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Nursing Foundation 2 Module 8

The document discusses enteral nutrition including types of feeding tubes, initiating tube feedings, potential complications, and assessments. It describes checking gastric residuals, flushing tubes, and interventions for complications like occlusion or delayed stomach emptying.

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15 views7 pages

Nursing Foundation 2 Module 8

The document discusses enteral nutrition including types of feeding tubes, initiating tube feedings, potential complications, and assessments. It describes checking gastric residuals, flushing tubes, and interventions for complications like occlusion or delayed stomach emptying.

Uploaded by

johnbryanmalones
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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NF2 Module 8

Enteral Nutrition

Darkening of the skin in diabetic patients are caused by high blood sugar
 Dark, velvety color
 Armpits, groin, arms, inside of knee, everyhere
 Can be reversed
Types of feeding tubes: Review from Module 7

LO#2 Identify and differentiate between the following alternative measures to feeding. GT, TPN,
NG

Initiating enteral nutrition


Formulas (milliosmoles/kg)
 Isotonic:
o Concentration of nutrients in formula is same as concentration of plasma (fluid
content in blood)
• 300 mOsm/kg of water
o Generally well-tolerated
o Start infusion at full strength and ordered rate
 Hypertonic:
o Higher concentration of nutrients than that in plasma
• >300 mOsm/kg of water
o Water moves out of cells to even out the concentration
o Pressure gradient pulls water into the intestine (Dumping Syndrome)
o Start infusion at full strength but lower rate, increase to target rate slowly while
monitoring tolerance (avoid diarrhea and cramping)
Most formulas have osmolarity between 300-700mOsm/kg
Potter et al., 2019, p. 1148
Initiating enteral nutrition
Administration
 Know facility policy and procedures
 Type, frequency and amount are ordered by a physician or dietician
 Nursing can insert NG/NJ/OG/OJ tubes with a physician order
o Intermittent
• Syringe (no plunger)
• Gravity feed set
• Given over 20-30min
o Continuous
• Prescribed hourly rate
• Feeding pump used
• 4-hour supply at a time to avoid spoilage

LO# 4 Describe and provide nursing interventions to common problems and safety
consideration associated with enteral feedings
LO#10 Demonstrate steps and underlying rationale for… administering a tube feeding
Potter et al., 2019, pp. 1095-1096

Initiating enteral nutrition


Assessment
What would you assess prior to administering enteral nutrition?
 Indication
 Order for route, formula, rate, frequency
 Labs/capillary glucose levels/weight
 Bowel sounds/abdominal assessment
 Skin integrity of site
 Have feed at room temperature for patient comfort
 Placement, positioning, patency

LO# 4 Describe and provide nursing interventions to common problems and safety
consideration associated with enteral feeding
LO# 8 Integrate the nursing process and BVC conceptual framework…..

Initiating enteral nutrition


 Placement
o tube can migrate from small bowel to stomach or stomach to esophagus or worse,
lungs
o Methods:
1. X-ray confirmation, GOLD standard
2. Aspirating gastric residuals-test pH
3. Checking tube graduation marks- ensure same as insertion
4. CO2 distal end of NG/OG
 Positioning
o What position should a patient be in prior to initiating a feed or administering a
medication through an enteral tube? Why?
o High fowler’s position
 Patency
o Flush before and after administering mutrition/medication with syringe using
push/pause method
o Pressure is gonna burst so we need to flush out any blockages

LO#10 Demonstrate steps and underlying rationale for… verifying tube patency prior to
feeding.
Potter & Perry, 2019, pp. 1153, "Assist patient to sit up in high Fowler's position, if possible (to
protect patient from drainage). Encourage patient participation."

