Enteral Feedings

Question 1

Enteral Nutrition is also called-

Answer 1

Total Enteral Nutrition (TEN)

Question 2

Whenever a pt is unable to use the GI route, what could be beneficial for them?

Answer 2

TEN

Question 3

Enteral Access is achieved by what?

Answer 3

Nasogastric tubes
Nasointestinal (nasoenteric) tubes
Gastrostomy tubes
Jejunostomy tubes

Question 4

Inserted through nostril, advanced down through the nasopharynx, and into the alimentary tract =

Answer 4

Nasogastric Tubes

Question 5

Are NG Tubes for short or long term therapy (Feedings)?

Answer 5

Short term therapy

Question 6

What size catheter is used for a nasogastric tube?

Answer 6

Traditional Large-Bore (Larger than 12 Fr)

Question 7

NG Tubes are not advised for feeding if-

Answer 7

The gag reflex is not intact

Question 8

Why are NG Tubes not recommended if the pt’s gag reflex isn’t intact?

Answer 8

Because of the risk of accidental placement in the lungs

Question 9

What are the purposes of an NG Tube?

Answer 9

Tube feedings and med administration

For stomach lavage following poisoning or overdose

For prevention of N/V & gastric distention postoperatively

To obtain stomach contents for diagnostic analysis

Question 10

Inserted through a nostril and goes down into the upper small intestine =

Answer 10

Nasointestinal Tubes

Question 11

Used when clients are at risk for aspiration. May need specialized training to insert =

Answer 11

Nasointestinal Tube

Question 12

How long are Nasointestinal Tubes?

Answer 12

Longer than NG tubes (~ 40 cm)

Question 13

What are Nasointestinal Tubes used for?

Answer 13

Pt’s at risk for Aspiration

Question 14

Clients who are at risk of aspiration during a tube feeding are those with:

Answer 14

Decreased LOC
Poor cough or gag reflexes
Inability to participate in the procedure
Restlessness or agitation

Question 15

How are Gastrostomy Tubes inserted?

Answer 15

Surgically inserted by surgeon through surgery or by laparoscopy through abdominal wall into stomach

Question 16

What are Gastrostomy Tubes used for?

Answer 16

Long term nutritional support (More than 6-
8 weeks)

Question 17

How are Jejunostomy Tubes inserted?

Answer 17

Surgically implanted through abdominal wall into jejunum

Question 18

What are Jejunostomy Tubes used for?

Answer 18

Long term nutritional support

Question 19

What are some things that you’d do for a NG Tube insertion?

Answer 19

Explain procedure
Position in high fowler’s position
Assess nostril patency
NEX Measurement
Lubricate tube (water soluble jelly)
Insert tube
Check placement
Secure tube
Document

Question 20

What should you lubricate a NG Tube with?

Answer 20

Water soluble jelly

Question 21

What position should you put a pt in when inserting an NG Tube?

Answer 21

High Fowler’s

Question 22

How should you care for a NG Tube on the daily?

Answer 22

Inspect nostril for discharge or irritation

Clean nostril and tube with moist cotton-tipped applicator

Apply water soluble lubricant if nostril dry or encrusted

Remove tape daily; clean & dry skin; assess skin; re-tape

Frequent oral care; mouth breather possibly due to tube presence

Question 23

Methods for checking NG Tube placement include:

Answer 23

X-ray
Aspirate gastric contents
Measure pH
Confirm tube length with insertion mark

Question 24

Which is the best indication of proper nasogastric
tube placement?

A.) pH of contents
B.) Gastric content aspiration
C.) Air auscultation
D.) X-ray

Answer 24

D

Question 25

What should you always do during NG Tube removal to prevent fluids from draining into the throat?

Answer 25

Pinch the tube

Question 26

What are some things that you should do during NG Tube removal?

Answer 26

Explain procedure Wash hands Sitting position if able Pad or towel across chest Detach tube Have client take a deep breath and hold it Pinch tube to prevent contents from draining into throat Remove tube slowly and evenly over 3 – 6 seconds Coil tube around hand while removing Place tube into trash bag Provide oral care & allow to blow nose following removal Dispose of correctly Document

Question 27

What should you always do before NG Tube irrigation?

Answer 27

Check Placement

Question 28

How often should you irrigate an NG Tube, why?

Answer 28

Irrigate every 4 hours to check placement and to maintain patency of tube

Question 29

How many mL of water should you instill when irrigating an NG Tube? How should you irrigate one?

Answer 29

Gently instill 30-50 mL of water or NS with irrigation syringe per agency policy Pull back into syringe to check patency; repeat if tube flow sluggish

Question 30

How many mL of food are usually given during an NG Tube feeding?

Answer 30

Less than 100 mL

Question 31

Hold/delayed feedings may be warranted whenever giving how many mL of food?

Answer 31

Over 100 mL

Question 32

When doing an NG Tube feeding, what should you do?

Answer 32

Assess bowel sounds; absent (hold feeding and contact HCP) Assess tube placement (check pH) Check residual and return contents Warm feedings to room temperature to prevent cramping and diarrhea Use feeding pump for cyclic or continuous feedings Keep HOB elevated Check expiration date of formula

Question 33

During an NG Tube feeding, you shouldn’t leave solutions hanging for any more than how long? Why?

Answer 33

8-12 hours. Prevents microbial growth

Question 34

What are some precautions to keep in mind whenever it comes to NG Tubes?

Answer 34

Check placement before feedings & meds Change tubing and container every 24 hours Do not hang more than 8-12 hours worth of solution at a time in open systems (prevents bacterial growth) Check expiration date Check formula type Shake formula well before pouring Assess bowel sounds Administer feeding per prescriptions Flush with 30-50 mL after feeding complete

Question 35

You have a pt who is getting a feeding via a NG Tube. What should you assess about your pt?

Answer 35

Assess bowel sounds + Placement of tube + Abdominal distention + Urine for sugar and acetone + Hematocrit + Urine specific gravity + BUN + Sodium level

Question 36

What are some potential GI Complications from NG Tube Feedings?

Answer 36

Diarrhea Vomiting Constipation

Question 37

What are some potential non-GI Complications from NG Tube Feedings?

Answer 37

Tube displacement Delayed gastric emptying Fluid overload Aspiration Clogged tube

Question 38

How should you administer meds via an NG Tube?

Answer 38

Make sure med can be crushed or capsule opened Crush meds and dissolve in 15-30 mL water Check placement and residual prior to administration Assess bowel sounds Draw medication up into catheter tip syringe Administer medication into tube Flush tube with 30-50 mL water or NS Clamp tube for 30-60 minutes depending on agency policy

Question 39

Low continuous suction or high intermittent may be used with this kind’ve tube =

Answer 39

Salem Sump

Question 40

Low intermittent suction is recommended with this kind’ve tube =

Answer 40

Levin Tube

Question 41

Why is it important to have a client take a deep breath and hold it during NG tube removal? A.) To prevent client from gagging B.) Prevents accidental aspiration of contents C.) Prevents contents from draining in throat D.) Prevents transmission of microorganisms

Answer 41

B

Question 42

Nurses should assess placement of any gastrointestinal tube before performing which actions? Select all that apply: A.) Instilling feedings B.) Administering medications C.) Irrigation of tube D.) Lung auscultation E.) Assessing bowel sounds

Answer 42

A, B, C