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NRSG 202 > Week 5: Enteral Feeding > Flashcards

Week 5: Enteral Feeding Flashcards

1
Q

What are abdominal bruits

A

Additionally sounds sometimes heard during auscultation (swishing sound) that can indicate aortic aneurysm, but does not ALWAYS indicate disease

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2
Q

What is enteral nutrition?

A

Administration of nutrients directly into the GI tract

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3
Q

What is the preferred method for providing nutrition

A

enteral nutrition

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4
Q

what MUST the patient have in order to have enteral nutrition

A

a functioning GI tract

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5
Q

What is enteral nutrition considered?

A

An advanced directive that may have ethical implications associated with this intervention

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6
Q

What is malnutrition

A

the lack of necessary or appropriate food substances

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7
Q

S&S of Malnutrition

A

mental confusion, irritability
inability to concentrate
lack of appetite or interest in food
changes in skin colour
dry scaly skin
brittle pale nails
dully sparse hair
swollen and bleeding gums, decaying teeth
sunken dry eyes
hollow cheeks
fatigue low energy
muscle wasting
distended abdomen
enlarged liver
weight loss muscle wasting
poor immune function

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8
Q

Abnormal blood results in malnutrition

A

DECREASED:
- albumin
- Hgb
- iron
- lymphocytes
- blood glucose
- K+ and calcium
- BUN and CR
- serum vitamins and mineral levels

INCREASED:
- liver enzymes

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9
Q

What happens when patients are starved

A

villous atrophy
loss of gut mass
compromising the physical barrier (decreased surface area)

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10
Q

Enteral nutrion

A

maintains fut mass, function, and integrity

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11
Q

Early feeding provides these outcomes

A

decreased length of stay
decreased infection/sepsis
increased nutritional goal
improved nitrogen balance

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12
Q

Parenteral feeding

A

via an IV through a central vein

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13
Q

Indications for an Enteral feeding

A

functioning and accessible GI tract
malnourished or at risk of malnutrition
to supplement food intake
unable to ingest oral food
unwilling to take oral feeds
upper GI tract impairment
Dysphagia
critical illness
malabsorption disorders
decreased LOC, coma

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14
Q

Parenteral feed is used when the patient

A

has a NON FUNCTIONING GI tract

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15
Q

Contraindications for enteral feeding

A
  • no gag reflex
  • non functioning GI tract
  • cannot elevate HOB
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16
Q

Complications of enteral feeding

A

referring syndrome
aspiration
metabolic provlems
over hydration
hypo/hypernatremia
tube dislodgement
infection
GI side effects

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17
Q

How to prevent aspiration

A

ensure head of bead is elevated during feeding and for 1 hour following intermittent feeds

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18
Q

what S&S should be observed for with aspiration

A

increased SOB, productive cough, sputum, difficulty swallowing
assess gag reflex, temperature, HR, RR

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19
Q

What is a Nasogastric tube?

A

Inserted into nostril down into the stomach (nasal tubes are usually inserted by a nurse unless a contraindication)

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20
Q

What must a patient have in order to have a NG tube

A

intact gag/cough reflex and adequate gastric emptying

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21
Q

What is NG tubes required for

A

short term feedings (less than 4-6 weeks)

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22
Q

What is a Salem sump

A

A large bore NG tube that has a double lumen

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23
Q

What is a salem sumps usual size

A

12-18 FR

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24
Q

What may a salem sump also be used for?

A

Suction as the smaller vent lumen allows for an inflow of air which prevents vacuum if the tube adheres to the stomach wall

