ATI Fundamentals Chapter 54
Nursing actions in regards to nausea or vomiting when performing a enteral feeding (5-8):
Notify the provider. Check the tube's patency. Aspirate gastric residual volume. Auscultate for bowel sounds. Obtain a chest x-ray.
Intra-procedure for enteral feeding tube placement (1-4):
Prepare the formula, tubing, and infusion device. Check expiration dates, and note the content of the formula. Ensure that the formula is at room temperature. Set up the feeding system via gravity or pump.
Nursing actions in regards to skin irritation around the tubing site when performing a enteral feeding (1-2):
Provide a skin barrier for any drainage at the site. Monitor the tube's placement.
In regards to discomfort when performing a nasogastric intubation (4-5):
Provide oral hygiene frequently. Replace soiled tape or loose fixation devices.
Modular enteral feeding formulas (1-4):
3.8-4 kcal/mL Single-macronutrient preparation Not nutritionally complete Supplement to other foods
Nasogastric or nasointestinal feeding tubes (2):
For short-term therapy Inserted via the nose
Specialty enteral feeding formulas (1-4):
1-2 kcal/mL For meeting specific nutritional needs Not nutritionally complete Primarily for clients who have hepatic failure, respiratory disease, or HIV infection
Standard (polymetric) enteral feeding formulas (1-4):
1-2 kcal/mL Milk-based blenderized foods Whole-nutrient formulas, either commercial or from the dietary departments Only for clients whose GI tract can absorb whole nutrients
Elemental enteral feeding formulas (1-4):
1-3 kcal/mL Predigested nutrients Not nutritionally complete Easier for a partially dysfunctional GI tract to absorb
Intra-procedure for nasogastric tube placement (10-11):
Clamp the NG tube, or connect it to the suction device. Salem sump tubing has a blue pigtail for negative air release, preventing vacuum pressure if the tube adheres to the stomach lining and allowing secretions to drain continuously. Do not clamp it when the tube is attached to suction.
Nasogastric tube
A hollow, flexible, cylindrical device the nurse inserts through the nasopharynx into the stomach.
"Setting up the equipment" for enteral feeding tubes includes (9-11):
Clean gloves Supplies for blood glucose (if protocol or prescription indicates) Suction equipment to use in case of aspiration
Enteral feeding indications (4-6):
GI disorders: enterocutaneous fistula, inflammatory bowel disease, mild pancreatitis Respiratory failure with prolonged intubation Inadequate oral intake
Why are enteral access tubes necessary?
Gastroparesis, esophageal reflux, or a history of aspiration pneumonia generally requires intestinal placement.
Percutaneous endoscopic gastrostomy or jejunostomy (2):
Therapy duration longer than 6 weeks Inserted endoscopically
Intra-procedure for nasogastric tube placement (8-9):
After placement verification, secure the NG tube on the nose, avoiding pressure on the nares. If the tube is not in the stomach, advance it 1-2 inches.
Nasogastric tube feeding (2):
Alternative to the oral route for administering nutritional supplements. Tube types: Duo, Levin, Dobhoff
In regards to possible excoriation (tissue damage) of nares and stomach when performing a nasogastric intubation (3):
Apply water-soluble lubricant to the nares as necessary. Asses the color of the drainage. Report dark, coffee-ground, or blood streaked drainage immediately. Consider switching the tube to the other naris.
Intra-procedure for nasogastric tube placement (1-4):
Auscultate for bowel sounds, and palpate the abdomen for distention, pain, and rigidity. Raise the bed to a level comfortable for the nurse. Assist the client to high-Fowler's position (if possible). Assess the nares for the best route to determine how to avoid a septal deviation or other obstruction during the insertion process.
How is nasogastric tube placement verified (2)?
Confirm placement with an x-ray. Injecting air into the tube and then listening over the abdomen is not an acceptable practice.
Gastrostomy or jejunostomy feeding tubes (2):
Therapy duration longer than 6 weeks Inserted surgically
How is enteral feeding tube placement verified (1-2)?
Check gastric contents for pH. A good indication of appropriate placement is obtaining gastric contents with a pH between 0 and 4. Aspirate for residual volume.
