Module 16: Enteral Nutrition

Which source is likely to have a pH test result of 1 to 5? (Select all that apply.) A. Intestine of fasting patient. B. Pleural fluid from tracheobronchial tree. C. Stomach of fasting patient.

c Gastric fluid from a patient who has fasted for at least 4 hours usually has a pH range of 1 to 5. Fluid from an NI tube of a fasting patient usually has a pH greater than 6. The pH of pleural fluid from the tracheobronchial tree is generally greater than 6.

Which of the following accurately describes the greatest risk related to having a feeding tube? A. Aspiration. D. Infection. E. Fluid volume overload. Electrolyte imbalance.

a Although the risk of aspiration is lessened with a jejunal feeding tube, once a feeding tube is placed, all patients remain at risk for aspiration and need careful nursing management to avoid this complication.

The nurse is going to irrigate a nasogastric feeding tube. The nurse would be correct to draw up how much water into the ENFit syringe? A. The same amount as the gastric residual volume. B. 15 mL. C. 30 mL. F. 60 mL.

c Thirty milliliters is enough to clear the tubing of a nasogastric feeding tube.

The nurse attempts to aspirate gastric contents from an established NG feeding tube and obtains no return. What action should the nurse take? A. Reposition the patient, flush tube with 30 mL air, and reattempt to aspirate. D. Get an order for a chest x-ray film to verify placement before administering the tube feeding. E. Document the finding. F. Remove the tube and insert a new one.

A The nurse should first reposition the patient. The tip of the tube may be lying against the stomach wall. Changing the patient's position may move the tip away from the stomach wall. If this fails, notify the health care provider. It is undetermined whether the tube needs to be removed. Documentation of how the issue is resolved will be necessary when the procedure is completed.

The nurse is inserting an NG feeding tube. Which step in the procedure is inaccurate, indicating further instruction is needed? A. Perform hand hygiene and place patient in left lateral position. Determine length of tube from the xyphoid process to the tip of the patient's nose. Insert stylet into feeding tube. Inspect nares. Dip end of tube in ice water. D. When tip of tube reaches carina, stop and listen for air exchange from distal portion of tube. Continue to advance tube until desired length has been passed. Check back of throat with a penlight and tongue blade. Check placement of tube. E. Mark exit site on tube with indelible ink. Apply tincture of benzoin to nose and allow to become "tacky." Remove gloves and apply stabilization device. Obtain an x-ray film to verify tube placement. F. Hand patient a cup of water with a straw. Gently insert the tube through the nostril to back of throat. Have patient flex head toward chest. Give small sips of water and advance the tube as patient swallows. Rotate tube 180 degrees while inserting.

A The patient should be placed in a high Fowler's or sitting position to reduce the risk of pulmonary aspiration in the event the patient vomits. If the patient is comatose, place in semi-Fowler's position. The nurse should first explain the procedure to the patient to gain cooperation and check the feeding tube for flaws that could injure the patient. The length of the tube to be inserted is determined by measuring the distance from the tip of the nose to the earlobe to the xiphoid process. Ten milliliters of water should be injected into the feeding tube to aid stylet insertion, and the stylet should be securely positioned against the weighted tip. The tube may be dipped in water, but not ice water because this would only make the tube less pliable for insertion.

When should placement of a feeding tube be verified? (Select all that apply.) A. Before administering water through the tube. C. Before administering formula through the tube. E. At least once every 6 hours when continuous feedings are given. G. Before administering medications through the tube. I. Only when the health care provider orders it. J. If the patient is complaining of a sore throat.

A C E G The nurse is responsible for ensuring that the tube has remained in the intended position before administering formula or medications through the tube. Verification of tube placement is an expectation of competent nursing care of patients with feeding tubes. Therefore, verification of correct tube placement is performed before each intermittent feeding, at least once every 6 hours when continuous feedings are given, and before medications are administered through the tube. The patient may have a sore throat if it is an NG or NI tube from the presence of the tube in the back of the pharynx.

The nurse is inserting an NG feeding tube. Which of the following supplies will the nurse need to perform the procedure? (Select all that apply.) A. Tincture of benzoin. C. Saline nasal spray. D. 8- to 12-Fr feeding tube. F. Sterile specimen cup. G. Tube fixation device. I. Cup of water/straw. K. 60-mL ENFit syringe. M. Stethoscope.

