Nutrition

Question 1

enteral nutrition

Answer 1

*nutrition that’s provided via the GI tract as a liquid
*it can include a normal oral diet, the use of liquid supplements or delivery by use of a tube (tube feeding)

Question 2

parenteral nutrition

Answer 2

nutrition that’s provided through a central IV route

Question 3

nasogastric tube

Answer 3

inserted through the nose into the stomach

Question 4

nasoenteric or nasointestinal

Answer 4

inserted through the nose into the small intestine

Question 5

gastrostomy tube

Answer 5

*tube that’s surgically inserted into a patient’s stomach through the abdominal wall
*most common is a PEG

Question 6

PEG tube

Answer 6

percutaneously endoscopically placed gastronomy tube - placed into stomach using an endoscope

Question 7

PEJ tube

Answer 7

percutaneously endoscopically placed jejunostomy tube - placed in jejunum using an endoscope

Question 8

whats the most reliable method for confirming INITIAL tube placement is using _____________

Answer 8

radiographic verification (aka xray)

Question 9

two other methods to confirm initial tube placement

Answer 9

1. aspirate and inspect contents
2. measure the volume and pH (Generally, a pH of 1 to 5.5 indicates gastric placement, a pH higher than 6 indicates that the tube is in the jejunum, while a pH of 7 or higher might indicate respiratory placement)

Question 10

the most common way to confirm ongoing tube placement

Answer 10

observe length of tube that extends from body

Question 11

capnography

Answer 11

tests for CO2 to see if it’s in the lungs (client will also be in respiratory distress….)

Question 12

gravity flow

Answer 12

method to administer feedings - patient at risk of GI reflux, diarrhea, and aspiration

Question 13

pump controlled infusions

Answer 13

recommended for jejunal and gastrostomy feedings

Question 14

cyclic : schedule to administer feedings

Answer 14

Feed over a set period of time each day, generally evening and night (AKA nocturnal feedings)

Question 15

intermittent : schedule to administer feedings

Answer 15

Feedings given every so many hours. (Ex: Give 480ml of formula every 6 hours)

Question 16

bolus : method to administer feedings

Answer 16

*Feedings administered with a syringe at ordered intervals.
*Can only do with gastric tubes NOT intestinal tubes.
*Easiest method to teach family members.

Question 17

continuous : schedule to administer feedings

Answer 17

Feeding runs around the clock or continuously

Question 18

*** Regardless of method the patient’s head of bed must be elevated _____ degrees to prevent aspiration during feedings and keep elevated for _______ after administering the feeding

Answer 18

*30-45 degrees
*1 hour

Question 19

When administering feeding the nurse needs to assess for tolerance - watching for signs of discomfort such as _______________ ____________________________________________

Answer 19

cramping, flatus, pain, vomiting, or diarrhea; respiratory status, ability to speak, amount of residual volume

Question 20

open system enteral feeding

Answer 20

*It is exposed to the environment during administration (usually syringe method or bag method.
*Limit exposure to 4 hours.
*Flush system with water to clean after each delivery or 4 hours worth of time.

Question 21

closed system enteral feeding

Answer 21

*Is a prefilled system (usually bag or bottle)
*Decreases risk of contamination
*Formula can hang for 24 - 48 hours if sterile technique is used

Question 21

assess the residual amount how often?

Answer 21

every 4 hours with continuous feedings or prior to intermittent feedings

Question 22

if the residual is less than 150 ml for gastric or 10 ml for intestinal OR equal to 1 hour’s worth of feeding, what would you do?

Answer 22

put the residual back in (with a syringe and graduated container) - flush - and continue to administer the feeding

Question 23

if the residual is more than 150 ml for gastric or 10 ml for intestinal OR 1 hour’s worth of feeding, what would you do?

Answer 23

hold feeding - follow orders (maybe the order is to wait 1 hour and reassess, or to call the provider, or to reinstall the residual contents over a period of time) BUT TO HOLD OFF ON ANY FEEDING AT THAT TIME

Question 24

STEPS TO GIVE FORMULA

Answer 24

1. flush tube with 1/2 the “free” (= warm tap water) water in the order
2. administer the feeding by the correct method and at the correct rate
3. flush tube with the 1/2 remaining water
4. close and secure end of feeding tube
5. if an open system, after feeding is complete run 15-50 ml of water through the bag and tubing
6. dispose of equipment, if appropriate (bags and syringes should be labeled with date and time b/c they’re good for 24 hours)
7. document
8. observe patient for any problems

Question 25

administering medication via a tube

Answer 25

1. 5 rights, verify orders, check for allergies
2. is the med available in liquid form?
3. if not, can the med be opened/crushed?
4. dissolve med in warm water (~20ml)
   DO NOT ADMINISTER WHOLE MEDS
5. label each med cup
6. go to patient’s room (introduce self, provide privacy, explain med, etc)
7. hand hygiene
8. confirm tube placement and check residual to ensure you are able to go ahead and administer meds
9. flush tube with 20-30 mls (or 5-10 ml for kids) with water
10. administer med ONE AT A TIME (they each have their OWN cup to prevent congealing)
11. after each med flush tube with 20-30 ml of water, including at the very end
12. clamp tube or reestablish tube feeding
13. keep head of bed up 30-45 degrees for one hour
14. hand hygiene
15. document
16. observe patient for desired effect and any potential undesired effects of meds

Question 26

decompression (AKA gastrointestinal suction) is used to: _______________

Answer 26

keep the stomach empty of gas or fluid content/gastric content

Question 27

modular formulas

Answer 27

single-nutrient formulas that require a functioning GI tract that can absorb whole nutrients

Question 28

elemental formulas

Answer 28

contain predigested nutrients that are easy for a partially functional GI tract to absorb

Question 29

polymeric formula

Answer 29

whole-nutrient formula that require a functioning GI tract that can absorb whole nutrients

Question 30

specialty formula

Answer 30

meet specific nutritional needs for clients who have conditions such as HIV, liver failure, or clients who have pulmonary disease

Question 31

to determine the length of a nasointestinal tube to insert, a nurse should measure what?

Answer 31

Measuring from the tip of the nose to the earlobe to the xiphoid process approximates the distance from the nose to the stomach for 98% of clients. For duodenal or jejunal placement, an additional 20 to 30 cm is required

Question 32

Nasogastric tubes are contraindicated for __________

Answer 32

clients at high risk of aspiration

Question 33

What kind of feeding tube is recommended for clients at a high risk of aspiration who require short-term feedings of less than 4 weeks

Answer 33

nasointestinal tube