L11

Question 1

Enteral feeding

Answer 1

Insert into the GI tract
1. NG tube: for short-term feeding
2. Nasoduodenal/Nasojejunal feeding tube
—> placed under the pyloric sphincter, lower chance for gastric regurgitating
—> xxx aspirate, the tube will recoil and collapse
—> not insert and remove by nurse
3. Percutaneous endoscopic gastrostomy: long-term nutritional support
—> need stoma care, risk of leakage or tube dislodgement
4. Jejunostomy
Xxx bolus feeding

Question 2

Confirm placements of NG tube

Answer 2

1. pH lower or equal to 5.5
2. Chest x-ray
3. Auscultation: whoosh test

Question 3

Nursing care of gastrostomy

Answer 3

1. Feeding can start 24 hrs after insertion
2. Check the marking before feeding
3. After healing, clean with soap and water daily
4. Change the water in the ballon every 1-2 weeks
5. Rotate the bumper daily

Question 4

Feeding plan

Answer 4

1. Intermittent feeding: 4-5 feeding daily, over 30 minutes
2. Continuous feeding: allow drip over long period of time
   —> prevent aspiration, distention, nausea, vomiting and diarrhea in poor gastric emptying patient
   —> aspirate and check pH q4H to ensure tube placement
   —> make sure complete filling of the tube and correct rate

Question 5

Nursing care of enteral feeding

Answer 5

1. Ensure the correct placement of feeding tube: check marking and pH every time before feeding
2. Rise patient bed head during feeding, and keep head elevated for 30-60 minutes after feeding
3. Flush the tube with 30mL warm water q4H; before and after each feeding; in between each medication
4. Monitor for signs of fullness, nausea and vomiting (gastric retention)
5. Monitor for the skin condition at exit site
6. Change the feeding bag daily
7. Medication issue:
   - do not add medication in enternal feeding formula
   - dilute viscous liquid medication
   - only crush immediate-release tablets, crush into fine powder and dissolve into 30-60mL purified water
8. Ensure correct indication before removing the tube; check tube integrity after removal

Question 6

Parenteral nutrition

Answer 6

Nutrition support via IV route
Continuous infusion of hyperosmolar solution; 1-3L over 24 hours
Should consider enteral nutrition first to maintain gut mucosal integrity and improve immune function
1. Peripheral parenteral nutrition (PPN)
- glucose content <10%, not enough to supply all the calorie needs
- short-term
- monitor the IV site for infiltration (soft tissue injury)
2. Total parenteral nutrition (TPN)
- high protein and calorie, long-term
- central venous catheter or peripherally inserted central catheter which tips lie in the superior vena cava

Question 7

Nursing care for parenteral feeding

Answer 7

1. Monitor vital signs, I&O, glucose level
2. Weight the patient daily to monitor any fluid overload
3. Administer by infusion pump; monitor the infusion rate hourly
4. Inspect the tube connection site and integrity of line and catheter
5. Aseptic technique when changing tubing and exit site dressing