N225 NUTRITION: Enteral Feeding
To determine the length of a nasointestinal tube to insert, a nurse should measure the distance from the tip of the client's nose to the earlobe and from the earlobe to the_____?
- 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.
What other complications would the nurse anticipate of enteral feeding?
- Tube misplacement or dislodgement to other organ -aspiration -irritation & leakage at the insertion site, nose, esohagus, mocusa, -clogging the tube
What is standard formulas?
- also called polymeric or intact - composed of whole protein, meats, eggs -
What are the indication a pt may require Nasoenteric tube?
- at risk of aspiration - delayed gastric emptying (gastroparesis)
What are the appropriate nursing action for tube misplacement?
- confirm tube placement prior to feedings such as radiology first, then ongoing care: aspirate gastric to determine ph -elevate head to 3o degrees & remain this positio for 60 mins - administer bolus feedings > 15-30 mins - unclog tubing using pressure 30-50 ml warm water in 60 ml piston syringe.
ENTERAL FEEDING DELIVERY METHODS: What are the types?
- continuous infusion - cyclic feeding -intermittent tube feeding - bulos feeding
What are the necessary preparations required of pt w/ enteral feeding tube?
- first: verify tube placement using x-ray -Gastric apiration is used when xray confirm tube placement -Gastric ph: < 4 - Flushed w/ warm water 15-30 ml b4 & after administration -Check gastric residual every 4-6 hrs
What indication a pt requires G-tube or jejunostomy?
- if pt had recent facial or nasal trauma -should not have a nasoenteric tube due to head, face, neck injury
How many calories does elemental provide?
- most provide 1-1.5 cal/ml - high calorie: 1.5-2 cal/ ml - composed of simplest form of nutrients & easily digest
What contraindicated condition that a pt cannot have enteral feeding?
- nonfunctional GI tract system (ex. paralytic ileus or intestinal obstruction
If an infant has feeding tube (NG tube), how long does the tape remained in place?
- up to 30 days
What is enteral nutrition?
- used when pt cannot consume adequate nutririents & calories oraly, but the GI tract system is still functioning.
What type of formula that has high osmolality?
-Elemental formula (due to hydrolized or partially hydrolized contains - good for pt w/ lactose intolerance (lactose free)
What formula is residue free?
-Elemental or hydrolized formula
What are the 3 types of Nasoenteric tube?
-Nasogastric (NG tube)= pass through the nose to the stomach -Nasoduodenunal = tube pass through the nose to an end of duodenum - Nasojejunal = tube pass through nose to end of jejunum
What formula is low residue, enriched in fiber & produce less abdominal distension or gas?
-Standard formula (good for pt who has bowel rest or post-op surgery, constipation or diarrhrea)
What is low-profile gastrostomy?
-an alternative to the PEG tube - a skin-level G-tube more comfortable, long-lasting & fully immersible in water Bad: difficult to check the residual due to close proximity of the button to the skin
What are the complications of enteral feeding?
-constipation, diarrhea, cramps, abdominal pain, distention/bloating, dumping syndrome (rapid emptying of formula into the small intestine, resulting fluid shift)
What expected manifestion of dumping syndrom (refeeding syndrome?
-dizziness, lightheadedness, rapid puslse, diaphoresis, palor
PACKAGING: in cans & prefilled bags When should the nurse discard the prefilled bags & administration of tubing>
-every 24 hr, even they are not empty
How long would the nurse check & measure the continuous infusion?
-every 4-6 hrs
What indications that pt requires enteral feeding tube?
-facial burns, prolonged intubation, eating disorders, chemotherapy, liver/renal dsyfunction, infection, IBS
What is Ostomies?
-for clients requires long term enteral feedings - high risk of aspiration, - nasal obstructions - foods directly delivered into the stomach via stoma.
What is advanatage of using G-tube over jejunostomy?
-fully immersable w/ water, comfortable, longer-lastig, - dumping syndrome usually avoided
What are the 2 types of ostomies?
-gastrostomy (G-tube) -jejunostomy
What indication a pt might need Jejunostomy?
-lacks stomack motility (paralytic ilues) - pt requires more than 4 weeks of enteral feeding - long term
How to prevent complications of enteral feeding tube?
-lower rate of delivery improves tolerance (not more than 200-300 ml over 10-20 mins to prevent abdominal cramping, nausea, and vomiting. -Don't allow the bag to empty before refilling it because it can result in an excessive infusion of air. -flush the tube every 4 to 6 hr to promote patency and prevent constipation. - hang the formula for up to 8 hrs
What is the status of condtion of pt w/ intermittent tube feeding?