A D G I K M The necessary supplies to insert a NG feeding tube include the following: 8- to 12-Fr nasogastric tube, 60-mL ENFit syringe, stethoscope, hypoallergenic tape, semipermeable (transparent) dressing, tube fixation device, tincture of benzoin or other skin protectant, pH indicator strip, cup of water and straw (for patients able to swallow), emesis basin, towel, facial tissues, clean gloves, suction equipment in case of aspiration, penlight to check placement in nasopharynx, and tongue blade.

The patient is receiving a continuous enteral feeding. Which of the following assessment findings would require follow-up? A. Gastric residual of 375 mL. D. pH of gastric contents 5.0. E. Less than 10 mL of aspirate from nasoenteric tube. F. Bowel sounds present in all four quadrants.

a GRVs in range of 200 to 500 mL should raise concern and lead to implementation of measures to reduce risk of aspiration. Normal residual for a nasoenteric tube is in the 10 mL or less range. Bowel sounds in all four quadrants and pH of 5.0 in gastric contents is normal for a patient who is receiving continuous enteral feeding.

The nurse aspirates stomach contents from a newly inserted feeding tube. The nurse is aware the patient has been on the proton pump inhibitor omeprazole. The pH strip reads "3." Where should the nurse expect the x-ray film to identify placement of the feeding tube? A. In the stomach. D. In the lungs. E. In the esophagus. F. In the small intestine.

a Gastric pH should measure 1 to 5; the proton pump inhibitor would only increase the pH reading, making stomach contents more alkaline.

The nurse is going to administer an intermittent tube feeding. Because the patient's feeding tube has been in place for 3 days, which action is best for the nurse to take at this time? A. Aspirate gastric contents and test on a pH strip. D. Obtain an order for x-ray film verification of tube location. E. Verify the indelible ink mark on the tube is at the nares. F. Auscultate over the gastric area while instilling 30 mL of air into the feeding tube.

a Ongoing verification of tube placement is made by pH testing of aspirate. Verification by x-ray film is necessary on feeding tube insertion and if tube migration is suspected. Auscultation is no longer considered a reliable method for determining feeding tube placement. The tube can migrate without moving at its externally taped location.

The nurse just inserted an NG feeding tube. The health care provider's order states to administer all meds per tube and a continuous feeding of Isocal at 30 mL per hour. The order also states to check the patient's blood glucose every 6 hours. When can the nurse begin to instill feedings, water, or medications through the feeding tube? A. When tube placement has been verified by x-ray film. D. When the patient's blood glucose is verified to be within normal limits. E. Immediately after placement is verified by pH testing. F. After administering 30 mL of water, the medications may be given, followed by another 30 mL of water, and then the continuous feeding may be initiated.

a Proper position is essential before instilling anything through the feeding tube. Upon insertion, placement of tube is verified by x-ray examination. Blood glucose readings aid in monitoring the patient's tolerance of the feeding.

The patient begins to cough and choke as the nurse is inserting the NG tube. What is the best action for the nurse to take at this time? A. Pull the tube back into the posterior nasopharynx and attempt to reinsert. D. Pull the feeding tube out and start over in the opposite naris. E. Auscultate over the carina. F. Instruct the patient to take small sips of water and swallow.

a The nurse should first pull the tube back without removing completely and attempt to reinsert. If the patient is already choking drinking water will not help. If the patient is coughing or choking, the tube has most likely entered the airway.

· Which sources are likely to have a pH test result of greater than 6? (Select all that apply.) A. Pleural fluid from tracheobronchial tree. C. Intestine of fasting patient. E. Stomach of fasting patient.

a c Gastric fluid from a patient who has fasted for at least 4 hours usually has a pH range of 1 to 5. Fluid from an NI tube of a fasting patient usually has a pH greater than 6. The pH of pleural fluid from the tracheobronchial tree is generally greater than 6.

