NG Tube and feedings

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sorry for any typos

_______is a means of poviding liquid nourishment through a tube into the gastrointestinal (GI) tract

Tube feeding

Tube feedings may also be called_______because it involves the GI tract

enteral feedings

Why might a tube feeding be necessary?

in certain conditions that prohibit the person from taking adequate oral nourishment

What are some examples of why you would use a tube feeding?

1. loss of consiousness
2. inability to swallow
3. esophageal or gastric cancer
4. trauma
5. oral trauma
6. mouth surgery
7. anorexia

Those suffering from conditions with increased nutritional requirements, such as burns, infection, surgery, or fractures, may __________

also need supplemental nutrition

Tube feedings in some cases may be needed to maintain adequate what?

nutritional status

What must a client have in order to have any type of tube feeding?

functioning GI tract

What do the liquid formulas for tube feedings contain?

adequate amounts of protein, fat, carbohydrates, vitamins, and minerals to maintain good nutrition

Routine formulas generally provide what per milliliter?

one calorie

Routine formulas are free of what and low in what and contain how much protein?

Lactose free and low in residue and about 14% to 16% protein

Routine formula can be high in what?

high calorie, high protein, and high fiber

There is specialized formula marketed specifically for what?

stress, renal failure, diabetes, AIDS, and other disorders

Who helps the physician choose the right formula for the client?

Dietitian

______is a formula that is avaiable in cans, powder formulas are also avaiable.

Ready-mixed

________can be pureed in a blender are often used in the home

Table foods

What are the major considerations when choosing a formula?

type and amount of formula and the amount of extra water needed

The cost of different formulas_______

varies

Sites of access to the GI tract may ______

differ

___________is the tube that passes through the clients nose and into the stomach

Nasogastric tube or NG Tube

What feeding device is uncomfortable and not used for long term administeration?

NG Tube

_________is the tube that may be placed directly into the stomach through the abdominal wall

Gastrotomy tube or G tube

________is the tube that jejunum of the small intestine.

Jejunal tube or J tube

Where does the name come from that is given

can be derived from a particular device, the type of procedure used, placement of the tube

_______ is through the nose into the somach

nasogastric tube

What does PEG tube mean?

Percutaneous endoscopic gastrostomy

_____placed through the skin

PEG tube

______is place with an instrument called an endoscope

endoscopic

______is inserted into the stomach

Gastrostomy

_______ is a small silicone device used in place of a gastrostomy tube

Button feeding device

Each tube has its own equipment but the formula instillation is what?

the formula instillation is similar for all types of tubes

How far does the PEG tube extend beyond the skin and whats on the end of it?

12 to 15 inches above skin with cap covering the end

_______is a short crosspiece place near the opening through the skin (stoma)

bloster

What must the nurse note and report imediately with the PEG tube?

she must note the level of the PEG and wether there is any changes, if there are changes she must report imediately due to the tube has moved

What does a button feeding device replace if it is suspected that the client may have this for long term?

PEG-type G tube

The function of the button is the same as?

the PEG tube- but the button is level with the skin

The button is less cumbersome and more_____ for the confused adult or child to pull out.

difficult

The nurse is responsible for washing or replacing the __________ as per hospital policy and documenting care.

feeding bag

Can clients continue to eat or drink by mouth if the physician allows?

yes

What is extra water allowance called when adminstering feedings or between feedings?

free water

When is water especially important?

When the client has a fever or if signs of inadequate hydration develope.

What should you do if signs of dehydration occur?

document findings and alert the physician

What are signs of dehydration?

dry mouth, poor skin turgor (tone), complaints of thirst, illness, fever, or physical complaints

The head of the bed must be elevated to what when client is recieving a tube feeding?

about 30 degrees

What can happen to the client if the bed is put flat for even a short period of time?

the client is at risk for aspirating stomach contents and this can cause serious complications such as aspiration pneumonia and may even lead to morbidity or death.