-non critical pt - home tube feedings -clients in rehab
What is elemental formula?
-nutrients that made partially of hydrolized or broken down
What indicates the used of elemental formula?
-pt w/ partially functioning GI tract, IBS, liver failure, pancreatic disorders, short-gut syndrome
What are the process oftransitioning from enteral feeding to oral feeding?
-stop enteral feeding for an 1hr before a meal - slowly increase meals until pt is eating > 6 small meals daily -when oral intake is 500-700 cal/day - the continous feeding is administered only nights
INTERVENTIONS: When would the nurse discontine or wean off the pt from enteral feedings?
-when pt consumes 2/3 of protein & calories orally for 3-5 days
What is the caloric density required in the enteric feeding formula?
1-1.2 cal/ml
How many calories does standard formula provides?
1-2 cal/ml
A nurse is instructing a client on how to administer cyclic enteral feedings at home. which of the following information should the nurse include ?
1. set the feeding up before you go to bed 2. weigh yourself daily
What is the required water content in the formula?
1.0 cal/ml or 850 ml water per 1 L of formula.
What is the amount of water used to flush feefing tuber in infants?
1.5 time the amount predetermine formula
How many ml of warm water should the nurse flushed the feeding tube and for how long to maintain patency?
20-50 ml or almost 2cups - every 4 hr
What is the feeding time for intermittent tube feeding?
20-90 mins
How long would the nurse run the formula using continuous infusion?
24 hr period or whole day
In intermittent tube feeding, the formula is administered every____ and for how long?
4-6 hr equal portions of 250- 400 ml 30-60 mins timeframe
In bolus feeding, what is rate of administration required for infants children?
5 ml/10 mins infants (slower infusion than children) 10 ml/min children
For how long does the formula be administered in bolus feeding?
5-30 mins, 6 times per day
What is the volume requires for bolus feeding?
700 ml max 250-400 usual volume
In cyclic feeding, the formula is adminisited at a rate of_____?
8-20 hrs (often during sleeping) -used for transtion from EN to oral intake
What is the expected gastric residual volume for continuous infusion?
> 250 ml on two consecutive measurements for adults - 1/4 of prescribed volume for children
A nurse is teaching a client who is starting continuous feedings about the various types of enteral nutrition (EN) formulas. Which of the following should the nurse include in the teaching? A. Formula rich in fiber is recommended when starting EN. B. Standard formula contains whole protein. C. Hydrolyzed formula is recommended for a full-functioning GI tract. D. The high-calorie formula has increased water content.
B. Standard formula contains whole protein. -Hydrolized or elemental formula is recommended when starting EN because it is residual free w/o fiber to prevent abdominal distention, flatus, or gas - Hydrolized formula is recommended for partially functioning GI Tract - The high calorie formula is less water content
What are the types of enteral feeding formulas?
Commercial products = preferred over home ingredients Standard formulas & Elemental formulas = two primary types of enteral feeding formula & categorize by protein comlexities
A nurse is caring for a client who has a dysfunctional gastrointestinal tract and requires enteral feeding. Which of the following formulas should the nurse administer to the client? Modular Elemental Polymeric Specialty
Elemental Rationale: Elemental formulas contain predigested nutrients that are easy for a partially functional gastrointestinal tract to absorb.
What is modular formula?
Modular formulas are single-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients. - a type of enteral feeding formula
A nurse is caring for a client who has a paralytic ileus and requires nutritional support for approximately 2 weeks. Which of the following types of feeding tubes should the nurse anticipate the provider to prescribe? Nasogastric tube Nasointestinal tube Percutaneous endoscopic gastrostomy tube Percutaneous endoscopic jejunostomy tube
Nasointestinal tube -A nasointestinal tube allows post-pyloric feeding by depositing enteral formula directly into the intestines. An appropriate choice for a client who lacks stomach motility (paralytic ileus) and requires short-term (less than 4 weeks) enteral feeding.
A nurse is administering an enteral tube feeding to a client. Which of the following actions should the nurse take to prevent aspiration?
Place client in high Fowler's position
What is polymeric formula?
Polymeric formulas are whole-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients. - a type of enteral feeding formula
What is specialty formula?
Specialty formulas meet specific nutritional needs for clients who have a conditions such as HIV, liver failure, or clients who have pulmonary disease. - a type of enteral feeding formula
T/F: osmolality is increased if formula contains more digested proteins?
T
How long should the nurse flush the enteral tube?
The nurse should flush the tube every 4 to 6 hr to promote patency and prevent constipation.
