101 Unit 8

Intermittent feedings

Similar to bolus feedings in that they are administered in equal amounts throughout the day, but use smaller volumes and longer administration times.

Cyclic feedings

Similar to continuous feedings except that the formula is infused over a period of 8 to 12 hours, often during the night when the patient is sleeping.

Closed feeding system

Sterile RTH bottles 48 hrs Aseptic handling *Do not use IV tubing

Continuous feedings are delivered at a constant rate over a long period of time. T/F

True

Intermittent feedings are administered regularly throughout the day over one or more hours. T/F

True

Monomeric formulas contain molecules of fat, carbohydrates, and proteins in a form that is easier to digest. T/F

True

Open feeding systems

Used for cans of formula 1. Syringe --replace 24 hrs --date, time, nurse initials 2. Bag --replace 24 hrs --hang 4-8 hrs max --up to 1000 mL --Continuous --Cyclic --Intermittent --Large bolus

The nurse is teaching a patient how to reconstitute a powdered formula for enteral feedings. Which of these statements made by the patient indicates the need for additional teaching? a. "I can save money by using more water than indicated in the instructions." b. "I can store leftover formula in the refrigerator for up to 24 hours. c. "I need to thoroughly mix the reconstituted solution before using." d. "Formula left at room temperature must be used within four hours."

a. "I can save money by using more water than indicated in the instructions."

An open system enteral nutrition bag should be changed every: a. 24 hours. b. 48 hours. c. 72 hours. d. 96 hours.

a. 24 hours.

Nursing care of a patient receiving enteral nutrition encompasses—

a. Verifying provider order b. Correct labeling of the delivery system (syringe or enteral bag) c. Verifying placement of the tubes and checking the insertion site (if PEG or PEJ tube placed) d. Maintaining aseptic technique while administering the formula e. Preventing aspiration by elevating the head of the bed f. Checking gastric residual volume

Enteral nutrition is preferred over intravenous nutrition because: a. enteral nutrition stimulates normal GI function. b. enteral nutrition provides more carbohydrate, fat, and protein than intravenous nutrition. c. enteral nutrition helps maintain intestinal immunity. d. enteral nutrition stimulates the release of digestive enzymes.

a. enteral nutrition stimulates normal GI function. c. enteral nutrition helps maintain intestinal immunity. d. enteral nutrition stimulates the release of digestive enzymes.

Which type of tube feeding offers the highest risk of aspiration? a. nasogastric tube b. nasojejunal tube c. percutaneous endoscopic gastrostomy tube d. percutaneous endoscopic jejunostomy tube

a. nasogastric tube

The nurse is preparing to give medications through a feeding tube. Which of the following types of water is the most appropriate to reduce the risk of bacterial contamination? a. normal saline (0.9% sodium chloride solution) b. distilled water c. tap water d. sterile water for irrigation

a. normal saline (0.9% sodium chloride solution) d. sterile water for irrigation

Labeling

a. patient identifiers (per facility protocol) b. type of formula c. enteral access site (NG, gastrostomy, or jejunostomy tube) d. administration method (bolus, continuous, intermittent, cyclic) e. initials of person preparing the feeding f. date and time the formula was prepared and hung

Open system enteral bags and associated equipment must be discarded

after 24 hours.

The nurse is preparing to document findings about gastric residual volume. Which of the following statements provides the most accurate information? a. "Aspirated large quantity of white gastric residual." b. "Aspirated 100 mL white, slightly curdled gastric residual from PEG tube. Contents returned to stomach." c. "Aspirated 150 mL greenish brown gastric residual from PEG tube." d. "Aspirated small quantity of white, liquid gastric residual. Returned to stomach."

b. "Aspirated 100 mL white, slightly curdled gastric residual from PEG tube. Contents returned to stomach."

Which feeding most closely mimics natural mealtimes? a. continuous feeding b. bolus feeding c. cyclic feeding d. intermittent feeding

b. bolus feeding

The four basic delivery methods for enteral feedings are

bolus, continuous, cyclic, and intermittent.