Initiating enteral nutrition: Potential complications


 Pulmonary aspiration
 Tube displacement
 Diarrhea, constipation, abdominal cramping, nausea, vomiting
 Serum electrolyte imbalance
 Fluid overload
 Hyperosmolar dehydration
 Tube occlusion (blocked or clogged tube)
 Delayed gastric emptying

Give them a different brand when they feel any of these symptoms (Diarrhea, constipation,
abdominal cramping, nausea, vomiting)
Reach out to a diestitian first

LO# 4 Describe and provide nursing interventions to common problems and safety
consideration associated with enteral feeding
See Table 42-9 p 1151

Potential complications: Delayed stomach emptying


Checking gastric residual (delayed stomach emptying)
 Know what kind of enteral tube- delivery to jejunum vs stomach?
 If suspecting gastric residual (delayed stomach emptying) is occurring, complete
GI assessment
 May be reflected if 200-500mL or more remains in adult’s stomach (dependent on unit
policy)
 Feeds may need to be withheld and reassessed- inform the physician!
Potential complications: Tube occlusion
 *PREVENTION* Flush with sterile water before/between/after medications and
enteral nutrition
 Check all equipment for functioning, look for kinks
 Flush with 10-30mL between each medication, flush with warm water if clogged and
clamp tube to allow water to soak
 Reposition the patient (release potential internal kinks or blockages)
 Push/pull with syringe (do not use too much force as equipment will fail and we
want to avoid replacing the NG tube)
 May affect dosing if you don’t flush the tubing

Potential complications: Accidental removal of G-tube


**Know facility policy and procedure**
 Replace with same size Foley catheter to keep stoma open until reinsertion by physician
 Keep the stoma sterile and covered
 Keep same size Foley catheter at bedside for quick intervention

LO# 4 Describe and provide nursing interventions to common problems and safety
consideration associated with enteral feeding

Post-enteral nutrition assessments


What would you assess during/after administering enteral nutrition?
**Know facility policy and procedure**
1. Intake and Output every shift with 24-hour totals.
2. Daily weights/weekly weights
3. Closely monitor Respiratory status
4. Observe laboratory values for return to normal
5. Monitor blood glucose levels usually for 48 hours after initiation
6. Mouth care
7. Clean/change enteral feeding equipment every 24 hours (weekly in long term/home
care)
8. Monitor for signs of intolerance (monitor gastric residuals, bloating, nausea & vomiting,
diarrhea, constipation)
9. Skin integrity around feeding tube

LO# 6 Identify the responsibilities of the practical nurse regarding common lab values and
electrolytes pertaining to enteral feeding
LO# 8 Integrate the nursing process and BVC conceptual framework…..

Patient teaching
 Care and Maintenance
o Positioning, placement, patency
o Supplies
o Routine changes
 When to seek help
o Dislodgement/accidental removal
o Tube occlusion
o Signs of Intolerance
o Signs and symptoms associated with complications
• Shortness of breath
• Distension, nausea/vomitting, diarrhea

LO#5 Apply knowledge of enteral nutrition in the instruction of the patient and/or significant
other

Enteral nutrition: Documentation


FOCUS:
 Tube feed administration
DATA:
 Patency of tube, stoma site, skin integrity around tube, how it is secured, verification of
placement, mouth assessment, auscultate lung and bowel sounds, residuals etc.
ACTION:
 How the feed was given (amount, type, timeframe)
 Any education given to patient or family
 Communication of abnormal findings
RESPONSE:
 How patient tolerated feed/administration (reassessment)
PLAN:
 Reinforce care of feeding tube, positioning, oral care, chest x-ray to confirm placement
of tube or assess lungs

LO#7 Recall information to be recorded and documented following administration of a tube


feed.

Interdisciplinary resources
• Speech and Language Pathologist
 Dietitian
 Physician/Nurse Practitioners
 Social Workers
 Southern Alberta Home Nutrition Program http://www.calgarygi.com/index.php?
mode=webpage&id=727&pp=591
 Pediatric Home Nutrition Support Programhttp://www.calgarygi.com/index.php?
mode=webpage&id=727&pp=591
 Nurse educator

LO#9 Identify possible interdisciplinary resources the practical nurse has access to in
consultation for improving patient management of enteral nutrition

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