A nurse is planning care for a client who is receiving continuous drip enteral nutrition. Which of the following interventions should be included in the plan of care? (Select all that apply. A. Administer with an infusion pump. B. Measure residual every 8 hr. C. Flush the feeding tube every 4 hr. D. Reinstill the residual feeding into the stomach. E. Reduce the flow rate if residual exceeds infused volume over the previous 3 hour period.
a, c, d
A nurse is administering bolus enteral feedings to a client who has malnutrition. Which of the following are appropriate nursing interventions? (Select all that apply.) A. Verify the presence of bowel sounds. B. Flush the feeding tube with warm water. C. Elevate the head of the bed 20°. D. Administer the feeding at room temperature. E. Inspect the tube insertion site. F. Instill the formula over 60 min.
a,b,d,e - elevate head 30 degrees & maintain this position for 60 min - instill formula 5-30 mins
A client who lives in a long-term care facility is receiving intermittent enteral feedings and is experiencing social isolation. Which of the following interventions should the nurse recommend? Encourage the client to go to the dining room at meal times to talk with other clients. Suggest that the client watch television while feedings are being administered. Remind the client that they can have visitors after feeding administration times. Ask the facility chaplain to speak with the client.
a. By encouraging the resident to maintain a normal schedule and social interactions, the nurse is helping to promote socialization and reverse patterns of isolation.
A nurse is preparing to administer a continuous enteral tube feeding to a client. The nurse should take which of the following actions to prevent a complication of the tube feeding? Limit the time the formula hangs to 8 hr. Flush the tube every 8 hr. Deliver the formula at a brisk rate. Allow the feeding bag to empty before refilling it?
a. Formula that hangs longer than 12 hr for an open system and 48 hr for a closed system is at risk for spoilage of the formula or bacterial contamination, typically manifested as diarrhea.
A nurse is inserting a nasogastric tube for a client and asks the client to flex their head toward their chest after the tube passes through the nasopharynx. This action facilitates proper insertion of the tube by achieving which of the following? Closing off the glottis Preventing curling of the tube in the mouth Allowing the client to breathe through the mouth Opening the lower esophageal sphincter
a. This action prohibits the tube from entering the trachea by closing it off and opening the esophagus.
What preferred temperature would the nurse administered the formula?
at room temperature Rationale: Prevent GI upset, cramps, bloating
A nurse is preparing to administer intermittent enteral feeding to a client who has neuromuscular disorder.Which of the following are appropriate nursing interventions? (Select all that apply.) A. Fill the feeding bag with 24 hr worth of formula. B. Discard irrigation equipment after 24 hr. C. Leave unused portions of formula at the bedside. D. Label the unused portion of the formula. E. Replace administration tubing and feeding bag every 48 hr. F. Elevate head of the clietns bed for 15 mins after administration
b, d, e - the feeding bags filled up to 4 hr to prevent contamincation - Elevate head 60 mins after administration -
A nurse is providing teaching about risk for aspiration with a client who is receiving intermittent bolus nasogastric feedings. Which of the following findings should the nurse instruct the client to report? A feeling of fullness Persistent coughing Discomfort in the naris Postfeeding belching
b. A persistent cough can indicate that the distal end of the nasogastric tube has moved into the respiratory tract. The client should report this finding to the nurse immediately because this is a risk for aspiration.ing
A nurse is inserting a small-bore feeding tube. Before initiating the feeding, the nurse should take which of the following actions to verify placement? Measure the pH of gastric aspirate. Auscultate the epigastric area while injecting air. Obtain an x-ray. Place the open end of the tube in a cup of water.
c. Obtaining an x-ray is the only reliable method for verifying initial placement of a small-bore feeding tube.
A nurse is caring for a group of clients. The nurse should identify that which of the following clients requires an enteral tube feeding? A client who has a paralytic ileus A client who has recently experienced facial trauma A client who has dysphagia A client who has a decreased appe
c. The nurse should identify that a client who is unable to swallow oral nutrition can benefit from enteral feedings. -at risk of aspiration
What additional device the nurse used in intermittent feeding?
electronic pump
What is bolus feeding?
intermittent feeding delivered with a large syringe into the stomach.
A nurse is discussing the use of a low profile gastronomy device w/ the guardian of a child who is receiving an enteral feeding, Which of the following is an appropriate statement by the nurse? a) the device is more comfortable for the children b)checking residual is much easier w/ this device c) this access requires less maintenance than traditional nasal tube d) mobilty of the child is limited w/ this device
the device is more comfortable for the children
What is percutaneous endoscopic gastrostomy (PEG)?
used to aid of an endoscope