CH 11 Administering a Tube Feeding

The nurse is administering an intermittent tube feeding using a gravity set-up and open feeding bag system. At what level should the nurse place the feeding bag on the pole?

12 in (30 cm) above the stomach. The nurse would hang the feeding bag 12 in (30 cm) above the stomach. Proper feeding bag height reduces the risk of formula being introduced too quickly.

The nurse is preparing to administer an intermittent feeding to a client who has a nasogastric feeding tube. Place the following steps in the correct order. Use all options.

1)Position the client with the head of bed elevated 30 to 45° degrees. 2)Verify correct tube placement. 3)Aspirate all gastric contents. 4)Verify that residual volume is less than 200 mL. 5)Flush the tube with 30 mL of water. 6)Administer the feeding. Elevating the head of the bed 30 to 45° degrees minimizes the possibility of aspiration into the trachea. Verifying correct tube placement ensures that the formula is being delivered to the stomach appropriately. The nurse should aspirate all gastric contents with the syringe and measure to check for gastric residual, the amount of feeding remaining in the stomach from the previous feeding. This is done to identify delayed gastric emptying. High gastric residual volumes (200 to 250 mL or greater) can be associated with high risk for aspiration and aspiration-related pneumonia, so feedings should be held if residual volumes exceed 200 mL on two successive assessments. Flushing the tube prevents occlusion.

The nurse has finished aspirating the gastric contents before administering a prefilled, continuous tube feeding. At this point in the procedure, how much sterile water would the nurse use to flush the tube?

30 mL Following aspiration of the gastric contents, the nurse would use 30 mL of sterile water to flush the tube. Water rinses the feeding from the tube and keeps it patent.

A client is receiving a continuous tube feeding. Which accurately describes an aspect of this procedure?

A feeding pump is used for a continuous feeding. A continuous tube feeding is administered over a 24-hour period and a feeding pump is always used. The nurse would check for residual every four to six hours. Regardless of the type of tube used, the procedure for tube insertion is the same.

The nurse provides the client with a gravity feeding via a gastrostomy tube. Which action is correct?

Allow the feeding to infuse slowly from the feeding bag. The nurse allows the gravity feeding to infuse over about 30 minutes from the feeding bag. The tube is flushed before and after feedings with 30 mL of tap water. Gastric contents are replaced unless there is a large quantity according to institution policy. The nurse does assist the client to be comfortable, but the client must stay in an upright position for approximately 1 hour after feeding for safety.

A nurse enters a client's room to perform a tube feeding. Which nursing action should be performed first?

Aspirate stomach contents and check pH. Nasogastric tube placement should be checked before flushing, giving medications, or feeding. After placement has been ensured, the gastric residual should be checked, the nasogastric tube should be flushed as ordered, and the tube feeding administered.

The nurse is preparing to administer an intermittent feeding to a client who has a feeding tube. The nurse is unable to aspirate gastric contents and realizes that the tube is clogged. Which action is correct?

Connect a syringe filled with warm water to the feeding tube and flush it out using gentle pressure. Most obstructions are caused by coagulation of formula. The nurse should try using warm water and gentle pressure to remove the clog. Carbonated sodas, such as Coca-Cola, and meat tenderizers have not been shown effective in removing clogs in feeding tubes. Never use a stylet to unclog tubes. Advancing the tube is not needed, as this will not address the clog.

When monitoring a client with a continuous tube feeding, how often should the nurse confirm placement of the tube?

Every 4 to 6 hours. The nurse would confirm the tube placement for a client receiving a continuous tube feeding every 4 to 6 hours. Checking placement verifies that the tube has not moved out of the stomach.

The nurse is using a large syringe to administer an intermittent feeding to a client who has a nasogastric feeding tube. Which method should the nurse use to increase the flow rate of the formula?

Raise the height of the syringe. Syringe feedings are infused via gravity. Raising the syringe will increase the rate of infusion. Syringe pumps are used for IV infusions rather than gastric feeding. Feeding through a syringe should be done by gravity, not by positive pressure using the plunger. The client bearing down will likely have little effect on the rate of infusion.

Which should the nurse advise the client to do following successful administration of a tube feeding?

Sit up for 1 hour. After administering a tube feeding, the nurse should have the client sit up for at least 30 minutes to one hour to minimize risk for backflow or aspiration if any reflux or vomiting should occur.

The nurse is providing a continuous tube feeding for a client. At what angle should the head of the bed be set during the feeding?

30 to 45 degrees. During the administration of a continuous tube feeding, the head of the bed should be elevated at 30 to 45 degrees. This position minimizes possibility of aspiration into the trachea. Clients considered high risk for aspiration should be assisted to at least a 45-degree position.

The charge nurse is observing a new nurse care for a client who is receiving a continuous feeding through a nasogastric feeding tube. Which action by the new nurse would require intervention by the charge nurse?

The new nurse places the client in the left lateral recumbent position. The client's head should be elevated 30 to 45 degrees. All of the other actions are correct and would not require intervention by the charge nurse.

The nurse is administering an intermittent tube feeding using a gravity set-up and open feeding bag system. After checking tube placement, which action would the nurse take next?

Check the residual (the amount of feeding left in the stomach from the last feeding). After checking for tube placement, the nurse would check for the residual and then flush the tube with 30 mL of sterile water. If the residual amount does not exceed agency policy or the limit indicated in the medical record, then the nurse would proceed with the feeding.

When administering a continuous tube feeding using a feeding pump and closed tube feeding system, the nurse plans to check for residual at which frequency?

Every 4 to 6 hours. When administering a continuous tube feeding, the nurse would check for residual every 4 to 6 hours.

The nurse is administering an intermittent tube feeding to a client via gravity using an open feeding bag system. What step would the nurse perform when the feeding bag is empty?

Flush the feeding bag with 30 mL water. When the feeding bag is empty, the nurse would flush the feeding bag with 30 mL water to flush out the bag itself and the feeding tube at the same time. The nurse would then clamp the tubing when the water is instilled.