A nursing instructor is reviewing the skill of irrigating a feeding tube with a group of nursing students. Which statement(s), if made by the nursing student, is(are) accurate, indicating learning has occurred? (Select all that apply.) A. "Bowel sounds should be present if the patient is receiving tube feedings." C. "It is unnecessary to irrigate a feeding tube if the patient's medications are in liquid form." D. "It is acceptable to delegate routine irrigation of a feeding tube to NAP." E. "Curdled enteral formula and improperly crushed medications are the most common causes of feeding tube occlusion." G. "The patient should be placed in a high Fowler's or semi-Fowler's position for feeding tube irrigation." I. "It is unnecessary to irrigate nasoenteric feeding tubes; only nasogastric tubes require irrigation."

a e g All types of feeding tubes require routine irrigation to keep a tube patent. Curdled enteral formula and improperly crushed medications are the most common causes of feeding tube occlusion. Having the patient in a high Fowler's or semi-Fowler's position reduces reflux and risk for pulmonary aspiration during irrigation. Certain formulas have properties that predispose to tube clogging. Irrigation prevents mixing of medications in tube, which may cause clogging.

The health care provider just left the patient's room after explaining the options of NG or NI feeding tube placement. A student asks a nurse about the differences between nasogastric and nasointestinal feedings. Which of the following are accurate statements made by the nurse? (Select all that apply.) A. Gastric aspirate is expected to have a lower pH than intestinal aspirate. C. Insertion of an NG tube requires clean gloves, whereas insertion of an NI tube requires sterile gloves. D. NI tubes are used for patients with nasal problems such as nosebleeds or deviated septums. NG tubes are used for patients without nasal problems. E. Both NG and NI tubes are usually used for less than 30 days. G. The advantage to an NI tube is that there is less risk for aspiration.

a e g Gastric aspirate is expected to have a pH less than 5 in a fasting patient, whereas intestinal pH is expected to be 6 or higher. There is believed to be less risk of aspiration with a nasoenteric tube because it is placed beyond the pylorus. Both NG and NI tubes are used for less than 30 days. Patients needing tube feedings for a longer period are candidates for a more permanent solution, such as a gastrostomy or jejunostomy tube.

Identify signs and symptoms of accidental respiratory migration of a feeding tube. (Select all that apply.) A. Coughing. C. Sore throat. E. Choking. G. Decreased pulse oximetry. I. Distention.

a e g Signs of respiratory distress such as paroxysms of coughing, choking, or persistent gagging; decreased pulse oximetry; cyanosis; or change in respiratory patterns (e.g., increase in rate) are symptomatic of accidental feeding tube migration into the airway. A sore throat may occur because of irritation by the feeding tube. Distention of the abdomen is not a symptom of accidental respiratory migration of a feeding tube.

Identify the appropriate times to verify enteral tube placement by pH testing. (Select all that apply.) A. Before administration of medications through the tube. C. Immediately after administration of medications through the feeding tube. D. Upon discontinuing the feeding tube. E. At least once every 6 hours during continuous feedings. G. Before each intermittent feeding.

a e g Verification of correct tube placement is performed before each intermittent feeding, at least once every 6 hours when continuous feedings are given, and before medications are administered through the tube. The nurse should wait at least 1 hour after medication administration before aspirating gastric contents. Premature aspiration of gastric fluid will remove medication, reducing the dose delivered to the patient. Medication may also interfere with pH testing. It is unnecessary to verify placement upon discontinuing the feeding tube.

A nurse is reviewing the policy for irrigating a feeding tube. What information should the nurse include that would address accurate principles of infection control when performing this procedure? (Select all that apply.) A. Perform hand hygiene and apply clean gloves to irrigate a feeding tube. C. Use only sterile water for irrigation. E. Change irrigation bottle every 24 hours. G. Tap water should not be used for feeding tube irrigation with neonates. I. Sterile water may be required for patients who are critically ill.

a e g i Irrigation bottle should be changed every 24 hours to ensure sterile solution. Sterile water is required for neonates and patients who are immune suppressed or critically ill; tap water may be appropriate in some clinical settings and in home care unless agency policy or health care provider orders state otherwise. Hand hygiene is performed and clean gloves are worn to irrigate a feeding tube to reduce the transmission of microorganisms.

Which of the following patients may benefit from enteral nutrition? (Select all that apply.) A. A patient with paralytic ileus. B. A patient with burns of the lower extremities. D. A patient who had a CVA (stroke) and has dysphagia (difficulty swallowing). F. A patient who has a brain injury. H. A patient with oral cancer.

b d f h Patients with brain injury or an altered or reduced level of consciousness and patients with neuromuscular diseases who have a high incidence of aspiration may benefit from long-term enteral therapy. Patients with head or neck cancer may be candidates for enteral nutrition. A patient with paralytic ileus has a nonfunctional GI tract, and enteral nutrition is inappropriate. Some patients have an increased metabolism as a result of sepsis or burns and are unable to ingest enough calories to meet their bodies' metabolic needs. These patients may also benefit from enteral nutrition.

