tube feeding.pptx

7/28/2019 tube feeding.pptx

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Question

What is a nasogastric tube?

A. Tube inserted through the nose into thebeginning of the small intestine.

B. Tube inserted through the nose into thestomach.

C. Tube inserted through the nose into the secondportion of the small intestine.

D. Tube inserted through the mouth into thestomach.


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Answer

B

A nasoduodenal tube is inserted through thenose into the beginning of the small

intestine. A nasogastric tube is insertedthrough the nose into the stomach. Anasojejunal tube is inserted through the noseinto the second portion of the small intestine.

An orogastric tube is inserted through themouth into the stomach.


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Purposes of Gastrointestinal

Intubation Decompress the stomach

Lavage the stomach

Diagnose GI disorders Administer medications and feeding

To treat an obstruction

To compress a bleeding site To aspirate gastric contents for analysis


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Types of Tubes

Gastric tubes

Levin

Sump Enteric tubes


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Gastric Sump TubeRefer to fig. 36-1


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Question

What is total nutrient admixture?

A. Method of supplying nutrients to the body by theintravenous route.

B. An oil in water emulsion of oils, egg phospholipids, andglycerin.

C. A device designed and used for long-term administration ofmedications and fluids into central veins.

D. An admixture of lipid emulsions, proteins, carbohydrates,electrolytes, vitamins, trace minerals, and water.


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Answer

D

Parenteral nutrition is a method of supplying nutrients to

the body by the intravenous route. Intravenous fatemulsion is an oil-in-water emulsion of oils, eggphospholipids, and glycerin. A central venous accessdevice is designed and used for long-term administrationof medications and fluids into central veins. Total

nutrient admixture is lipid emulsions, proteins,carbohydrates, electrolytes, vitamins, trace minerals,and water.


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Parenteral Nutrition A method to provide nutrients to the body by

an IV route.

A complex mixture containing proteins,

carbohydrates, fats, electrolytes, vitamins,trace minerals, and sterile water isadministered in a single container.

The goals of parenteral nutrition are to

improve nutritional status and to attain apositive nitrogen status.


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Indications for Parenteral Nutrition Intake is insufficient to maintain anabolic state. Ability to ingest food orally or by tube is

impaired.

Patient is not interested or is unwilling to ingestadequate nutrients.

The underlying medical condition precludes oralor tube feeding.

Preoperative and postoperative nutritionalneeds are prolonged.


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Question

Is the following statement True or False?

The nasogastric tube is secured to the nose withtape to prevent injury to the nasopharyngealpassages.


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Answer

True

The nasogastric tube is secured to the nose withtape to prevent injury to the nasopharyngealpassages.


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Nursing Care of the Patient with a

Nasogastric, Nasoenteric, Gastrostomy,

or Jejunostomy Tube

Patient teaching and preparation

Tube insertion

Confirming placement

Securing the tube

Monitoring the patient

Maintaining tube function

Oral and nasal care

Monitoring, preventing, and managing complications

Tube removal


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Measuring for Nasogastric Tube

Insertion


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Securing the NG Tube


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Answer

False

Bolus feedings are administered into thestomach in large amounts and at designatedintervals. Cyclic feedings are periodicfeedings given over a short period of time.


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Purposes and Advantages of Enteral

Feedings Meet nutritional requirements when oral intakeis inadequate or not possible, and the GI tract isfunctioning.

Advantages: Safe and cost-effective Preserve GI integrity Preserve the normal sequence of intestinal and

hepatic metabolism Maintain fat metabolism and lipoprotein synthesis Maintain normal insulin and glucagon ratios


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Tube Feeding Administration Methods

Tubes Nasogastric or nasoenteral tubes

Gastrostomy or jejunostomy tubes for long-termfeeding

Methods Intermittent bolus feedings

Intermittent gravity drip

Continuous infusion Cyclic feeding


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Bolus Gastrostomy Feeding by

Gravity


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Nasoenteric Feeding by Continuous

Controlled Pump


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Question

What position should the patients head be inwhen receiving a tube feeding to preventaspiration?

A. Flat

B. 10 20 degree elevation

C. 30 45 degree elevation

D. 60 90 degree elevation


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Answer

C

The semi-Fowler position is necessary for an NGfeeding with the patients head elevated atleast 30 to 45 degrees to reduce the risk ofaspiration.


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Nursing Process: The Care of the Patient

Receiving an Enteral FeedingAssessment

Nutritional status and nutritional assessment

Factors or illnesses that increase metabolic needs

Hydration and fluid needs

Digestive tract function Renal function and electrolyte status

Medications and other theories that effect nutritionintake and function of the GI tract

Compare the dietary prescription to the patient needs.


