Enteral Tube Feeding Posttest ATI

A nurse is providing teaching to a patient who is receiving intermittent nasogastric feedings. Which of the following should the nurse instruct the patient to report immediately? A. A feeling of fullness B. Persistent coughing C. Discomfort in the naris. D. Postfeeding belching

Persistent coughing. Persistent coughing could indicate that the distal end of the NG tube has moved into the respiratory tract. The nurse should report feelings of fullness; however, this does not indicate the client is as risk for aspiration. The client might benefit from using a prokinetic agent. Friction from the presence of the tube can be uncomfortable; however, this does not indicate the client is at risk for aspiration. The nurse should monitor the site closely and move the securing device or talk to the provider about moving the tube. Belching can be expected depending on the composition of the formula and the client's usual response to the nutrients. This finding does not need to be reported.

A nurse inserting a nasogastric tube asks the patient to flex her head toward her chest after the tube passes through the nasopharynx. This action facilitates proper insertion of the tube by

closing off the glottis. Flexing the head closes off the glottis to prevent the NG tube from entering the trachea versus the GI area.

The most reliable method for verifying initial placement of a small-bore feeding tube is by

obtaining an abdominal x-ray. Obtaining an x-ray is the only reliable method for verifying initial placement of a small-bore feeding tube. Gastric contents are acidic, with a pH from 1 to 4. A pH above 6 is an indication that the distal end of the tube can be in the respiratory tract or in the intestines. This method can be used to confirm placement of the tube; however, another method is used for verifying initial tube placement. Auscultation is no longer considered a valid method of determining tube placement. With this method, there is no guarantee the tube is in the client's stomach and not in their lung. Bubbling after the tube is placed in water might indicate that the tube has passed through the larynx into the trachea; however, this action can cause aspiration.

To prevent aspiration during the administration of an enteral tube feeding, a nurse should

place the patient in Fowler's position.

To determine how much of the length of a nasoenteric tube to insert, a nurse should measure the distance from the tip of the patient's nose to the earlobe and from the earlobe to

xiphoid process, plus 20 to 30 cm more. Measuring from the tip of the nose to the earlobe to the xiphoid process approximates the distance from the nose to the stomach for 98% of clients. For duodenal or jejunal placement, an additional 20 to 30 cm is required.

Nasogastric tube feedings are an appropriate choice for a patient who A. A client who has a paralytic ileus B. A client who has recently experienced facial trauma C. A client who has dysphagia D. A client who has a decreased appetite E. is postoperative following laryngectomy.

Both C and E: A client who has dysphagia, is postoperative following laryngectomy. E: Laryngectomy is the right answer and is indicated for nasogastric enteral feeding until the patient is capable of swallowing, 7-10 days later. Pancreatitis is inflammation of the pancreas, which calls for food and fluids to be withheld to allow the pancreas to rest, reducing pancreatic secretion. The nurse should identify that a client who is unable to swallow oral nutrition can benefit from enteral feedings. A client who has a decreased appetite might require oral supplements or nutrient-dense foods. A client who has a paralytic ileus has an absence of gastrointestinal motility and is unable to tolerate enteral nutrition. Due to the high risk of improper tube placement, a client who has had recent facial or nasal trauma should not have a nasoenteric tube placed. This client requires surgical placement of a gastric or jejunal tube.

Which of the following formulas is appropriate to administer to a patient who has a dysfunctional gastrointestinal tract?

Elemental formulas. Elemental formulas contain predigested nutrients, easy for a PARTIALLY functional GI tract to absorb. Modular formulas are single-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients. Polymeric formulas are whole-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients. Specialty formulas meet specific nutritional needs for clients who have a conditions such as HIV, liver failure, or clients who have pulmonary disease.

An older adult patient in a long-term care facility is receiving intermittent enteral feedings in his room. His affect is flat, and the nurse suspects that he is feeling isolated. Which of the following interventions is appropriate for this patient? A. Encourage the client to go to the dining room at meal times to talk with other clients. B. Suggest that the client watch television while feedings are being administered. C. Remind the client that they can have visitors after feeding administration times. D. Ask the facility chaplain to speak with the client.

Encourage him to go to the dining room at meal times to talk with other patients. (By encouraging the resident to maintain a normal schedule and social interactions, the nurse is helping to promote socialization and reverse patterns of isolation) Although television can provide a useful distraction for some clients and might help improve the client's mood, this diversion is not interactive; therefore, it is unlikely to reduce any feelings of isolation the client might have. Although visitation policies vary at every facility, generally visitors are permitted during meal times in long-term care facilities. However, this intervention will not improve the situation if the client does not have a family and social network outside of the facility. The nurse should not contact the chaplain without first consulting with the client.

To prevent a common complication of continuous enteral tube feedings, a nurse should

Limit the time the formula hangs to 4 hours. Formula hanging longer than 4 to 8 hours puts the patient at risk for bacterial contamination and the subsequent diarrhea. The nurse should flush the tube every 4 to 6 hr to promote patency and prevent constipation. Administering enteral formula too fast (generally, more than 200 to 300 mL over 10 to 20 min) can cause abdominal cramping, nausea, and vomiting. A lower rate of delivery improves tolerance. Allowing the feeding bag to empty before refilling it can result in an excessive infusion of air.

A patient with a gastric ileus post-operatively requires nutritional support for approximately 2 weeks. Which of the following types of feeding tubes is appropriate for this patient?

Nasointestinal tube. Nasointestinal tube allows POSTPYLORIC feeding, bypassing the gastric ileus(block) and directly into the intestines. Nasogastric tubes are contraindicated for clients at high risk of aspiration. Therefore, another tube should be placed. Percutaneous endoscopic gastrostomy (PEG) tubes are indicated for long-term use in clients. Therefore, another tube should be placed. A percutaneous endoscopic jejunostomy tube is indicated for clients who require enteral feedings for more than 4 weeks. Therefore, another tube should be placed.