Week 7: Enteral/Parenteral Flashcards
Enteral
Nutrition delivered through the GI system (mouth, gastric tube)
Pt nutrition
NPO (nothing by mouth): to rest the GI tract; pre-op, severe V/D, bowel obstruction, dysphagia
Clear liquid: to slowly introduce nutrients to GI tract (tea, jelly, broth, ginger ale); post-op
Full liquid: (1) clear liquid and (2) foods that become liquid at room temp. (ice cream, sherbet)
Soft diet: pureed diet for poor dentition or dysphagia
As tolerated: go by what pt feels is tolerable
Restrictive diets:
- Cardiac (low sodium/fat)
- Diabetic (low sugar)
- Renal (low protein/sodium/K+, fluid restriction)
- Obese (calorie-restrictive)
Fluid restrictive diets
Visual fluid volume guides: indicate how many ml are in different items for I&O documentation
NG intubation
Purposes:
1. Gastric decompression: fluid or air is suctioned from the stomach (rest GI after bowel surgery, paralytic ileus)
- Gastric lavage: irrigation of the stomach to remove irritants (ingestion of poison/overdose)
- Gastric gavage: gastric feeding
NGT insertion
Inserted by nurses, nursing students
Confirmed by XRAY before use upon placement
Placement checked (before tube feeding) by:
- Inserting air and auscultating “whoosh” over LUQ
- Checking gastric pH
- Suctioning green/yellow gastric content
NGT insertion procedure
- WIPE
- Measure and mark length to be inserted from tip of nose to earlobe and xiphoid
- Gather supples
- Position pt in semi-Fowler’s
- Lubricate end of NGT (3-4 in.)
- Guide up nostril while pt swallows/drinks water (epiglottis will prevent entry into trachea)
- Tape in place
- Check placement by XRAY
- Pt should be able to speak, minimal discomfort
Salem sump NGT
SHORT-term dual lumen NGT for gastric (1) decompression, (2) lavage, (3) medication delivery (NOT intended for lavage)
Blue “pigtail” allows air exchange to allow movement of fluid (do not knot to prevent leak; counterintuitive)
Typical adult size: 14-16 Fr.
Levin NGT
SHORT-term single lumen NGT for (1) gastric decompression, (2) lavage, and (3) gavage
Special feedings with infants
Preemies
Cleft lip or palate/structural deformities
Stiff lungs (makes sucking too exhausting)
Percutaneous Endoscopic Gastrostomy (PEG)
LONG-term feeding tube for BOLUS or CONTINUOUS feeding; it is inserted through the abdominal wall into the stomach, anchored by a balloon
MIC-KEY: flatter version of PEG; requires specific feed tubing that snaps onto valve
Used for: Head and neck CA, infants that cannot consume enough nutrients by mouth
Gastrojejunostomy/Jejunostomy tube
LONG-term, CONTINUOUS-only feeding tubes that decrease the risk for aspiration by keeping the esophageal-gastric sphincter (above stomach) closed; difficult/expensive to place (by interventional radiology)
Flush with sterile water to remain patent: in between meds., q8h if not in use, and q4h if continuous feeding
Types:
1. Gastrojejunostomy tube: three ports; G-port terminates in the stomach (suctions), while J-ports (FEED and Rx) terminate in the duodenum
- Jejunostomy tube: bypasses stomach directly into intestines
Kangaroo (patrol) pump
Controls rate of tube feed delivery (max 8 hr. feed volume; kangaroo bag changed q24h)
Meds. CANNOT be placed in bag
Must keep HOB at 30-45 deg. at all times to decrease risk of aspiration and V/
Gastric Residual Volume (GRV)
In continuous feeding, check GRV: if >1.5-2x the rate of tube feed delivery, re-instill residual, flush, and hold for 1 hr.
Re-check GRV before continuing feed
Stopcock/Lopez valve
Permits GRV-check or medication administration without disconnecting NGT/PEG from Kangaroo pump
Tube feed
Tube feed is hypertonic (pulls water out of cells) and may cause sudden D/ (d/t circulatory overload)
Types:
- Cans: used with kangaroo pumps
- Bottles with purple caps: inverted and hung on IV poles
Parenteral
Delivered intravenously (NOT through the GI tract)
Provides:
1. Fluids and electrolytes (NS, K+)
- Nutritional support (CPN/TPN or PPN; includes carbs., proteins, fats, electrolytes, vitamins, minerals)
- Medication administration (antibiotics)