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Receiving an Enteral FeedingDiagnoses

Imbalanced nutrition

Risk for diarrhea

Risk for ineffective airway clearance

Risk for deficient fluid

Risk for ineffective coping

Risk for ineffective therapeutic regimen

management Deficient knowledge


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Collaborative Problems/Potential

Complications

Diarrhea

Nausea and vomiting

Gas/bloating/cramping

Dumping syndrome Aspiration pneumonia

Tube displacement

Tube obstruction

Nasopharyngeal irritation

Hyperglycemia Dehydration and azotemia


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Nursing Process: The Care of the

Patient Receiving an Enteral Feeding

Planning

Major goals may include nutritional balance,normal bowel elimination pattern, reduced risk ofaspiration, adequate hydration, individual coping,knowledge and skill in self-care, and prevention ofcomplications.


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Maintaining Nutrition Balance and Tube

Function Administer feeding at prescribed rate and method andaccording to patient tolerance.

Measure residual prior to intermittent feedings and every 4-8hours during continuous feedings.

Administer water before and after each medication and eachfeeding, before and after checking residual, every 4-6 hours,and whenever the tube feeding is discontinued or interrupted.

Do not mix medications with feedings.

Use a 30-mL or larger syringe.

Maintain delivery system as required. To avoid bacterialcontamination, do not hang more than 4 hours of feeding in anopen system.


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Maintaining Normal Bowel Elimination

Selection of TF formula; consider fiber, osmolality, andfluid content

Prevent contamination of TF; maintain closed system, donot hang more than 4 hours TF in an open system

Maintain proper nutritional intake

Assess for reason for diarrhea and obtain treatment asneeded

Administer TF slowly to prevent dumping syndrome

Avoid cold TF


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Reduce Risk for Aspiration

Elevate HOB at least 30-45 degreesduring and for at least 1 hour after

feedings Monitor residual volumes


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Other Interventions

Maintain hydration by supplying additionalwater and assessing for signs of dehydration

Promote coping by support andencouragement, encourage self-care andactivities

Patient teaching


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Patient with a GastrostomyAssessment

Patient knowledge and ability to learn

Self-care ability and support

Skin condition Nutrition and fluid status


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Patient with a Gastrostomy

Diagnoses Imbalanced nutrition

Risk of infection

Risk for impaired skin integrity

Ineffective coping

Disturbed body image

Risk for ineffective therapeutic regimen

management


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Collaborative Problems/Potential

Complications

Wound infection

GI bleeding

Premature removal of tube Aspiration

Constipation

Diarrhea


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Patient with a GastrostomyPlanning

Major goals include attaining an optimal levelof nutrition, preventing infection,maintaining skin integrity, enhancing copingskills, adjusting to changes in body image,acquiring knowledge of and skill in self-care,and preventing complications.


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PEG Dressing


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Receiving Parenteral NutritionAssessment

Assist in identifying patients who are candidates forPN

Nutrition status

Hydration status

Electrolytes

Signs and symptoms of hypoglycemia/hyperglycemia Monitor blood glucose

Assess for potential complications VS including temperature every 4 hours or by protocol


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Receiving Parenteral NutritionDiagnoses

Imbalanced nutrition

Risk for infection

Risk for excess or deficient fluid Risk for immobility

Risk of ineffective therapeutic regimen


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Collaborative Problems and

Potential Complications Pneumothorax

Clotted or displaced catheter

Sepsis

Hyperglycemia

Rebound hypoglycemia

Fluid overload


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Patient Receiving Parenteral NutritionPlanning Major goals may include attaining an optimal level

of nutrition, absence of infection, adequate fluid

volume, optimal level of activity, knowledge ofself-care, and absence of complications.


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Prevention of Infection Appropriate catheter and IV site care

Strict sterile technique for dressing changes

Wear mask when changing the dressing

Assess insertion site

Assess for indicators of infection

Proper IV and tubing care


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Maintaining Fluid Balance Use infusion pump. Flow rate should not be

increased or decreased rapidly. If fluid runsout, hang 10% dextrose solution.

Monitor indicators of fluid balance andelectrolyte levels.

I&O.

Weights. Monitor blood glucose levels.


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Patient Teaching Goals and purpose Components of PN

Emergency contact numbers

Demonstrate use of equipment and how to handle andhang the IV

Demonstrate dressing changes

Demonstrate how to flush or heparinize the catheter

Potential complications and actions


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Alternative Feeding

1. Enteral hyperalimentation- delivery of nutrients directly tothe GI tract.

a. Short- term- esophagostomy; nasogastric tube

b. Long- term- gastrostomy; jejunostomy

Indications of NGT:

a) Gavage- to deliver nutrients; for feeding purposes

b) Lavage- to irrigate the stomach

c) Decompression- to remove stomach contents or air


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2 H p lim nt ti n (t t l p nt l nut iti n) m th d f


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2. Hyperalimentation (total parenteral nutrition)- method ofgiving highly concentrated solutions intravenously to maintain apatients nutritional balance when oral or enteral nutrition isnot possible

Nursing Managements:

Filter is used in the IV tubing to trap bacteria

Solution and administration equipment should be changed every24 hours

Dressing changes every 48-72 hrs with antibiotic ointment tocatheter insertion

Medication is never administered in a TPN line

Observe for complications

Infection

Venous thrombosis

Hyperglycemia

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