Module 5

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:

"Because feeding tubes are flexible, a guide wire or stylet is used to provide rigidity that facilitates positioning"

Which of the following patients may benefit from enteral nutrition?

-A patient who has a brain injury -A patient with oral cancer -A patient with burns of the lower extremities

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?

-Advance the tube until the mark is even with the naris and verify correct tube placement

The nurse is reading the healthcare provider's orders to increase the rate of the patient's NG feeding. Which of the following orders should the nurse question?

-Advance tube feeding rate by 100 mL/hr every 8 to 12 hours to target rate of 250 mL/over 12 hours.

Identify the appropriate times to verify enteral tube placement by pH testing.

-Before each intermittent feeding -At least once every 6 hours during continuous feedings -Before administration of medications through the tube

Enteral feedings may be administered by:

-Continuous feeding pump -Intermittent gravity drip -Large-bore syringe (bolus)

Identify signs and symptoms of accidental respiratory migration of a feeding tube.

-Coughing -Choking -Decreased pulse oximetry

The patient is presently receiving intermittent tube feedings of 120 mL every 6 hours. The healthcare 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 indicates patient intolerance of the tube feeding and therefore inability of the rate to be increased?

-Diarrhea -Abdominal distention and discomfort -Nausea -Residual volume greater than 250 mL

The nurse suspects the patient's feeding tube has migrated. Which of the following would indicate the greatest risk related to tube migration?

-Dyspnea and decreased oxygen saturation

The healthcare provider just left the patient's room after explaining the options of NG or NI feeding tube placement. A student asks a nurse about he difference between nasogastric and nasointestinal feedings. Which of the following are accurate statements made by the nurse?

-Gastric aspirate is expected to have a lower pH than intestinal aspirate -The advantage to an NI tube is that there is less risk for aspiration -Both NG and NI tubes are usually used for less than 30 days

You have inserted the NG feeding tube. The patient vomited during insertion and continues to gag. What action(s) should you take?

-Suction airway as needed -Remove feeding tube -Position patient on side -Contact health care provider for possible chest xray

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 rhonchi upon 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?

-Turn off the tube feeding -Position the patient in Fowler's position and suction the patient -Notify the healthcare provider -Prepare for chest xray examination

Which of the following, if exhibited by the patient, may increase the risk for spontaneous enteral tube dislocation?

-Vomiting -Frequent nasotracheal suctioning -Severe bouts of coughing

D) Patient with continuous tube feeding

1) 5 or higher

C) Determines approximate depth of insertion

1) Measures distance from tip of nose to earlobe to xyphoid process of sternum and mark tube with tube or indelible ink

Sequence the procedure for verifying feeding tube placement

1) Perform hand hygiene. Apply clean gloves. Draw up 30 mL of air into the syringe, then attach to end of feeding tube. Flush tube with 30 mL of air. 2) Draw back on syringe and obtain 5 to 10 mL of gastric aspirate. Observe appearance of aspirate. 3) Draw pH of aspirate. Compare the color of the strip with the color on the chart provider by the manufacturer. 4) Discard used supplies, remove gloves and discard, and perform hand hygiene.

D) Activates lubricant to facilitate passage of tube into GI tract

2) Dip tube with surface lubricant into a glass of water

B) Pleural fluid from tracheobronchial tree

2) Greater than 6

C) Intestine of fasting patient

2) Greater than 6

A) Stomach of fasting patient

3) 1 to 5

A) Closes off glottis and reduces risk of tube entering trachea

3) Have patient flex head toward chest after tube has passed through nasopharynx

E) Facilitates passage of tube pat oropharynx, rotation decreases friction

4) Have patient mouth breathe and swallow. Give small sips of water or ice chips when possible. Advance tube as patient swallows. Rotate tube 180 degrees while inserting

B) Ensures tube patency and aids in guide wire or stylet insertion

5) Inject 10mL of water from 30-mL or larger syringe into the feeding tube

the nurses are discussing feeding tube migration and prevention. Which of the following statements indicates correct understanding?

A feeding tube can enter the airway without causing obvious respiratory symptoms.

A patient had an NG feeding tube inserted 1 week ago. You notice that the patient's nasal mucosa is inflamed, and the patient complains of pain at the site of insertion. The other naris appears patent with intact skin. What is the best action to take at this time?

Call the health care provider; get an order to remove the feeding tube and insert a new feeding tube in the opposite naris

Why is it important to have the tube feeding at room temperature?

Cold formula can cause gastric cramping

The patient is receiving a continuous enteral feeding. Which of the following assessment findings would require follow-up?

Gastric residual of 275 mL

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 (Pepcid). The pH strip reads "3". Where should the nurse expect the xray to determine placement of the feeding tube?

In the stomach

Which of the following is an appropriate nursing action to prevent a complication of NG tube feedings?

Keep the head of the patient's bed elevated at least 30 degrees

For intestinal placement of a feeding tube, in what position should the nurse place the patient while waiting for radiological confirmation of correct placement?

On the patient's right side

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?

Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube

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?

Pull the tube back and attempt to reinsert

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 action should the nurse take?

Re-position the patient

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 feedings, what actions should the nurse take?

Return the aspirate to the patient's stomach and administer the feeding

If the nurse suspects the NG feeding tube has migrated, the nurse should:

Stop any enteral feedings and obtain an order for a chest x-ray to determine placement

The nurse is inserting an NG feeding tube for the first time. What action, if made by the nurse, indicates further instruction is needed?

The nurse has the patient flex the head as the tube is inserted into the naris.

The healthcare 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?

The tube feedings are used to improve indigestion

The nurse is going to administer an intermittent tube feeding. Since the patient's feeding tube has been in place for 3 days, which action is best for the nurse to take at this time?

Aspirate gastric contents and test on a pH strip

Which of the following accurately describes the greatest risk related to having a feeding tube?

Aspiration