NG tube care and nutrition

Question 1

What are the most common sites for long-term feeding tubes?

Answer 1

Gastrostomy tube
Jejunostomy tube

Question 2

What is a small-bowel feeding?

Answer 2

(Duodenim or jejunum)
Feeding occurs beyond the pyloric sphincter of the stomach, which theoretically reduces the risk for aspiration.

Question 3

Why should small-bowel feedings be given continuously?

Answer 3

To prevent “dumping” syndrom (diarrhea, fullness, cramping, or vomiting.

Question 4

What is a nasogastric tube?

Answer 4

• Most common
• Easy to provide
• Non-invasive
• Can trigger gag reflex
• Through the nares

Question 5

Where is an orogastric tube inserted?

Answer 5

Through the mouth

Question 6

What type of enteral feeding tube would a client with throat/esophageal trauma be given?

Answer 6

PEG tube

Question 7

What should the nurse instruct the client and caregiver to do after a bolus feeding?

Answer 7

Remain upright for 1 hour

Question 8

What is the first step of prepartion before administering an enteral feeding?

Answer 8

Verify practitioner’s order for formula, rate, route, and frequency.

Question 9

What temperature should tube feedings be given at?

Answer 9

Room temperature (liquid is not warmed by the mouth or esophagus)

Question 10

What part of a tube feeding should remain sterile?

Answer 10

Bag, connections, and tubing

Question 11

How much formula should be administered to patients with enteral tube feedings?

Answer 11

Only the amount needed for 8 hours

Question 12

What labels should the nurse add to a feeding bag after administering it to a patient?

Answer 12

Label bag with tube-feeding type, strength, and amount. Include date, time, and initials. Label administration set “Tube feeding only”

Question 13

What should the nurse do if pH, auscultation of bowels, and patient complaints occur prior to adminsitering a tube feeding?

Answer 13

Obtain radiographic confrimation

Question 14

What is the typical range of gastric pH?

Answer 14

0-4

Question 15

What does the pH of the small intestine usually reflect?

Answer 15

Greater than 6

Question 16

What would the pH of aspirated respiratory contents reflect?

Answer 16

pH of 5 or greater

Question 17

How often should the nurse check gastric residual volume?

Answer 17

Before each feeding for intermittent feedings, and every 4-6 hours initially for continuous feedings.

Question 18

What should the nurse do after aspirating the gastric contents?

Answer 18

Return the gastric contents

Question 19

When shouldn’t the nurse return the gastric contents?

Answer 19

If the gastric risidual volume exceeds 250 mL

Question 20

What should the nurse do after returning the aspirated gastric residual volume to the stomach?

Answer 20

Flush with water

Question 21

How often should the nurse monitor intake and output and calculate daily totals?

Answer 21

Every 8-12 hours
Calculate every 24 hours

Question 22

How often should the nurse weigh a patient with an enteral tube feeding in the hospital setting?

Answer 22

Daily. To indicate fluid balance

Question 23

How much water per kilocalorie is administered through enteral tube feeding?

Answer 23

1 mL of water per kilocalorie

Question 24

The nurse believes a patient with an NG tube is experiencing dehydration. What should she do.

Answer 24

Request free water prescription from provider. MUST BE PRESCRIBED

Question 25

When can the nurse stop weighing a patient with an enteral tube feeding?

Answer 25

Until maximum adminstration rate is reached and maintained for 24 hours, then weigh client 3x per week

Question 26

A patient gains 2 lb in 24 hours. Is this okay?

Answer 26

No. This indicates fluid retention

Question 27

Why shouldn't GRV exceed 250 mL?

Answer 27

Aspirated contents of 250 mL could indicate impaired gastric emptying

Question 28

A patient develops diarrhea after a tube feeding. What should the nurse ask the provider to do?

Answer 28

Assess, and suggest a different feeding style

Question 29

What could indicate gastric ileus?

Answer 29

N/V

Question 30

What is refeeding syndrome?

Answer 30

When tube feeding is pushed too quickly on a malnourished client. Causes electrolyte and fluid shifts that can be LIFE THREATENING

Question 31

What type of modular nutrition does ProMod or Propac administer?

Answer 31

Protein

Question 32

What type of nutrition does Polycose moducal (modular feeding) administer?

Answer 32

CHO (carbs)

Question 33

What type of nutrition does MCT oil (modular feeding) administer?

Answer 33

Fat

Question 34

Which tube feeding is elemental/semi-elemental?

Answer 34

Vivonex

Question 35

What types of tube feedings are complete nutritional supplements?

Answer 35

Jevity, ensure

Question 36

What are 4 things the nurse should document after administering a tube feeding?

Answer 36

- Amount and type of feeding (What rate) - Condition of the abdomen - Length of the tube from nares to end of tube (NG tube) - Client's resposne to tube feeding

Question 37

A client's living will indicates refusal of artifical feeding by tube. What should the nurse do?

Answer 37

Understand this decision must be honored

Question 38

Will a patient that has refused artifical feeding feel pain?

Answer 38

No, not at end of life. Most clients are not hungry at this stage of illness, but they will be thirsty- IV hydration will suffice.

Question 39

What are some older adults more susceptible to in regards to enteral tube feedings?

Answer 39

Hyperglycemia related to glucose intolerance from diabetes or other factors such as medications.

Question 40

Why are gastric residual check of special importance in clients with impaired congnition important?

Answer 40

Some older adults have decreased gastric emptying so formula remains in the stomach longer GRV checks are essential in clients with impaired cognition to decrease the risk for aspiration during gastric feeding

Question 41

What information should the nurse include while educating a caregiver about tube feedings?

Answer 41

- Monitor intake and output using household measuring devices - Ask patient/caregiver about any symptoms of discomfort (contact nurse if any symptoms occur) - How to do skin care around the gastrostomy or jejunostomy tube and educate about infection.

Question 42

What are the steps the nurse should take PRIOR to medication administration through enteral tube?

Answer 42

1. Check order/MAR and 5 rights 2. Check for allergies 3. Check for compatibility of medication with feeding - If med is absorbed in stomach, will NOT be absorbed using intestinal tbe 4. Perform hand hygiene and prepare med for administration 6. Explain meds to client based on current knowledge of meds

Question 43

What are the steps the nurse should take TO administer medications through enteral tube?

Answer 43

1. Flush tube with at least 15 mL of sterile water using 60 mL syringe 2. Draw med in 60 mL syringe 3. Push med or allow syringe to flow freely by gravity 4. Administer each med SEPARATELY followed by at least 15 mL-30 mL water 5. After meds are administered flush with at least 30-60 mL water 6. Restart feeding 7. Document in MAR 8. Evaluate client response