Administering the formula through continuous-drip feeding (1-4):
Connect the feeding bag system to the feeding tube. If using a pump, program the instillation rate, and set the total volume to instill. Start the pump. Flush the enteral tubing with at least 30 mL water every 4-6 hr, and check tube placement again.
Enteral feeding indications (1-3):
Critical illness/trauma Neurologic and muscular disorders: brain neoplasm, stroke, dementia, myopathy, Parkinson's disease Cancer that affects the head and neck, upper GI tract
Enteral feeding tube complications (4):
Diarrhea three times or more in a 24-hour period Nausea or vomiting Aspiration of formula Skin irritation around the tubing site
Nasogastric intubation indications (4):
Decompression Feeding Lavage Compression
Enteral feedings
Enteral feeding is a method of providing nutrients to clients who cannot consume foods orally but whose GI tract is functioning.
Pre-procedure for nasogastric tube placement (4-6):
Evaluate the client's ability to assist and cooperate. Establish a means of communication to signal distress (the client raising a hand). Perform hand hygiene.
Nasogastric intubation complications (3):
Excoriation of nares and stomach Discomfort Occlusion of the NG tube leading to distention
"Setting up the equipment" for enteral feeding tubes includes (1-4):
Feeding bag Tubing 30- to 60- mL syringe (compatible with the tubing) Stethoscope
Administering the formula through intermittent feeding (5-6):
Fill the syringe with 40-50 mL formula. If using a feeding bag, fill the bag with the total amount of formula for one feeding, and hang it to drain via gravity until empty (about 30-45 minutes).
Administering the formula through intermittent feeding (8-10):
Follow the manufacturer's recommendations for formula hang time. Refrigerate unused formula, and discard after 24 hrs. Some facilities require gastric residual volume checks, typically every 4-6 hr. Check facility protocol for specific actions to take for the amount of residual. Do not delegate this skill to assistive personnel.
Administering the formula through intermittent feeding (7-8):
If using a syringe, hold it high enough for the formula to empty gradually via gravity. Continue to refill the syringe until the amount for the feeding is instilled. Follow with at least 30 mL water to flush the tube and prevent clogging.
In regards to occlusion of the NG tube leading to distention when performing a nasogastric intubation (2):
Irrigate the tube per the facility's protocol to unclog blockages. Use water with enteral feedings. Have the client change position in case the tip of the tube is against the stomach wall. Verify that suction equipment functions properly.
Post-procedure for nasogastric tube placement (4-6):
Measure and record any drainage, assessing it for color, consistency, and odor. Ensure comfort. Document all relevant information.
Intra-procedure for enteral feeding tube placement (5-7):
Mix or shake the formula, fill the container, prime the tubing, and clamp it. Assist the client to Fowler's position, or elevate the head of the bed to a minimum of 30 degrees. Auscultate for bowel sounds.
Nursing actions in regards to aspiration of formula when performing a enteral feeding (6-9):
Monitor for decreased oxygen saturation or increased respiratory rate. Auscultate breath sounds for increased congestion. Notify the provider. Obtain a chest x-ray.
Administering the formula through intermittent feeding (5-7):
Monitor intake and output, and include 24-hr totals. Monitor capillary blood glucose every 6 hr until the client tolerates the maximum administration rate for 24 hr. Use an infusion pump for intestinal tube feedings.
Intra-procedure for enteral feeding tube placement (8-10):
Monitor tube placement. Flush the tubing with at least 30 mL water. Administer the formula.
"Setting up the equipment" for nasogastric tube placement includes (1-4):
NG tube: selected according to the indication Tape or use a commercial fixation device to secure the dressing Clean gloves Water-soluble lubricant
Types of enteral access tubes (3):
Nasogastric or nasointestinal Gastrostomy or jejunostomy Percutaneous endoscopic gastrostomy or jejunostomy
How is enteral feeding tube placement verified (3-4)?
Note the appearance of the aspirate. Return aspirated contents, or follow the facility's protocol.
Administering the formula through intermittent feeding (1-4):
Prepare the formula and a 60 mL syringe. Remove the plunger from the syringe. Hold the tubing above the instillation site. Open the stopcock on the tubing, and insert the barrel of the syringe with the end up.