· Why is it important to have the tube feeding at room temperature? A. It is unnecessary to keep the tube feeding cold because it will be hanging at room temperature anyway. B. Cold formula can cause gastric cramping. E. Cold formula may lower the patient's body temperature. F. It aids the speed of digestion.

b Cold formula can cause gastric cramping.

If the nurse suspects the NG feeding tube has migrated, the nurse should: A. Instill 10 mL of water into the feeding tube, reinsert the stylet, and reposition the tube. B. Stop any enteral feedings and obtain an order for a chest x-ray film to determine placement. E. Reposition the patient from side to side. F. Irrigate the tube with tap water.

b If the nurse observes signs of respiratory impairment, the feeding tube may have migrated from the stomach to the airway, or if the nurse obtains a larger amount of gastric residual, the tube may have migrated from the intestine to the stomach. The nurse should stop any enteral feedings, notify the health care provider, and prepare to obtain a chest x-ray film as ordered. A stylet should never be reinserted in a patient because this can cause perforation of the tube and injure the patient. Irrigating the tube with water would be appropriate if the tube were clogged. Turning the patient from side to side may help in obtaining aspirate.

A nurse is telling a coworker that she is unable to flush a feeding tube. Which suggestion offered by the coworker would be accurate, useful information? A. "Try using Coca-Cola to flush the tubing; the carbonation will break up any blockage." B. "Reposition the patient and see if you are able to flush the tubing with water." E. "Call the health care provider; the tube is going to have to be replaced." F. "Cranberry juice works well because the acidity dissolves occlusions from medication."

b If unable to instill fluid, the nurse should reposition the patient in a left side-lying position and try again. The tip of the tube may have been against the wall of the stomach. Changing the patient's position may move the tip of the tube away from the stomach wall. Cola or fruit juices should not be used to flush tubing. The nurse should first reposition the patient and reattempt flushing the tube before calling the health care provider. The health care provider should be notified if the tube remains obstructed.

Which of the following nursing actions helps reduce the risk of aspiration? A. Keeping the patient well hydrated. B. Elevating the head of the patient's bed. E. Encouraging the patient to deep breathe and cough. F. Performing nasotracheal suctioning before instilling a tube feeding.

b Keeping the head elevated above the stomach helps reduce the risk of aspiration. Risk factors for tube dislodgement include frequent nasotracheal suctioning and severe coughing. Dislodgement of the tube places the patient at high risk for aspiration. Keeping the patient well hydrated does not reduce the risk of aspiration.

For intestinal placement of a feeding tube, in what position should the nurse place the patient while waiting for radiological confirmation of correct placement? A. In a left lateral position B. On the patient's right side E. Lying flat F. In a high-Fowler's position

b Placing the patient on the right side promotes passage of the tube into the small intestine (duodenum or jejunum).

The patient's wife is watching as the nurse prepares to insert a small bore feeding tube. She asks the nurse, "What is the purpose of the guide wire?" The nurse correctly responds: A. "To serve as a guide to determine when the correct length of tubing has been inserted." B. "Because feeding tubes are flexible, a guide wire or stylet is used to provide rigidity that facilitates positioning." E. "To keep the patient from pulling the tube out as readily." F. "Because placement must be verified by a chest x-ray, the guide wire is used to determine correct placement when it shows up on radiography."

b The guide wire or stylet provides rigidity that facilitates positioning and is removed once correct placement is verified via a chest x-ray. The tip of the feeding tube contains a radiopaque material that will show up on the x-ray of the chest/abdomen to verify feeding tube placement. Once measured, tape or indelible ink is placed on the tube to indicate the length at which the nurse should stop inserting the tube.

The nurse is inserting an NG feeding tube for the first time. Which action, if made by the nurse, indicates further instruction is needed? A. The nurse aims back and down toward the ear. B. The nurse has the patient flex the head as the tube is inserted into the naris. E. The nurse advances the tube as the patient swallows. F. The nurse dips the end of the tube into a glass of water to activate the lubricant.

b The nurse should have the patient flex the head toward the chest after the tube has passed the nasopharynx because this closes off the glottis and reduces the risk of the tube entering the trachea. Flexion of the head as the tube is inserted into the naris is unnecessary and may make the passage of the tube through the nasopharynx more difficult. Dipping the tube into a glass of water activates the surface lubricant to facilitate passage of the tube into the naris to the GI tract. The nurse should aim back and down toward the ear. Natural contour facilitates passage of the tube into the GI tract. Swallowing facilitates passage of the tube past the oropharynx.

