7/28/2019 tube feeding.pptx
1/47
7/28/2019 tube feeding.pptx
2/47
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.
7/28/2019 tube feeding.pptx
3/47
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.
7/28/2019 tube feeding.pptx
4/47
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
7/28/2019 tube feeding.pptx
5/47
Types of Tubes
Gastric tubes
Levin
Sump Enteric tubes
7/28/2019 tube feeding.pptx
6/47
Gastric Sump TubeRefer to fig. 36-1
7/28/2019 tube feeding.pptx
7/47
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.
7/28/2019 tube feeding.pptx
8/47
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.
7/28/2019 tube feeding.pptx
9/47
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.
7/28/2019 tube feeding.pptx
10/47
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.
7/28/2019 tube feeding.pptx
11/47
Question
Is the following statement True or False?
The nasogastric tube is secured to the nose withtape to prevent injury to the nasopharyngealpassages.
7/28/2019 tube feeding.pptx
12/47
Answer
True
The nasogastric tube is secured to the nose withtape to prevent injury to the nasopharyngealpassages.
7/28/2019 tube feeding.pptx
13/47
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
7/28/2019 tube feeding.pptx
14/47
Measuring for Nasogastric Tube
Insertion
7/28/2019 tube feeding.pptx
15/47
Securing the NG Tube
7/28/2019 tube feeding.pptx
16/47
7/28/2019 tube feeding.pptx
17/47
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.
7/28/2019 tube feeding.pptx
18/47
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
7/28/2019 tube feeding.pptx
19/47
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
7/28/2019 tube feeding.pptx
20/47
Bolus Gastrostomy Feeding by
Gravity
7/28/2019 tube feeding.pptx
21/47
Nasoenteric Feeding by Continuous
Controlled Pump
7/28/2019 tube feeding.pptx
22/47
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
7/28/2019 tube feeding.pptx
23/47
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.
7/28/2019 tube feeding.pptx
24/47
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.
7/28/2019 tube feeding.pptx
25/47
Nursing Process: The Care of the Patient
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
7/28/2019 tube feeding.pptx
26/47
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
7/28/2019 tube feeding.pptx
27/47
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.
7/28/2019 tube feeding.pptx
28/47
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.
7/28/2019 tube feeding.pptx
29/47
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
7/28/2019 tube feeding.pptx
30/47
Reduce Risk for Aspiration
Elevate HOB at least 30-45 degreesduring and for at least 1 hour after
feedings Monitor residual volumes
7/28/2019 tube feeding.pptx
31/47
Other Interventions
Maintain hydration by supplying additionalwater and assessing for signs of dehydration
Promote coping by support andencouragement, encourage self-care andactivities
Patient teaching
7/28/2019 tube feeding.pptx
32/47
Nursing Process: The Care of the
Patient with a GastrostomyAssessment
Patient knowledge and ability to learn
Self-care ability and support
Skin condition Nutrition and fluid status
7/28/2019 tube feeding.pptx
33/47
Nursing Process: The Care of the
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
7/28/2019 tube feeding.pptx
34/47
Collaborative Problems/Potential
Complications
Wound infection
GI bleeding
Premature removal of tube Aspiration
Constipation
Diarrhea
7/28/2019 tube feeding.pptx
35/47
Nursing Process: The Care of the
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.
7/28/2019 tube feeding.pptx
36/47
7/28/2019 tube feeding.pptx
37/47
PEG Dressing
7/28/2019 tube feeding.pptx
38/47
Nursing Process: The Care of the Patient
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
7/28/2019 tube feeding.pptx
39/47
Nursing Process: The Care of the Patient
Receiving Parenteral NutritionDiagnoses
Imbalanced nutrition
Risk for infection
Risk for excess or deficient fluid Risk for immobility
Risk of ineffective therapeutic regimen
7/28/2019 tube feeding.pptx
40/47
Collaborative Problems and
Potential Complications Pneumothorax
Clotted or displaced catheter
Sepsis
Hyperglycemia
Rebound hypoglycemia
Fluid overload
7/28/2019 tube feeding.pptx
41/47
Nursing Process: The Care of the
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.
7/28/2019 tube feeding.pptx
42/47
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
7/28/2019 tube feeding.pptx
43/47
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.
7/28/2019 tube feeding.pptx
44/47
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
7/28/2019 tube feeding.pptx
45/47
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
7/28/2019 tube feeding.pptx
46/47
2 H p lim nt ti n (t t l p nt l nut iti n) m th d f
7/28/2019 tube feeding.pptx
47/47
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
Top Related