TOPIC 7 - parenteral and enteral feeding

Question 1

enteral feedings are given to patients who

Answer 1

are unable to maintain or achieve adequate nutritional status

Question 2

enteral feeding is administered through

Answer 2

a tube inserted into the stomach, duodenum, or jejunum in a balanced liquefied food

Question 3

indications for enteral nutriton

Answer 3

patients who have a condition that impacts swallow ability, anorexia, facial fractures, head/neck cancer, neurologic or psychiatric conditions, chemo, critical illness, stroke

Question 4

tube features for enteral nutrition

Answer 4

polyurethane or silicone tube
soft, flexible, radiopaque, placed in small intestine, decreased likelihood for regurgitation and aspiration

Question 5

what is the benefit of placement into the small intestine

Answer 5

intestine decreases the chance of regurgitating gastric contents into the esophagus and subsequent aspiration. However, the patient can still aspirate gastric secretions if the stomach is not emptying properly

Question 6

when is a stylet used

Answer 6

in a comatose patient because the ability to swallow is not essential during insertion. A complication that can result from using a stylet is increased risk for perforation

Question 7

complications of nasogastric and nasointestinal tubes

Answer 7

clog easily, can be dislodged by vomiting or coughing, can be knotted or kinked in GI tract

Question 8

gastrostomy and jejunostomy tubes (PEG( may be used for patients

Answer 8

who require tube feedings for an extended time

patient must have intact, unobstructed GI tract

can be placed surgically, radiologically, or endoscopically

Question 9

placement of PEG tube

Answer 9

Using endoscopy, a gastrostomy tube is inserted through the esophagus into the stomach and then is pulled through a stab wound made in the abdominal wall. a retention disk and bumper then secure the tube

Question 10

delivery options of enteral nutrition

Answer 10

continuous infusion by pump, cyclic feedings by pump, intermittent by gravity, intermittent by bolus by syringe

Question 11

when are enteral feedings started

Answer 11

when bowel sounds are present, usually 24 hours after placement

PEG tubes are started 2 hours after insertion

Question 12

interventions for preventing aspiration risk

Answer 12

ensure proper position of tube, maintain head of bed elevation, check gastric residual volume

Question 13

client position for enteral feedings

Answer 13

sitting or lying with HOB at 30-45 degrees, remain elevated for 30-60 minutes for intermittent delivery

Question 14

confirming tube placement

Answer 14

mark exit site of tube (observe for change in length)
check placement before each feeding/drug admin or every 8 hours with continuous feeds
check insertion length regularly

Question 15

methods to check placement

Answer 15

aspiration of stomach contents
pH <5
xray

Question 16

when to check GRV

Answer 16

every 4 hours during first 48 hours

increased volume leads to aspiration

Question 17

site care

Answer 17

assess the skin around the tube daily

monitor bumper tension

apply a dressing until site is healed

after healed, wash with soap and water and protective ointment or skin barrier

Question 18

why is skin at risk around gastrostomy and jejunostomy tubes

Answer 18

digestive juice irritates skin

Question 19

protective ointments and skin barriers

Answer 19

zinc oxide, petroleum gauze, karava, stomahesive

Question 20

checking tube patency

Answer 20

flush with 30ml water before and after each feeding, drug admin, and residual check

Question 21

preventative measure for continuous feedings

Answer 21

occlusion alarm

Question 22

misconnection

Answer 22

SAFETY ALERT
inadvertent connection between enteral feeding and nonenteral feeding system

Question 23

admin of feedings pump vs intermittent

Answer 23

pump: gradually increase over 24-48 hrs
intermittent: usually 200-500 mL per feed

Question 24

nursing considerations

Answer 24

daily weights, assess bowel sounds, I+O, initial glucose checks, label with data and time started

Question 25

how often is pump tubing changed

Answer 25

every 24 hours

Question 26

complications of enteral nutrition

Answer 26

vomiting, dehydration, diarrhea, constipation

Question 27

potential problems of gastrostomy or jejunostomy feedings

Answer 27

skin irritation pulling out of tube

Question 28

parenteral nutrition administers ...

