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NRSG 202 > Week 5: Enteral Feeding > Flashcards

Week 5: Enteral Feeding Flashcards

1
Q

What are abdominal bruits

A

Additionally sounds sometimes heard during auscultation (swishing sound) that can indicate aortic aneurysm, but does not ALWAYS indicate disease

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2
Q

What is enteral nutrition?

A

Administration of nutrients directly into the GI tract

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3
Q

What is the preferred method for providing nutrition

A

enteral nutrition

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4
Q

what MUST the patient have in order to have enteral nutrition

A

a functioning GI tract

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5
Q

What is enteral nutrition considered?

A

An advanced directive that may have ethical implications associated with this intervention

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6
Q

What is malnutrition

A

the lack of necessary or appropriate food substances

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7
Q

S&S of Malnutrition

A

mental confusion, irritability
inability to concentrate
lack of appetite or interest in food
changes in skin colour
dry scaly skin
brittle pale nails
dully sparse hair
swollen and bleeding gums, decaying teeth
sunken dry eyes
hollow cheeks
fatigue low energy
muscle wasting
distended abdomen
enlarged liver
weight loss muscle wasting
poor immune function

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8
Q

Abnormal blood results in malnutrition

A

DECREASED:
- albumin
- Hgb
- iron
- lymphocytes
- blood glucose
- K+ and calcium
- BUN and CR
- serum vitamins and mineral levels

INCREASED:
- liver enzymes

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9
Q

What happens when patients are starved

A

villous atrophy
loss of gut mass
compromising the physical barrier (decreased surface area)

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10
Q

Enteral nutrion

A

maintains fut mass, function, and integrity

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11
Q

Early feeding provides these outcomes

A

decreased length of stay
decreased infection/sepsis
increased nutritional goal
improved nitrogen balance

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12
Q

Parenteral feeding

A

via an IV through a central vein

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13
Q

Indications for an Enteral feeding

A

functioning and accessible GI tract
malnourished or at risk of malnutrition
to supplement food intake
unable to ingest oral food
unwilling to take oral feeds
upper GI tract impairment
Dysphagia
critical illness
malabsorption disorders
decreased LOC, coma

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14
Q

Parenteral feed is used when the patient

A

has a NON FUNCTIONING GI tract

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15
Q

Contraindications for enteral feeding

A
  • no gag reflex
  • non functioning GI tract
  • cannot elevate HOB
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16
Q

Complications of enteral feeding

A

referring syndrome
aspiration
metabolic provlems
over hydration
hypo/hypernatremia
tube dislodgement
infection
GI side effects

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17
Q

How to prevent aspiration

A

ensure head of bead is elevated during feeding and for 1 hour following intermittent feeds

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18
Q

what S&S should be observed for with aspiration

A

increased SOB, productive cough, sputum, difficulty swallowing
assess gag reflex, temperature, HR, RR

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19
Q

What is a Nasogastric tube?

A

Inserted into nostril down into the stomach (nasal tubes are usually inserted by a nurse unless a contraindication)

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20
Q

What must a patient have in order to have a NG tube

A

intact gag/cough reflex and adequate gastric emptying

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21
Q

What is NG tubes required for

A

short term feedings (less than 4-6 weeks)

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22
Q

What is a Salem sump

A

A large bore NG tube that has a double lumen

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23
Q

What is a salem sumps usual size

A

12-18 FR

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24
Q

What may a salem sump also be used for?

A

Suction as the smaller vent lumen allows for an inflow of air which prevents vacuum if the tube adheres to the stomach wall

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25
Q

Levin

A

A large bore NG tube that has a single lumen, often used with an anti-reflux valve

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26
Q

How often does a levin tube need to be changed?

A

Weekly

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27
Q

Anti-reflux valve

A

Prevents gastric reflux or leakage through the vent lumen of a double lumen NG tube

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28
Q

What does the valve do on an anti-reflux valve

A

allows the passage of air into the vent lumen when atmospheric pressure exceeds stomach pressure
when stomach pressure exceeds atmospheric pressure the valve prevents the flow of fluids through the tube

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29
Q

What is a small bore NG tube?

A

Levin
most common in IH for enteral feeding

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30
Q

what is the diameter for a levin?

A

6-12 FR

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31
Q

What does a small NG tube look like

A

smaller more flexible less irritating
may have weighted tip
have stylet to assist insertion

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32
Q

How often does a small NG tube need to be changed?

A

Monthly

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33
Q

What is a Naso-enteric tube

A

longer than a nasogastric tube (40cm or grater)
inserted into the upper small intestine
usually greater dilution and smaller volumes

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34
Q

What is a Naso-enteric tube used for?

A

clients at risk of aspiration

35
Q

What kinds of clients are at risk of aspiration

A

decreased LOC
poor or absent cough or gag reflexes
endotracheal intubation
recent extubation
inability to cooperate with procedure
restlessness or agitation

36
Q

What are some complications of Nasal Tubes?

A

Nasal pharyngeal irritation and pain
misplacement of tube
perforations (lung, esophagus, stomach, small intestine)
Inadvertent lung placement
sinitus, sore throat, epistaxis

37
Q

What is a gastrostomy tube (jejunostomy tube)

A

inserted THROUGH abdominal wall into the stomach or jejunum (placed laparoscopy)
larger abdominal incision
usually longer NPO time before starting feeds

38
Q

How long is a gastronomy tube usually in for?

A

more than 6-8 weeks

39
Q

What is a Percutaneous Endoscopic Gastrostomy (PEG)/Jejunostomy tube?