Which of these actions shows that the nurse understands the concepts of caring for a patient with a feeding tube? a. The nurse aspirates stomach contents to check gastric residual volume right after completing a bolus feeding. b. The nurse elevates the head of the bed to 15 degrees during the feeding. c. The nurse wipes the formula lid with an alcohol swab prior to opening. d. The nurse obtains 100 mL of normal gastric aspirate and discards it.

c. The nurse wipes the formula lid with an alcohol swab prior to opening.

A feeding that is delivered continuously over a period of 8 to 12 hours, often during the night, is called a: a. continuous feeding. b. bolus feeding. c. cyclic feeding. d. intermittent feeding.

c. cyclic feeding.

How often should the nurse check gastric residual for a critically ill patient receiving continuous feedings? a. every 15 minutes b. every hour c. every 4 hours d. every 8 hours

c. every 4 hours

Enteral feeding labels should contain all of the following information except: a. patient identifiers. b. administration method. c. initials of the prescriber. d. date and time the formula was hung.

c. initials of the prescriber.

Which formula type is most likely to be ordered for a patient who has a normal functioning GI tract? a. monomeric b. monosterol c. polymeric d. polysterol

c. polymeric

Sterile, ready-to-hang bottles may hang for no longer than: a. 4 hours. b. 8 hours. c. 24 hours. d. 48 hours.

d. 48 hours.

Which of these statements is true regarding the administration of medications through a feeding tube? a. All types of medications may be given through a feeding tube. b. Dissolve enteric-coated tablets in a small amount of warm water. c. Delivering all medications through the feeding tube at the same time is acceptable. d. Flush the feeding tube after each medication with 15 to 60 mL sterile water.

d. Flush the feeding tube after each medication with 15 to 60 mL sterile water.

A feeding tube placed through the nares into the jejunum is called a: a. percutaneous endoscopic jejunostomy tube. b. percutaneous endoscopic gastrostomy tube. c. nasogastric tube. d. nasojejunal tube.

d. nasojejunal tube.

The choice of feeding tube placement depends upon all of the following conditions except: a. the reason why the patient needs the feeding tube. b. the length of time the tube is expected to be used. c. the presence of a functioning or partially functioning GI tract. d. the gender of the patient.

d. the gender of the patient.

The gold standard for verifying placement of a feeding tube is: a. injecting air into the tube and auscultating for whooshing sounds over the stomach. b. checking the pH of gastric aspirate. c. testing for the presence of carbon monoxide inside the feeding tube. d. using radiography (x-ray).

d. using radiography (x-ray).

Enteral formulas may be delivered via

enteral pump or by gravity.

Enteral nutrition provides nutrients for individuals who:

have a functioning or partially functioning GI tract, but who are unable to swallow or cannot eat adequate amounts of food normally.

An enteral pump should never be used to deliver

intravenous fluids.

An open system of delivery may hang for

maximum of 4 to 8 hours, depending upon facility policy.

Medications should be given

one at a time.

The choice of formula will depend on the specific needs of the patient, and the formula may be

polymeric, monomeric, or disease-specific.

Enteral nutrition is delivered to

the stomach or the small intestine through tubes placed in the nares or placed directly into the stomach or jejunum.

Closed systems of enteral delivery may hang for:

up to 48 hours after opening

Indications for Enteral Nutrition

• Risk of aspiration due to a neurological disorder or injury • Difficulty chewing food or swallowing food or fluids • Intestinal obstruction • Coma or altered level of consciousness • GI tract disorder, injury, or surgery • Severe burns • Mechanical ventilation (respirator) • Malnutrition

Clogged tube Intervention

-Flush tube with 20 to 30 mL water before and after every feeding or every 4 hours during a continuous feed. -Flush tube before, after, and between medications.

Aspiration of stomach contents into the lungs Intervention:

-Immediately discontinue tube feeding. -Suction oral cavity to clear contents. -Notify physician for possible chest x-ray and prophylactic antibiotics. -Check placement of tube.

Nausea or vomiting Intervention:

-Reduce the flow rate. -Check the gastric residual volume. -Notify the provider. Anticipate orders for reduced volume of feedings, increased frequency of feedings, or change to continuous feeding. -Administer medications such as metoclopramide as ordered to increase GI motility. -Administer antiemetics as ordered for nausea. -Anticipate change to a less-concentrated formula.

