medication administration pt 3.

Question 1

types of tubes:

Answer 1

naso-gastric (NG) tube, percutaneous endoscopic gastrostomy (PEG) tube, and gastrostomy button (G-button)

Question 2

what is the most common enteral nutrition?

Answer 2

closed system, can safely hang for 24-36 hours

Question 3

open system

Answer 3

prepared by the nurse bedside, solution(s) added to empty system container

Question 4

continuous nutrition

Answer 4

administered over 24-hour period using an enteral pump, initiate full strength formula at designated rate and gradually increase every 8-12 hours until goal rate reached, HOB elevated at 30 degrees AT ALL times

Question 5

cyclic nutrition

Answer 5

administered under 24 hour period using enteral pump, often overnight, patient may eat during break periods, HOB elevated 30 degrees or greater during feed administration and for a minimum of 1 hour after stop, pre and post-flush with 30 mL sterile water

Question 6

intermittent nutrition

Answer 6

initiate full strength formula at specified volume (2.5 - 5 mL/kg), and increase gradually every 8-12 hours until goal volume reached, usually administer over at least 20-30 minutes by enteral pump syringe, HOB at least 30 degrees for 1 hour minimum after each feed, pre and post-flush 30 mL of sterile water

Question 7

bolus nutrition

Answer 7

syringe used to administer formula by gravity (flow rate regulated by raising and lowering syringe), administered quickly than intermittent feeding, HOB elevated at least 30 degrees for 1 hour minimum after feeding, pre and post-flush with 30 mL sterile water

Question 8

administering of feedings: gravity

Answer 8

ensure HOB 30 degrees, connect device & administer via gravity flow- slowly, flush, keep HOB elevated at least 1 hour

Question 9

administering of feedings: pump

Answer 9

ensure HOB is elevated at 30 degrees at all times, connect primed pump tubing, ensure pump rate as ordered, open clamp and start infusion, monitor gastric residual every 4 hours IF signs of intolerance, flush per protocol

Question 10

high risk of continuous or bolus feeding tubes are:

Answer 10

aspiration, diarrhea, constipation, N/V, gas, bloating, cramping, dehydration, and hyperglycemia

Question 11

signs and symptoms of aspiration:

Answer 11

cough, shortness of breath, raspy voice, gurgling

Question 12

interventions of aspiration:

Answer 12

stop the feeding, elevate HOB at least 30-45 degrees, notify physician, check placement with order

Question 13

adult tube feeding intolerance algorithm is

Answer 13

abdominal signs: distention, firm, tense, guarding, discomfort
Nausea: antiemetics, minimize narcotics, check for constipation, and notify provider
emesis: hold feeding, check constipation, notify provider

Question 14

proceeding with feed you will do what:

Answer 14

assess patient’s GI system- presentation of abdomen, bowel sounds, ensure patient is in proper position

Question 15

checking placement

Answer 15

verify tube placement, aspirate tube patency/gastric contents (exception - NOT Jejunostomy tubes, Levin, or Dobhoff tubes), measure contents and return, flush, document findings

Question 16

do not proceed with feeding if

Answer 16

> 500 mL residual (greater), return residual and flush 30 mL sterile water, recheck in about 4 hours, if (above) > 500 mL, hold feed and notify pcp and dietician

Question 17

metoclopramide (reglan)

Answer 17

gastroporesis (low stomach motility), GERD, N/V

Question 17

ondanesetron (zofran)

Answer 17

after the fact medicine if they are already vomiting or nauseous

Question 18

nursing interventions:

Answer 18

assess tubes for correct placement and proper labeling, don’t let tubing run dry, be aware of tubes during patient transfer or turns

Question 19

skin irritation and infection prevention:

Answer 19

clean site regularly, thin gauze and external disk - replace and rotate, monitor skin for irritation, breakdown, drainage/bleeding, and candida (yeast) infection