_______is a means of poviding liquid nourishment through a tube into the gastrointestinal (GI) tract
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
5. oral trauma
6. mouth surgery
Those suffering from conditions with increased nutritional requirements, such as burns, infection, surgery, or fractures, may __________
also need supplemental nutrition
What do the liquid formulas for tube feedings contain?
adequate amounts of protein, fat, carbohydrates, vitamins, and minerals to maintain good nutrition
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
There is specialized formula marketed specifically for what?
stress, renal failure, diabetes, AIDS, and other disorders
What are the major considerations when choosing a formula?
type and amount of formula and the amount of extra water needed
___________is the tube that passes through the clients nose and into the stomach
Nasogastric tube or NG Tube
_________is the tube that may be placed directly into the stomach through the abdominal wall
Gastrotomy tube or G 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
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
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 nurse is responsible for washing or replacing the __________ as per hospital policy and documenting care.
When is water especially important?
When the client has a fever or if signs of inadequate hydration develope.
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).
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
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)
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
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 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 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 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 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:
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)
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)
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)
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
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
If using a syringe to do a feeding how high do you raise the syringe?
12 to 18 inches above the somach
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