A

Uses an endoscope to visualize the inside of the stomach, making a puncture through the skin and inserting the tube through the puncture
smaller incision
shorter NPO time
catheter with external bumper
internal inflatable retention balloon to maintain placement

40
Q

What are the indications for a long term feeding tube

A

Both inability to meet nutritional needs orally
death is not imminent

meets one:
has been more than 4-6 weeks on NG and/or orogastric feeds
Low probability of nutritional needs being met orally over the next 4-6 weeks
NG tube placement contraindicated

41
Q

How long is a PEG tube in for

A

longer than 6-8 weeks

42
Q

What are some complications of a PEG tube

A

Peristomal infection
leakage
accidental tube removal
tube blockage
tube fracture
tube displacement
peritonitis
aspiration pneumonia
bleeding

43
Q

When do nurses check the feeding tubes balloons?

A

NOT for the first 4 weeks after insertion, after 4 weeks check volume weekly or per facility

44
Q

What is the procedure for checking a tube feeds balloon?

A

Verify initial volume on insertion
use a slip tip syringe to avoid damage
remove all old wattle from balloon, measure and discard
with new syringe, draw up right amount and reinflate balloon

45
Q

What are aspiration risk factors for all feeding tubes?

A

HOB less than 30 degrees
impaired LOC
neuro deficits
poor oral health
Mal-positioned feeding tube
gastroesophageal reflex
age over 60 years
delayed gastric emptying

46
Q

What is aspiration treatment?

A

STOP FEEDS
Lowe HOB and put pt on left side (to prevent further seepage of formula into lungs)
suction PRN
administer O2 as needed
notify MD immediately
continue suctioning PRN

47
Q

Whe is a closed system/continous drip used?

A

initially when the pt does not tolerate bolus

48
Q

What is a closed system containers volume

A

1000-1500mL

49
Q

How long can a closed system be hung?

A

up to 48 hours

50
Q

when are closed systems essential

A

when feedings are administered into the small bowel

51
Q

How often does a closed system tubing/bag need to be changed

A

up to Q48H

52
Q

When is an open system/bolus or intermittent used

A

when the pt is able to tolerate bolus feeds

53
Q

What are the typical sizes of open system

A

250mL tetra packs
usually 300-500mL given several times per day

54
Q

How long is open system usually administered

A

at least over 30 minutes

55
Q

Where must open system feeds be administered

A

given only in the stomach (monitor for aspiration and distension)

56
Q

How to treat for open system feeding

A

rinsed with tap water, drained, and hung to dry following intermittent feeds

57
Q

All feeding systems need to be labelled with

A

Pt information
date/time
preparer’s initials
enteral feeding formula type, rate, strength, and amount

58
Q

Enteral feeding formulas

A

provides 1kcal/mL of solution with protein, fat, carbs, minerals, and vitamins in specific proportions

59
Q

What are available enteral feeding formulas

A

Low volume
high fibre
high protein
low sugar/CHO
high nitrogen
with finer for diarrhea tot
pre-digested and easy to absorb
natural formula

60
Q

how long can a tetra pack be hung

A

8 hrs

61
Q

How long can a reconstituted powder formula be hung

A

4 hours

62
Q

how long can a closed system formula bottle be hung

A

48 hrs

63
Q

How often does a normal system need to be changed

A

Q24hrs

64
Q

How often does a closed system need to be changed?

A

Q48hrs

65
Q

how often does feeding accessory equipment need to be changed?

A

Q24hrs

66
Q

How often does feeding attachments need to be changed?

A

weekly

67
Q

What is needed prior to initiating a feed?

A
  1. doctors order
  2. X ray confirming tube placement
  3. documentation of confirmation of tube placement
  4. dietician consulted for all enteral feed pts
68
Q

what is a total free water requirement

A

amount of fluid client needs in a 24 hours period to sustain life

69
Q

how much free water do enteral formulas contain?

A

60-85% free water

70
Q

what may be ordered if sodium is low

A

NS

71
Q

What are the feeding rates if the pt is not at high risk for referring syndrome?

A

full strength starting at 25mL/hr x8 hrs then increased if tolerated
increase to 50mL/hr then by 25mL Q8H to goal rate

72
Q

What are the feeding rates for a patient at high risk for referring syndrome?

A

full strength starting at 25mL/hr for 24hrs if tolerated for 8hrs increase to 40mL/hr

73
Q

what needs to happen pre and post med admin

A

flush with tap water

74
Q

when crushing medication how much water does it need to be dissolved in?

A

30mL

75
Q

how much water should be added to thick medications

A

5-10mL to prevent blockage

76
Q

what occurs at the bedside when giving meds through tube

A

perform abdominal assessment
assess tube site and tube placement
stop feed
assess content and residuals if needed
flush tube at least 30mL water before, between and after
restart feed is required
document

77
Q

How much water if normal fluid allowed

A

30 mL before 30 with med 30 after

78
Q

how much fluid if restricted

A

15 before med 30 with med 15 after

79
Q

how often does a continous tube feed need to be flushed

A

Q4H

80
Q

What are some reasons for a tube occlusion

A

inadequate flushing
tube resting on mucosa wall
coagulation of enteral feeding formula
certain medications, combining meds, and/or not crushing meds fine enough
using too small of a bore tube

81
Q

What assessments need to be done prior to enteral feed

A

baseline resp assessment
baseline CNS assessment
GI assessment
hydration assessment
weight
tube site assessment
feeding solution, expirary date, rate of admin

82
Q

What are the 4 things to assess with feeding tube placement?

A
  1. External length measurement - are to end of tube
  2. aspirate for stomach content
  3. measure the pH
  4. Auscultating over the stomach
83
Q

Gastric Residuals

A

use 60mL syringe
put 10-20mL of air into tube
flush with 10-30ml water after

NRSG 202 (8 decks)

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