

· Daily weights
· Assess for bowel sounds before feedings
· Accurate I&O
· Initial glucose checks
· Label with date and time started
· Pump tubing changed q24h

Question 17

when should tubes be flushed

Answer 17

o Flush tube before and after drug administration

Question 18

Feedings can be started when

Answer 18

bowel sounds are present, usually 24 hours after placement

Question 19

Most PEG tube feedings can start within

Answer 19

· within 2 hours of insertion

Question 20

EN and Safety

Answer 20

· 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)

Question 21

With bolus feedings, the head should remain elevated for

Answer 21

30-60 minutes after feeding

Question 22

Maintaining EN Infusions

Answer 22

· 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

Question 23

Tube Position is checked by

Answer 23

· 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

Question 24

which pH is indicative of stomach contents

Answer 24

<5

Question 25

what is the most accurate assessment for tube placement

Answer 25

x-ray

Question 26

· Check gastric residual volumes…

Answer 26

o Every 4 hours during first 48 hours
o ↑ Volume leads to aspiration

Question 27

Site Care

Answer 27

· 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

Question 28

Tube Patency

Answer 28

· 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

Question 29

Refeeding syndrome

Answer 29

can occur any time a malnourished patient starts aggressive nutritional support.

Question 30

what is the hallmark sign for refeeding syndrome

Answer 30

o Hypophosphatemia is hallmark
-Characterized by fluid retention and electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia)

Question 31

what can refeeding syndrome result in

Answer 31

dysrhythmias, respiratory arrest and neurologic problems (paresthesias)

Question 32

Catheter-Related Infections

Answer 32

· Assess for signs of inflammation or infection. Phlebitis can occur with infusion of hypertonic solution.

Question 33

Local IV infection manifestations:

Answer 33

erythema, tenderness, exudate at the catheter insertion site

Question 34

systemic IV infection manifestations:

Answer 34

fever, chills, nausea, vomiting, malaise

Question 35

feeding bad must be refrigerated until

Answer 35

30 minutes before use

Question 36

what must be labeled on bag

Answer 36

· nutrient content, all additives, time mixed, and date and time of expiration