· The nurse understands that irrigating a feeding tube helps prevent it from becoming clogged and clears the tubing of fluid. At what times is it appropriate to flush a feeding tube? (Select all that apply.) A. Once a shift. B. Before an intermittent feeding. D. Before medication administration. F. After medication administration. H. Between medications.

b d f h Irrigate routinely before, between, and after final medication (before feedings are reinstituted) and before an intermittent feeding is administered.

The patient is presently receiving intermittent tube feedings of 120 mL every 6 hours. The health care provider's orders state: Jevity formula feeding 240 mL every 6 hours per feeding tube, increase per patient tolerance. Which of the following assessment data indicate patient intolerance of the tube feeding and therefore inability of the rate to be increased? (Select all that apply.) A. Thirst. B. Nausea. D. Residual volume greater than 500 mL. F. Flatulence. G. Diarrhea. I. Abdominal distention and discomfort.

b d g i If the patient develops diarrhea 3 or more times in 24 hours, this indicates intolerance. Notify the health care provider and confer with the dietitian to determine the need to modify the type of formula, concentration, or rate of infusion. Tolerance is indicated by absence of nausea and diarrhea and by low gastric residuals. Residual volume indicates whether gastric emptying is delayed; 500 mL or more remaining in the patient's stomach may reflect delayed gastric emptying. Abdominal discomfort and distention may indicate intolerance to the tube feeding, possibly from too rapid an infusion. Flatulence and thirst do not indicate an intolerance to tube feeding.

A patient is receiving a continuous enteral feeding by infusion pump. The nurse enters the patient's room to verify tube placement and measure residual. The nurse notices the patient's respirations are shallow and rapid and that the patient's color is ashen. The nurse notes crackles on auscultation, and the patient appears to be coughing up sputum of a color similar to the formula feeding. What action(s) should the nurse take? (Select all that apply.) A. Have the patient deep breathe and cough. B. Turn off the tube feeding. D. Ask if the patient feels short of breath. E. Notify the health care provider. G. Suction the patient. I. Position patient on side.

b e g i The patient has aspirated formula. The nurse should turn off the tube feeding immediately, position the patient in in a side-lying position, suction, and notify the health care provider. It is unnecessary to ask the patient about feeling short of breath because it is apparent. Having the patient deep breathe and cough will fail to help at this time.

Which of the following, if exhibited by the patient, may increase the risk for spontaneous enteral tube dislocation? (Select all that apply.) A. Ambulation. B. Nasotracheal suctioning. D. H2 antagonists. E. Vomiting. G. Nausea. H. Altered level of consciousness, agitation.

b e h Conditions that increase the risk of spontaneous tube dislocation from the intended position include vomiting or retching, nasotracheal suctioning, altered level of consciousness, and agitation. Nausea, ambulation, and H2 antagonists are not risk factors for spontaneous dislocation of an enteral feeding tube.

Which of the following pH test results on the aspirate of a patient who receives intermittent feedings indicates that the feeding tube is in the stomach? A. pH greater than 5. B. pH of 1 to 11. C. pH of 1 to 5. F. pH of 6 or greater.

c Gastric fluid from a patient who has fasted at least 4 hours usually has a pH range of 1 to 5. The range of 1 to 5 is a reliable indicator of stomach placement. Fluid from an NI tube of a fasting patient usually has a pH greater than 6. Intestinal contents are less acidic than stomach contents. The pH of pleural fluid from the tracheobronchial tree is also generally greater than 6. A patient with a continuous tube feeding may have a pH of 5 or higher. Formulas contain solutions that are basic.

A group of nursing students are studying together. They are discussing the differences between parenteral and enteral nutrition. Which statement, if made by one of the students, indicates further instruction is needed? A. "Enteral nutrition is preferred because it is less expensive than parenteral nutrition and maintains functioning of the gut." B. "Gastric feedings may be given to patients with a low risk of aspiration. If there is a risk of aspiration, jejunal feeding is the preferred method. Parenteral nutrition is provided if the patient's GI tract is nonfunctional." C. "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube." F. "An example of the parenteral route is subcutaneous or IM injections, or the IV route."

c Enteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube. Parenteral nutrition is a form of specialized nutrition support in which nutrients are provided intravenously.