_________or _______involves injecting into a vein any number of sterile solutions that the body needs including drugs and electrolytes

intravenous IV and/or Parenteral therapy

What does simple IV solutions contain and where are the infused?

they are infused into a peripheral vein, and they contain water with low concentrations of dextrose, electrolytes, or both

What are IV solutions used for and length of time?

They are used short-term basis to restore or maintain fluid and electrolyte balance

Why is simple IV therapy not ussed more than a few days without some sort of supplementation.

IV therapy is nutritionally inadequate for long term use

____________is used when the client cannot take sufficient amounts of nutrients via the enteral route (GI tract).

Parenteral therapy

What are some reasons that a client may be on Parenternal therapy?

clients with sever burns, or a disorder of the GI tract that may inhibit absorption of nutrients ( surgical removal of parts of the GI tract)

_______is specifically formulated and calculated solution that is nutritionally complete to meet a specific individuals needs.

Total parenteral nutrition TPN

What is another name for TPN?

hyperalimentation (although the term is not completely accurate)

_________uses several types of catheters (tubes).

TPN

TPN places the large catheter in a ____________ near the heart surgically.

central vein

Why is the TPN placed in a central vein near the hear?

to allow the concentrated solution to be diffused quickly into the circulation

What length of time can TPN be used?

it has become accepted to be used both short term and long term

When using a TPN what is one of the most important consideration?

prevention of infection of the catheter insertion site

_________contains lesser concentrations of the same ingredients found in central vein TPN, but is administered in a peripheral vein

Peripheral parenteral nutrition PPN

What is the PPN provide?

temporary nutritional support and to promote protein synthesis and weight gain when oral intake is inadequate or contraindicated

________is given peripherally must be hypotonic or isotonic ( to prevent dehydration and electrolyte imbalance)

infusions

PPN provides______calories.

fewer

The prolonged use of NPO is a serious problem , a client can be NPO for tests after surgery or because of vomitting. when should you bring the client to the attention of the team leader or physician?

when the client has been NPO for 3 or more days and is not recieving nutritional support

Medications and foods can sometimes cause what?

unwanted side effects

Can certain foods make medication ineffective?

yes

What should you take some medications with?

Food or water

Some medications should be given between what?

meals

Some medications react negatively with dairy products or alcohol. (t/f)

true

The nurse should know what when giving medications in regaurds of medication and reactions?

the nurse should be aware of the therapeutic medications reactions when given with certain foods

What could cause the inability to instill formula during a tube feeding?

Blocked tube

What can the nurse do if the the tube is blocked and not able to instill the formula during a tube feeding?

The nurse can aspirate gently with syringe or instill small amount of water, also can "milk" external tube with fingers.

What could cause the inability to aspirate stomach fluid from tube?

May be normal or none present or tube could be dislodged from proper position.

What can the nurse do if the she does not get stomach fluid from tube during a tube feeding?

Check placement, instill 10-20 mL tap water with syringe, quickly draw back (if discolored tubeis in stomach), Stop feeding and call physician if you think tube is dislodged

What can cause residual over 120 mL during a tube feeding

Feeding too fast or stomach slow to empty

What would the nurse do if residual is over 120mL?

Hold feeding for 2 hours, recheck residual; if still more than 120 mL call physician

What can cause nausea and vomiting during a tube feeding?

stomach emptying too slowly, solution running in too fast, gastrostomy tube has migrated to pylorus

What can cause abdominal cramps or diarrhea during a tube feeding?

formula is too high in fat , concentrated formula running too fast, formula too cold, formula may be spoiled, change in formula or medications

What can the nurse do for a client exsperiencing abdominal cramps or diarrhea during a tube feeding?

She can request to switch to lower fat formula, hold feeding for 2 hours or place the client on a slower drip rate,call physician if symptoms persist (dr may orderformula to be diluted or changed), give canned formulas at room temperature, warm refrigerated formulas to room temperature in hot water,refrigerate mixed formula and discard after 24 hours

What would cause gas during a tube feeding?

too much air in the stomach

What can the nurse do for a client with gas during a tube feeding?