Answer 28

directly into the bloodstream

Question 29

minimum caloric intake

Answer 29

1200-1500 a day

Question 30

parenteral nutrition indications

Answer 30

chronic severe diarrhea and vomiting, complicated surgery or trauma, GI obstruction, intractable diarrhea, severe anorexic, severe malabsorption, short bowel syndrome, GI tract abnormalities used when ingestion, digestion, and absorption is impaired

Question 31

composition of parenteral nutrition

Answer 31

base contains dextrose and protein in the form of amino acids electrolytes, vitamins, and trace elements IV fat emulsion is added

Question 32

trace elements

Answer 32

Zinc, copper, chromium, manganese, selenium, molybdenum, and iodine

Question 33

fat emulsion side effects

Answer 33

vomiting, shivering, fever, chills

Question 34

lipids should be cautioned in patients with

Answer 34

disturbance in fat metabolism, in danger of fat embolism, allergy to eggs

Question 35

methods of parenteral administration

Answer 35

central - used for long term support peripheral - used for short term therapy

Question 36

central parenteral nutrition

Answer 36

catheter tip lies in SVC subclavian or jugular vein PICCs

Question 37

peripheral parenteral nutrition indications

Answer 37

protein and caloric deficiency risk of central catheter is too great supplement inadequate oral intake

Question 38

difference in peripheral vs central tonicity

Answer 38

central : large vein can handle high tonicity (20-50%) peripheral : up to 20%

Question 39

solutions administered to prevent hypoglycemia

Answer 39

10, 20, or 5% dextrose solution used when a PN bag empties before the next solution is available

Question 40

complications of PN

Answer 40

refeeding syndrome : fluid retention and electrolyte imbalance hypophosphatemia

Question 41

conditions that predispose patients refeeding syndrome

Answer 41

long standing malnutrition, chronic alcoholism, N/V/D, chemo, major surgery

Question 42

metabolic problems of PN

Answer 42

Hyperglycemia, hypoglycemia, prerenal azotemia, fatty acid deficiency, electrolyte disturbances, hyperlipidemia, mineral deficiencies

Question 43

mechanical problems of PN

Answer 43

insertion problems dislodgment, thrombosis of great vein, phlebitis

Question 44

nursing management of PN

Answer 44

vitals every 4-8 hours, daily weights, glucose checks every 4-6 hours, monitor for hyper or hypoglycemia

Question 45

signs and symptoms of hyperglycemia

Answer 45

thirst, polyuria, confusion, elevated BS, blurred vision, dizziness, N/V, and dehydration

Question 46

signs and symptoms of hypoglycemia

Answer 46

sweating, hunger, weakness, tremors

Question 47

maintain glucose :

Answer 47

110-150

Question 48

management of increased glucose

Answer 48

maintain accurate infusion rate, never increase or decrease flow rate by more than 10%, never stop PN abruptly unless it is replaced by another glucose source, infusion pump must be used, need to periodically check volume infused

Question 49

labs to monitor daily

Answer 49

hyper or hypokalemia, hypophosphatemia, hypomagnesemia, BUN, CBC, liver enzymes

Question 50

air embolus

Answer 50

difficulty breathing or respiratory failure, chest pain, heart failure, stroke, pneumothorax, hemothorax, hydrothorax, hemorrhage

Question 51

main symptoms of air embolus

Answer 51

SOB and cyanosis

Question 52

local vs systemic manifestations of infection and septicemia

Answer 52

local : erythema, tenderness, exudate at catheter insertion site systemic : fever, chills, nausea, vomiting, malaise

Question 53

if no other cause of infection can be identified what is suspected

Answer 53

catheter related infection

Question 54

diagnostics for infection status

Answer 54

blood and catheter cultures xray : to check pulmonary status

Question 55

what caloric intake should be met before discontinuation

Answer 55

60% caloric needs