Infection Intervention

-Use aseptic technique when handling enteral feeding equipment and supplies. -Discard formula, administration sets, and supplies per manufacturer's specifications and facility policy. -Monitor tube insertion site for signs and symptoms of infection. -Monitor patient's vital signs as directed.

"French"

0.33 mm

Verifying placement of NG Tube

1) X-Ray is best -cost and danger 2) Bedside -aspiration (green color) -pH (4.0) -Air injection -CO2 (not in trachea!)

Jejunostomy tube (PEJ)

12 - 24 French Long-term feeding

Gastrojejunostomy tube (PEGJ)

12 - 30 French Long-term Feeding

Gastrostomy tube (PEG-percutaneous endoscopic gastronomy)

12 - 30 French Long-term feeding

Elevate head of bed

30 - 45 degrees

Nasogastric (NG) tube

5 to 8 French Short-term feeding

Nasoduodenal tube Nasojejunal tube

6 - 10 French Short-term feeding • Used when gastric feeding is not possible or is contraindicated

Before and after instilling each medication.

A feeding tube should be flushed with sterile water or normal saline

Bolus tube feedings

Administered at regular intervals in large quantities over a relatively short period. Mimic natural mealtimes

Before every feeding

Aspirate for gastric residual volume -measure -observe color/consistency -document -return to stomach (to maintain pH/electrolyte balance)

The accidental drawing of stomach contents into the respiratory tract.

Aspiration

Listening to sounds inside the body, usually with a stethoscope.

Auscultation

The interior diameter of a tube.

Bore

Polymeric formulas

Contain whole molecules of protein, fats, and carbohydrates and are intended for patients who can tolerate and digest complex molecules properly.

Monitoring residual times

Critically ill: 4 hrs non-critical: 6-8 hrs

Continuous feedings

Deliver a constant amount of formula to the patient using gravity flow or an electronic feeding pump set at a mL/hour flow rate as prescribed by the provider.

Disease-specific formulas

Designed for patients with liver, kidney, and pulmonary diseases, and patients with diabetes or impaired immunity.

Occurs when the contents of the stomach are rapidly emptied, or dumped, into the small intestine.

Dumping Syndrome

A long, thin tube used to visually examine the inside of a hollow organ, such as the stomach, colon, or bladder.

Endoscope

By way of the intestine; pertaining to the digestive tract.

Enteral

ALERT

Enteral formulas can cause death if infused intravenously. Most enteral tubes have bright orange end adapters or connections to differentiate them from intravenous tubing. Never use an enteral feeding pump to deliver intravenous fluids or medication, and vice versa.

Bolus feedings deliver large amounts of formula over 2 to 3 hours. T/F

False

Enteral pumps can be used to deliver both enteral and intravenous fluids. T/F

False

The volume of contents (usually an enteral formula) aspirated from the stomach through a patient's feeding tube.

Gastric Residual Volume

The length of time that a formula is considered safe for administration to the patient.

Hang-time

Describes a solution that contains the same concentration of salt as the cells and blood of the body.

Isotonic

Nutrients needed in large quantities, such as carbohydrates, proteins, and fats.

Macronutrition

Monomeric formulas

Made for patients who cannot digest or absorb whole nutrients. These formulas contain proteins, fats, and carbohydrates that are broken down into easy-to-digest molecules.

Preferable for feeding tube administration.

Medications in a liquid form

Should not be given through an enteral tube.

Medications that cannot be crushed

Nutrients needed in small quantities, such as vitamins and minerals.

Micronutrition

Giving Medications Through a Feeding Tube

NG tubes and jejunotomy tubes clog easily because of their small diameter. -Certain medications may form a solid mass when in contact with formula inside the tube -Some medications that are intended to be absorbed in the stomach may be rendered inactive if given through a jejunostomy tube.

The nostrils.

Nares

Powdered formulas

Peds -agitate before reconstituting -mixed (24 hrs fridge) -room temp (4 hrs)