Decompress as ordered

What could cause stoma bleeding (more than a few drops), or cause it to be red or irritated from the tube feeding?

Gastric leakage around the stoma

What can the nurse do for a stoma that is bleeding or appears to be red and irritated?

call the physician STAT if blood mixed with stomach contents, or fever, odor.

what could cause red irritated skin around the stoma?

improper skin care

What can the nurse do if the skin around the stoma is red and irritated?

provide good skin care

What does thirst, weakness, fever (over 100F) reduced urine output (normal is more than 1.5 L) signify in a patient with tube feedings?

infection, dehydration (body lacks fluid), formula intolerance

What can the nurse do in a client who is on a tube feeding and appears thirsty, dehydrated, running fever, and has reduced urine output?

Call physician (may increase amount of free fluids with or between feedings)

What does change in skin color (to pale or dusky) cough, noisy breathing, wheeze, restlessness, agitation, and fever of over 100F possibly caused from in a client who recieves tube feedings?

aspiration (backup of water or feeding into the lungs)

What can the nurse do for the client who has aspirated fluid or feeding back into lungs?

position the client with head/upper body elevated 40 degrees, keep elevated for 30 minutes after feedings, add a small amount of food coloring to formula to determine if sputum coughed up is mixed with formula, encourage person to cough and clear lungs, call physician for futher instructions

What can cause severe constipation (decreased number of bowel movements expected because of less residue in feeding formulas)?

lack of fluids in body, low residue formula, inactivity, change in formula or medications

What can the nurse do for a client with sever constipation that is on tube feeding?

check for adequate fluid intake (I&O), notify physician if continues more than 3 days, request/switch to higher fiber formula

What can cause the formula not to drip with gravity system in tube feedings?

Bag height too low, residue buildup in bag, residue buildup in tube

What can the nurse do if the feeding is not drippin properly?

raise bag to 3 feet above stomach level, wash feeding bag and flush tubing with vinegar water or replace the tube, flush tube with 50mL warm water, diet soda pop, or cranberry juice, use a small syringe (3mL or less) to provide greater pressure and unclog tube

What can cause gastostomy tube to become dislodged from the stomach?

malfunction of balloon or device holding tube in place

What can the nurse do if the gastostomy tube becomes dislodged?

Notify team leader or physician immediately for instructions the tract may be closed off

What can cause the gastrostomy tube to be longer or shorter than usual?

tube has become dislodged or migrated down into the stomach or pylorus

What can the nurse do if the gastrotomy tube is shorter or longer than normal?

gently pull, push, or rotate tube to its original posistion, call physician if unable to relocate.

When inserting a NG tube what would you check and why?

The physicians order and determine the type, size, and purpose of the NG tube.

If the physician did not order a specific size what is generally standard used?

16 or 18 french- adult
children can vary from a very small size 5 french to a size 12 french for older children.

What tubes may require insertion by a physician?

Larger NG tubes that are 20 to 30 french
enteric tubes such as:
---Ewald tube
---Cantor tube
---Miller-Abbott tube

What does the Ewald tube do?

it is used for gastric lavage of toxins

How is the cantor and miller-abbott tube made and what is the purpose of thes tubes?

they are quite large and have mercury, air or fluid filled bags attatched to the distal end of the tube, the purpose of the bag is to advance the tube with peristaltic waves with the therapeutic intent of breaking up intestinal blockages.

What should you do when setting up a tube feeding equipment or suction equipment?

make sure it functions properly.
( Be sure the equipment is at the right flow or strength of suction befor using it, Dr may order a specific type of NG tube such as Levin for short term use for gavage (forced feedings) or lavage (therapeutic irrigation), or Salem sump with it two lumens generally used for lavage and gastric suctioning, or a silicone type tube used for long term placement)

You should not explain the NG tube procedure to far in advance because the client anxiety about the procedure may interfere with its success. (T/F)

true

The NG tube is a ______technique.