Nursing actions in regards to diarrhea three times or more in a 24-hour period when performing a enteral feeding (4-5):
Provide skin care and protection. Consult with the provider if the client is receiving antibiotics, possibly for a prescription for a different antibiotic.
Nasogastric tube decompression (2):
Removal of gas or stomach contents to prevent or relieve distention, nausea, and vomiting. Tube types: Salem sump, Miller-Abbott, Levin
Pre-procedure for nasogastric tube placement (1-3):
Review the prescription and purpose, plan for drainage or suction, and understand the need for placement for diagnostic purposes. Identify the client, and explain the procedure. Review the client's history (nasal problems, anticoagulants, previous trauma, past history of aspiration).
Pre-procedure for enteral feeding tube placement (1-2):
Review the prescription. Generally, the provider and dietary staff consult to determine the type of tube feeding formula. Set up the equipment
In regards to discomfort when performing a nasogastric intubation (1-3):
Rinse the mouth with water for dryness. Throat lozenges and swabs moistened with water can help. Obtain a prescription for a local anesthetic solution for gargling to help relieve irritation.
Pre-procedure for nasogastric tube placement (7-9):
Set up the equipment. Position a disposable towel and basin. Provide privacy.
Nursing actions in regards to nausea or vomiting when performing a enteral feeding (1-4):
Slow the instillation rate. Keep the head of the bed at 30 degrees. Make sure the formula is at room temperature. Turn the client to the side.
Nursing actions in regards to diarrhea three times or more in a 24-hour period when performing a enteral feeding (1-3):
Slow the instillation rate. Notify the provider. Confer with the dietitian.
Enteral formulas (4):
Standard (polymetric) Modular formulas Elemental formulas Specialty formulas
"Setting up the equipment" for nasogastric tube placement includes (5-8):
Topical anesthetic Cup of water and straw Catheter-tipped syringe, usually 30-60 mL Basin to prepare for gag-induced nausea
"Setting up the equipment" for nasogastric tube placement includes (13-15):
Suction apparatus if attaching the tube to continuous or intermittent suction Gauze square to cleanse the outside of the tubing after insertion Safety pin and elastic band or commercial device to secure the tubing and prevent accidental removal
What is documented when removing a nasogastric tube (4)?
Tubing removal and condition of the tube. Volume and description of the drainage. Abdominal assessment, including inspection, auscultation, percussion, and palpation. Last and next bowel movement and urine output.
Post-procedure for nasogastric tube placement (1-3):
The insertion and maintenance of an NG tube is a nursing responsibility, but nurses may delegate measuring output, providing comfort, and giving oral care. For removal, wear clean gloves. Inform the client of the prescription and process, emphasizing that removal is less stressful than placement.
Nasogastric Intubation (NG)
The insertion of a nasogastric (NG) tube to manage GI dysfunction and provide enteral nutrition via the NG tube. Nurses also give enteral feedings through jejunal and gastric tubes.
Intra-procedure for nasogastric tube placement (5-7):
Use the correct procedure for tube insertion, wearing clean gloves, and evaluate the outcome. If the client vomits, clear the airway, and provide comfort prior to continuing. Check placement. Aspirate gently to collect gastric contents, testing pH (4 or less is expected), and assess odor, color, and consistency.
Nasogastric tube compression (2)
Using an internal balloon to apply pressure for preventing GI or esophageal hemorrhage. Tube type: Segstaken-Blakemore
Nasogastric tube lavage (2):
Washing out the stomach to treat active bleeding, ingestion of poison, or for gastric dilation. Tube types: Ewald, Levin, Salem sump
Nursing actions in regards to aspiration of formula when performing a enteral feeding (1-5):
Withhold the feeding. Turn the client to the side. Suction the airway. Provide oxygen if indicated. Monitor vital signs for elevated temperature.
"Setting up the equipment" for enteral feeding tubes includes (5-8):
pH indicator strip Infusion pump (if not a gravity drip) Appropriate enteral formula Irrigant solution: sterile or tap water, according to the facility's policy
"Setting up the equipment" for nasogastric tube placement includes (9-12):
pH test strip or meter to measure gastric secretions for acidity Stethoscope Disposable towel to maintain a clean environment Cap or plug to close the tubing after insertion