Which of the following is an appropriate nursing action to prevent a complication of nasogastric (NG) tube feedings? A. Leave the feeding tube unclamped and unplugged between feedings. B. Allow the syringe to empty of feeding before adding more to the syringe. C. Keep the head of the patient's bed elevated at least 30 degrees. F. Change the feeding tube bag and tubing every 72 hours for a continuous feeding.

c Head of bed elevation to a minimum of 30 degrees is a simple method to keep the risk for aspiration at a minimum. The nurse is instrumental in achieving this goal. To prevent air from entering stomach between feedings, clamp or plug end of tube when feeding is absent. The nurse should refill the syringe before it is completely empty until prescribed amount has been administered. Use a new administration set every 24 hours for an open system.

The nurse is irrigating a nasogastric feeding tube after having verified tube placement by pH testing. The nurse draws up 30 mL of tap water into an ENFit syringe, removes the plug at the end of the tube, attaches the ENFit syringe, and slowly instills the irrigation solution. The nurse removes the syringe and plugs the end of the tube. What error occurred in the performance of this skill? A. There was no error; the nurse performed the skill correctly. B. The nurse should have used sterile water from a container marked with the date and nurse's initials. C. The nurse failed to kink the tubing before connecting and removing the syringe from the end of the feeding tube. F. The nurse instilled the irrigation solution at an incorrect rate.

c The nurse failed to kink the feeding tube while removing plug at end of tube, allowing leakage of gastric secretions.

The nurse is going to irrigate the patient's established feeding tube with 30 mL of tap water before instilling the tube feeding. The nurse attempts to do so without success. What should action should the nurse take? A. Notify the health care provider. B. Irrigate the tubing with soda, such as Coca-Cola. C. Reposition the patient. F. Use a smaller syringe with the plunger to push the fluid through the feeding tube.

c The nurse should first reposition the patient on the left side and try again. The tip of the tube may be lying against the stomach wall. Changing the patient's position may move the tip away from the stomach wall. The nurse may attempt to flush the tubing with a large-bore syringe and warm water. If still unable to clear the feeding tube, the health care provider should be notified. Baking soda or cola should never be used because they could cause further complications if aspirated.

The nurse suspects the patient's feeding tube has migrated. Which of the following would indicate the greatest risk related to tube migration? A. Inability to flush the feeding tube. B. Pain and gastric aspirate hemoccult positive. C. Dyspnea and decreased oxygen saturation. F. Absence of bowel sounds.

c The risk for aspiration of regurgitated gastric contents into the respiratory tract is increased when the tip of a nasointestinal (NI) tube accidentally dislocates upward into the stomach or when the tip of either a nasogastric (NG) or NI tube dislocates upward into the esophagus. When a tube migrates to the lung, complications such as aspiration, pneumonia, pneumothorax, and peritonitis can develop if feedings are subsequently administered. Pain and gastric aspirate hemoccult positive would be symptoms indicating perforation and subsequent bleeding. The absence of bowel sounds is indicative of paralytic ileus. The inability to flush the feeding tube is indicative of clogging of the tube.

The nurse is going to administer a bolus enteral tube feeding of 240 mL. The nurse has obtained a pH of 4 and 50 mL of gastric aspirate. Based on these findings, what action should the nurse take? A. Stop the feeding and recheck the residual in 1 hour. B. Discard the aspirate and continue with the bolus feeding as prescribed. C. Return the aspirate to the patient's stomach and administer the feeding. F. Reposition the feeding tube under fluoroscopy.

c These are normal findings. The nurse should return the gastric aspirate to the patient's stomach to prevent an alteration in electrolyte balance and administer the tube feeding as prescribed.

Enteral feedings may be administered by: (Select all that apply.) A. Through a large vein. B. Intravenously. C. Continuous feeding pump. E. Intermittent gravity drip. G. Through a central vascular access device.

c e Enteral feedings may be administered continuously using a feeding pump or intermittently by gravity drip. Enteral feedings should never be administered intravenously. Parenteral nutrition is administered through a large vein as with a central vascular access device.

