CHAPTER 9/10: ENTERAL NUTRITION AND TPN Flashcards
Who gets enteral nutrition?
patients who are not able to consume adequate nutrients orally, but have at least a partially functioning digestive tract (stomach or small intestine)
** patient have condition that increases risk for malnutrition, neuromuscular impairment impacting chewing and swallowing, no gag reflex, infant who can’t swallow or suck **
What are the 2 types of enteral feeding options?
o NG Tube (Nasogastric): goes from nose to stomach
▪ Short-term use (3-4 wks)
▪ Duodenal (to duodenum) or jejunal (to jejunum) typically for people at r/f aspiration d/t gastroparesis (delayed gastric emptying)
o Gastrostomy tube: tube inserted directly into the stomach or intestines
▪ Long-term use
▪ PEG tube or G tube
> G-tube: skin level, comfortable, immersible in water; harder to check residual
▪ Jejunostomy –> J tube
What are the 2 formulas for enteral feedings?
o Standard/polymeric: whole proteins, require a fully functioning GI tract
* Standard formula: low residue and high fiber better for minimizing gas (ex. bowel rest, postop bowel surgery) or normalizing diarrhea or constipation*
o Hydrolyzed/elemental: partially digested (broken down) protein/nutrients, can be used if a patient has a partially impaired GI tract
What are the main nursing care for enteral feedings?
- When you first place the tube, you NEED to verify tube placement using an XRAY
- Measure gastric residual every 4-6 hours**
- Flush the feeding tubes with 30 mL of water every 4 hours***
- Solution should be at room temperature*****
- Flush the tubing with 15-30 mL of water before, after, and in-between medications****
- Slowly increase the volume or rate to the desired level***
What are the nursing care for enteral feedings?
- When you first place the tube, you NEED to verify tube placement using an XRAY
- A CLIENT CAN DEVELOP DIARRHEA if the FORMULA infused is TOO COLD.. so warm it to room temp before administration
- Measure the tube each shift and before each feeding
- Verify the presence of bowel sounds before each feeding
- Discard bags and tubing associated with the feeding every 24 hours
- Measure gastric residual every 4-6 hours**
- Return the residual to the stomach!!
- Hold feeding if the amount of the residual exceeds whatever the hospital policy is (usually about 500 mL or >25% of feeding vol in kids)
- Flush the feeding tubes with 30 mL (or 20-50 min) of water every 4 hours***
- Solution should be at room temperature*****
- Elevate the head of the bed at least 30 degrees during feeding and for 30-60 minutes after the feeding to help prevent aspiration
- Flush the tubing with 15-30 mL of water before, after, and in-between medications****
- Cover and label any unused formula with patient information and refrigerate it for up to 24 hours (after 24 you get rid of it)
- Fill feeding bag with only 4 hours’ worth of formula to prevent bacterial contamination
- Slowly increase the volume or rate to the desired level***
o When someone first starts you start the rate very low (5-10 mL per hour) and then slowly increase it to desired rate
o When you are weaning them off you’re going to do so slowly versus abruptly discontinuing it
▪ You will have weaned them as their oral consumption increases
What will a dehydrated patient on a enteral feeding need?
they will need CONTINUOUS infusion with HIGH CARBS and LOW PROTEIN
This feeding type decreases residuals, and increases the r/f aspiration and diarrhea
continuous infusion
This feeding is given for 8-20 hours (typically transitioned from total EN to oral)
cyclic feeding
This feeding is given 250mL-400mL every 4-6 hrs over 30-60min and is used in noncritical patients, for home feeds or rehab. Residual needs to be measured .
intermittent
This feeding is given 250-400 mL every 4-6hr over 5-30 min and carries a r/f dumping syndrome
bolus
How much of a bolus should be given to small infants and children?
<5mL/10min for infants; <10mL/min for children
How should medications be given via enteral feeding?
- Stop feeding prior
- Flush w/ 15-30 mL water before and after med admin, and between meds if multiple are being given
- Use liquid meds if possible; dissolve tablets in water not in formula
- For kids, use 1.5x amount predetermined to flush an unused feeding tube of same size
How should you wean a patient off of an enteral feeding?
- Start weaning if can eat 2/3 protein and calories orally for 3-5 days
- Stop EN 1hr before meal
- Slowly increase PO meals to 6 small meals/day
- When PO intake = 500-750 cal/day, switch to cyclic feeds at night
What complications can result from enteral nutrition?
- GI
> Slow infusion rate
> Administer at room temp - MECHANICAL
> Unclog tubing w/ 30-50 mL warm water in > 60 mL syringe - FOOD POISONING
> Wash hands
> Formula cans: clean tops, cover and label w/ name, room, date and time opened
> Use closed feeding systems
> Refrigerate unused portions for max 24hr
> Replace feeding bag, tubing, and any mixing equipment q24hr
> Fill generic bags w/ 4hr worth of formula
What is parenteral nutrition and who needs it?
Nutrient formula put directly into vascular system AKA a vein (GI tract not working)
Patients who have:
- GI disorders
- Cancer
- Critical illness
- Trauma
- Burns