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25
Levin
A large bore NG tube that has a single lumen, often used with an anti-reflux valve
26
How often does a levin tube need to be changed?
Weekly
27
Anti-reflux valve
Prevents gastric reflux or leakage through the vent lumen of a double lumen NG tube
28
What does the valve do on an anti-reflux valve
allows the passage of air into the vent lumen when atmospheric pressure exceeds stomach pressure when stomach pressure exceeds atmospheric pressure the valve prevents the flow of fluids through the tube
29
What is a small bore NG tube?
Levin most common in IH for enteral feeding
30
what is the diameter for a levin?
6-12 FR
31
What does a small NG tube look like
smaller more flexible less irritating may have weighted tip have stylet to assist insertion
32
How often does a small NG tube need to be changed?
Monthly
33
What is a Naso-enteric tube
longer than a nasogastric tube (40cm or grater) inserted into the upper small intestine usually greater dilution and smaller volumes
34
What is a Naso-enteric tube used for?
clients at risk of aspiration
35
What kinds of clients are at risk of aspiration
decreased LOC poor or absent cough or gag reflexes endotracheal intubation recent extubation inability to cooperate with procedure restlessness or agitation
36
What are some complications of Nasal Tubes?
Nasal pharyngeal irritation and pain misplacement of tube perforations (lung, esophagus, stomach, small intestine) Inadvertent lung placement sinitus, sore throat, epistaxis
37
What is a gastrostomy tube (jejunostomy tube)
inserted THROUGH abdominal wall into the stomach or jejunum (placed laparoscopy) larger abdominal incision usually longer NPO time before starting feeds
38
How long is a gastronomy tube usually in for?
more than 6-8 weeks
39
What is a Percutaneous Endoscopic Gastrostomy (PEG)/Jejunostomy tube?
Uses an endoscope to visualize the inside of the stomach, making a puncture through the skin and inserting the tube through the puncture smaller incision shorter NPO time catheter with external bumper internal inflatable retention balloon to maintain placement
40
What are the indications for a long term feeding tube
Both inability to meet nutritional needs orally death is not imminent meets one: has been more than 4-6 weeks on NG and/or orogastric feeds Low probability of nutritional needs being met orally over the next 4-6 weeks NG tube placement contraindicated
41
How long is a PEG tube in for
longer than 6-8 weeks
42
What are some complications of a PEG tube
Peristomal infection leakage accidental tube removal tube blockage tube fracture tube displacement peritonitis aspiration pneumonia bleeding
43
When do nurses check the feeding tubes balloons?
NOT for the first 4 weeks after insertion, after 4 weeks check volume weekly or per facility
44
What is the procedure for checking a tube feeds balloon?
Verify initial volume on insertion use a slip tip syringe to avoid damage remove all old wattle from balloon, measure and discard with new syringe, draw up right amount and reinflate balloon
45
What are aspiration risk factors for all feeding tubes?
HOB less than 30 degrees impaired LOC neuro deficits poor oral health Mal-positioned feeding tube gastroesophageal reflex age over 60 years delayed gastric emptying
46
What is aspiration treatment?
STOP FEEDS Lowe HOB and put pt on left side (to prevent further seepage of formula into lungs) suction PRN administer O2 as needed notify MD immediately continue suctioning PRN
47
Whe is a closed system/continous drip used?
initially when the pt does not tolerate bolus
48
What is a closed system containers volume
1000-1500mL
49
How long can a closed system be hung?
up to 48 hours
50
when are closed systems essential
when feedings are administered into the small bowel
51
How often does a closed system tubing/bag need to be changed
up to Q48H
52
When is an open system/bolus or intermittent used
when the pt is able to tolerate bolus feeds
53
What are the typical sizes of open system
250mL tetra packs usually 300-500mL given several times per day
54
How long is open system usually administered
at least over 30 minutes
55
Where must open system feeds be administered
given only in the stomach (monitor for aspiration and distension)
56
How to treat for open system feeding
rinsed with tap water, drained, and hung to dry following intermittent feeds
57
All feeding systems need to be labelled with
Pt information date/time preparer's initials enteral feeding formula type, rate, strength, and amount
58
Enteral feeding formulas
provides 1kcal/mL of solution with protein, fat, carbs, minerals, and vitamins in specific proportions
59
What are available enteral feeding formulas
Low volume high fibre high protein low sugar/CHO high nitrogen with finer for diarrhea tot pre-digested and easy to absorb natural formula
60
how long can a tetra pack be hung
8 hrs
61
How long can a reconstituted powder formula be hung
4 hours
62
how long can a closed system formula bottle be hung
48 hrs
63
How often does a normal system need to be changed
Q24hrs
64
How often does a closed system need to be changed?
Q48hrs
65
how often does feeding accessory equipment need to be changed?
Q24hrs
66
How often does feeding attachments need to be changed?
weekly
67
What is needed prior to initiating a feed?
1. doctors order 2. X ray confirming tube placement 3. documentation of confirmation of tube placement 4. dietician consulted for all enteral feed pts
68
what is a total free water requirement
amount of fluid client needs in a 24 hours period to sustain life
69
how much free water do enteral formulas contain?
60-85% free water
70
what may be ordered if sodium is low
NS
71
What are the feeding rates if the pt is not at high risk for referring syndrome?
full strength starting at 25mL/hr x8 hrs then increased if tolerated increase to 50mL/hr then by 25mL Q8H to goal rate
72
What are the feeding rates for a patient at high risk for referring syndrome?
full strength starting at 25mL/hr for 24hrs if tolerated for 8hrs increase to 40mL/hr
73
what needs to happen pre and post med admin
flush with tap water
74
when crushing medication how much water does it need to be dissolved in?
30mL
75
how much water should be added to thick medications
5-10mL to prevent blockage
76
what occurs at the bedside when giving meds through tube
perform abdominal assessment assess tube site and tube placement stop feed assess content and residuals if needed flush tube at least 30mL water before, between and after restart feed is required document
77
How much water if normal fluid allowed
30 mL before 30 with med 30 after
78
how much fluid if restricted
15 before med 30 with med 15 after
79
how often does a continous tube feed need to be flushed
Q4H
80
What are some reasons for a tube occlusion
inadequate flushing tube resting on mucosa wall coagulation of enteral feeding formula certain medications, combining meds, and/or not crushing meds fine enough using too small of a bore tube
81
What assessments need to be done prior to enteral feed
baseline resp assessment baseline CNS assessment GI assessment hydration assessment weight tube site assessment feeding solution, expirary date, rate of admin
82
What are the 4 things to assess with feeding tube placement?
1. External length measurement - are to end of tube 2. aspirate for stomach content 3. measure the pH 4. Auscultating over the stomach
83
Gastric Residuals
use 60mL syringe put 10-20mL of air into tube flush with 10-30ml water after

NRSG 202 (8 decks)

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