Clean, the GI tract is not considered sterile

How should the client be positioned in ordered to insert a NG tube?

Full fowlers if possible- this assists the client to swallow and promotes peristalsis

How do you measure the length of the tube that will be needed to reach the stomach?

Measure from tip of nose to the ear then to the xiphoid process and mark the spot with a piece of tape.

Why should you clean the face and nose befor taping the NG tube?

the NG tube will stay more secure if taped on a clean non oily nose. if the nose has been cleaned with an alcohol wipe the tape will stay more secure and the tube will not move in the throat which could cause a gagging reflex later.

The blocked nasal passage may be totally occluded but its possible to still pass a NG tube through it. (t/f)

true

How far on the NG tube should you apply water soluable lubricant?

4 to 8 inches

What can be done prior to having a NG tube done to reduce the gag reflex?

hold ice chips in the mouth for a little while and the physician can also use a numbing nose spray

When inserting a NG tube how should the head be positioned?

Head flexed forward while tilting the tip of the nose upward

By asking the client to swallow this allow for a better chance of what when inserting the NG tube?

a better chance of passing into the stomach instead of the trachea

Stimulating the gag reflex is normal but asking client to swallow will do what?

minimize the gag reflex

If couging, persistant gagging, cyanoisis, or dsypnea occurs what should you do when inserting the NG tube?

remove the tube imediately the tube may be in the trachea

If obstruction is felt when inserting NG tube what should you do?

Pull tube out let client rest and try in the other nostril

you can place a temporary piece of tape across the nose to hold the NG in place while you check for placement also you should check the back of clients throat. (t/f)

true

What is the most accurate form to check for placement of NG tube?

XRay

How many methods do you use to check for placement of the NG tube?

at least two

What are the ways to check for placement of the NG tube?

Aspirate stomach contents- contents should appear cloudy, green, tan, off-white, bloody, or brown ( sometimes its hard to distinguish between stomach contents and respiratory aspirates.)
Check pH of aspirate- this is considered more accurate than visual inspection. pH should be in the range of 0-4 commonly less than 4 (respiratory is usually a 7 or more)
Inject 30mL of air into the stomach and listen for a whoosh sound
Xray- this is the only method that is considered positive

Its not uncommon to have slight bleeding form irritation of the mucosa in the nose (T/F)

true

What is considered low intermittent suction?

25 mm Hg

Always confirm placement of tube befor what?

medications, application of suction, or instillation of tube feedings

What should you do when preparing a formula?

shake can thoroughly and check expiration date, if formula is powder form mix according to instructions this type of formula can only be used for 24 hours befor it spoils and should be refrigerated although befor using the formula it must reach room temp

Befor administering a tube feeding what should you do?

determine placement of feeding tube by either:
1. aspirating stomach secreations
attach syringe to end of feeding tube
gently pull back on plunger
measure amount of residual fluid
return residual to stomach via tube and continue with feeding if amount does not exceeds agency protocal
2. injecting 10 to 20mL of air into tube (3-5mL for children)
attach syringe filled with air to tube
inject air while listening with stethoscope over left upper quadrant
3. measuring the pH of aspirated gastric secretions
4. take an xray

How high do you hang a feeding bag?

12 to 18 inches above the somach

How much water do you add to the feeding bag?

30 to 60mL (this clears the tubing)

If using a syringe to do a feeding how high do you raise the syringe?

12 to 18 inches above the somach

How would you controle a feeding rate with a syringe?

raising and lowering it

When using a pump to administer feeding how often should you stop it?

every 4 to 8 hours and assess the residual. you should flush it every 6 to 8 hours

What should you always do after administering a feeding?

Provide mout care by brushing teeth, offering mouth wash, and keeping the lips moist.

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