The nurses are discussing feeding tube migration and prevention. Which of the following statements indicates correct understanding? A. The nurse should have the patient deep breathe and cough and suction the patient frequently. B. The nurse should keep the head of the bed flat to reduce the risk of tube migration. C. As long as the external portion of a feeding tube is taped in place, the tube will be unable to migrate out of position. D. A feeding tube can enter the airway without causing obvious respiratory symptoms.

d Absence of signs and symptoms does not ensure nonrespiratory placement, especially in patients with decreased level of consciousness or altered cough and gag reflex. The nurse is responsible for ensuring that the tube has remained in the intended position before administering formula or medications through the tube. Coughing and frequent suctioning may increase the risk of feeding tube migration. A tube's distal tip can migrate upward or downward from its original correct position, even when the external portion of the tube is taped in place. The nurse should keep the head of the bed elevated 30 degrees at all times to reduce the risk of aspiration.

A patient has a nasogastric feeding tube. The nurse is aware of the need to monitor the patient for potential complications. Which of the following symptoms, if demonstrated by the patient, would potentially indicate the greatest risk related to tube feedings? A. Throat irritation. B. Abdominal distention. C. Diarrhea. D. Dyspnea.

d Aspiration, generally from tube displacement, is the greatest risk related to tube feedings. Diarrhea may be an unexpected outcome, and abdominal distention may be an indication of intolerance of the formula feedings. A patient with an NG or nasointestinal (NI) tube may complain of throat irritation from the presence of the tube in the nasopharynx, but this does not pose a risk.

The health care provider has ordered an enteral feeding tube for an elderly patient. Which statement, if made by the patient's family member, indicates further instruction is needed? A. "Tube feedings are less likely to cause infection than getting nutrients by IV infusion." B. "This will help prevent her from getting pneumonia again from choking." D. "The tube feedings are used to improve digestion." G. "The enteral feedings will help provide additional calories."

d Enteral feedings will not improve digestion. Enteral feedings are used with patients who have adequate digestion and absorption but cannot ingest, chew, or swallow food safely or in adequate amounts. Advantages of enteral feedings over parenteral feedings are that they are less expensive, maintain functioning of the gut, and are less likely to cause infection.

· You have inserted an NG feeding tube. The patient vomited during insertion and continues to gag. What action(s) should you take? (Select all that apply.) A. Have patient sip ice water. B. Place patient in high-Fowler's position. D. Position patient on side. F. Contact health care provider for possible chest x-ray. H. Suction airway as needed.

d f h Persistent gagging leads to vomiting with aspiration of GI contents. You should position the patient on the side, and suction the airway as needed. The health care provider should be contacted and consideration made of the need for an immediate chest x-ray film.

Which of the following may be delegated to nursing assistive personnel (NAP)? A. Assessing for peristalsis. C. Verifying feeding tube placement. D. Administering medication through a feeding tube. E. Administering a tube feeding. F. Inserting a nasogastric (NG) feeding tube.

e Administration of enteral tube feeding is a procedure that can be delegated to NAP (usually seen in a long-term care facility). The assessment for the presence of peristalsis and verification of tube placement should be performed by a nurse before the feeding. Instruct NAP to position patient upright in bed or chair and to infuse feeding slowly (in case of bolus and intermittent feedings). Have NAP immediately report any difficulty infusing the feeding or any distress experienced by patient. The skill of administering medication through a feeding tube or of inserting an NG feeding tube requires the critical thinking and knowledge application unique to a nurse and may not be delegated.

The nurse observes a confused patient pulling at her NG feeding tube. As the nurse retapes the tube to the bridge of the patient's nose, the nurse notices that the mark on the tube has moved away from the naris. What action should the nurse take? A. Secure the tape on the patient's nose well with the tube in the current location. B. Pull back on the tube. C. Remove the tube. D. Restrain the patient's hands before leaving the room. E. Advance the tube until the mark is even with the naris and verify correct tube placement.

e An increased external length of tube may indicate that the distal tip is incorrectly positioned. Using the tube in its current location could place the patient at greater risk for aspiration. The nurse needs to advance the tube until the mark reaches the patient's naris and then verify correct tube placement. It is unnecessary to remove the tube unless the nurse is unable to advance the tube the desired length. Pulling back on the tube will only increase the external length of the tube, thus preventing the tube from being inserted the desired depth.