week 8 enternal nutrition tubes and pumps

Question 1

indications for enternal nutrition

or reason on why you give tubes

Answer 1

facial and jaw injury
head and neck cancers
swallowing disorders
hypermetabolic conditions- where the pt may need more calories
major burns, trauma, sepsis, post-op recovery

Question 2

contraindications to tube feeding

or why you should not use the tubes

Answer 2

intractable vomiting
intestinal obstruction
upper GI bleeding
Severe, acute pancreatitis (pancreas has to secrete digestive enzyme/ insulin)
Expected need less than 5-10 days

Question 3

Short term enternal routes

Answer 3

nasogastric, nasoduodenal, nasojejunal

Question 4

long term enternal routes

Answer 4

G tubes, J tubes (both are PEG tubes)

Question 5

With nasally inserted tube size. How to choose the size

Answer 5

size depends on the viscosity of the formula
select the smallest size possible
generally 8 french will do for commercial formulas
10-14 french will work for home blenderized foods
16 is the biggest tube

Question 6

With nasally inserted tube length. How to choose the length

Answer 6

length will depend on the placement
30 inch for NG
45 inch for ND and NJ
How far you go in depends on how far you want to end up

Question 7

NG tube indications

Answer 7

intact gag reflux
no esophageal reflux
normal gasstric emptying
stomach not invlolved with a primary disease (stomach cancer

Question 8

NG tube advantages

Answer 8

easy insertion

Question 9

NG tube disadvantages

Answer 9

high risk of pulmonary aspiration

patient may be self conscious r/t appearance of tube

Question 10

NJ tube indications

Answer 10

Gastoparesis or imparies gastric emptying
esophageal reflux
gastric dysfunction due to trauma or surgery

Question 11

NJ advantages

Answer 11

can initiate immeditely after injury

reduced risk of aspiration

Question 12

NJ disadvantages

Answer 12

intolerance may need endoscopic placement

patient sel cons., tube may become displaced

Question 13

ND tube indications

Answer 13

gastoparesis or impaires gastric emptying

esophageal reflux

Question 14

ND advantages

Answer 14

reduced risk of pulmonary aspiration

Question 15

ND disadvantages

Answer 15

GI intolerance (bloating, Diarrhea)
may require endoscopic placement
patient self consc
tube may displace into the stomach

Question 16

G tube indications

Answer 16

long term feeding, sotmach empties normally
swallowing dysfunction
NG route not available
Gag refux intact
no esophageal reflux
stoamch not involved in primary disease

Question 17

G tubes advantages

Answer 17

can be palced endoscopically (no surgery)
less costly
tube is large bore-less clogging
larger reservoir capacity in stomach

Question 18

G tube disadvantages

Answer 18

risk for aspirations
stoma care, infection around stoma
potential for skin excoriation from leakage of digestive secretions

Question 19

J tube indications

Answer 19

stomach is somehow not working
long term feedin
high risk of aspiration
esophageal reflux
inability to access the upper GI tract
impaired gastric emptying
gastric dysfucntion due to trauma or surgery

Question 20

J tube advantage

Answer 20

reduced risk of aspiration
no surger required
less costly
con be placed immediately after injury

Question 21

J tube disadvantages

Answer 21

possible intolerance to feedin
stoma care
skin excoration
tube occlusion r/t small bore size

Question 22

how do you check tube placement

Answer 22

x-ray is the most reliable way to check the tube
aspiration of the gastric content
testing PH level of the contents
injecting air into the tube and listen over the stoamch and hear a gurgling sound. Lack scientif support. Placement done at least once a shift and prior to feeding always x2 methods

Question 23

how do you monitor residual

Answer 23

using a syringe to withdraw and measure how much formula is left in the stomach prior ro starting the next feeding
residual is subtracted from the next feeding
it is then returned to the stomach

Question 24

when do you stop the feeding

Answer 24

when the complains of pain or nausea - call physican

Question 25

what do you do with water during tube feeding

Answer 25

rinse the tube with at least 30 mL water after each bolus
extra water may be ordered
continous feeding are usually run at 80-150 ml/hr

Question 26

what are the medication that can and cannot be given in tube feedings

Answer 26

Oral meds that can be crushed can be given by
the feeding tube using a cath tipped syringe.

extended release/ temy coated medication should not be crushed

Question 27

Tubing and bag must be changed

Answer 27

every 24 hours

Question 28

Hang no more than

Answer 28

6 hours of feeding at a

time to prevent contamination

Question 29

when Selecting Formula

• Based on patient need

Answer 29

How well the GI tract is working
– How much capacity the GI tract has
– Underlying disease processes
– Patient tolerance

Question 30

ways to administer feedings? by?

Answer 30

Bolus
• Intermittent
• Continuous

By gravity
• By pump

Question 31

Bolus feedings are for

Answer 31

Non-critical patient
– Home tube feedings
– Rehab patients

Question 32

bolus feedings advantages

Answer 32

Easy, inexpensive, short (15 minutes or less)

Question 33

bolus feedings disadvantages

Answer 33

Risk of aspiration is high, N/V, abdominal pain,

distension and diarrhea.

Question 34

intermittent feedings are for

Answer 34

Non-critical patients
– Home tube feedings
– Rehab patients
May require formulas with more calories and
protein.

Question 35

intermittent feeding advantages

Answer 35

Flexible feeding schedule, inexpensive, short

Question 36

intermittent feeding disadvantages

Answer 36

Risk of aspiration, N/V/D, bloating and abd.

pain.

Question 37

continuous feedings are for

Answer 37

– Critically ill patients
– Usually fed into the small bowel
– Can be used for patients with intolerance to
intermittent or bolus feedings

Question 38

continuous feedings advantages

Answer 38

Pump assisted
• Placement of the tube minimizes risk of
aspiration.

Question 39

continuous feedings disadvantages

Answer 39

Minimizes patient movement
• Infusion is 24 hours a day
• Increased cost r/t pump and tubing change
every 24 hours

Question 40

if formula is isotonic

Answer 40

do not dilute it

Question 41

If feeding is diluted

Answer 41

do not advance the

concentration and the rate at the same time.

Question 42

How do you decide if the patient is tolerating

the tub feeding?

Answer 42

Check gastric residuals
– Diarrhea or constipation
– Nausea or abdominal pain
– Bloating or excess gas production

Question 43

Clogging is more likely with

Answer 43

protein products and thicker solutions.

Question 44

Most clogs can be prevented by

Answer 44

flushing and
assuring medications are crushed well and
dissolved.

Question 45

To unclog a tube

Answer 45

Warm water and slight manual pressure
– Parcrelipase and sodium bicarb solution to “digest”
the clog.
– Tube “roto router”

Question 46

Formula is administered at

Answer 46

room temp

Question 47

Head of bed should always be at least

Answer 47

30 degrees when administering a tube feeding.

Question 48

milky colored solution is

Answer 48

fats and lipids

Question 49

Who needs TPN or PPN?

Answer 49

Debilitated and malnourished with weight loss
of 10% or more.
– Short bowel syndrome
– Inflammatory bowel syndrome
– Hypermetabolic states
• Patients who have high energy and protein needs
– Burn victims
– Cancer patients
– Multiple trauma
– Large open wounds

Question 50

TPN

Answer 50

Satisfies all body
requirements
• Can be short or long term
• Must be administered by a
central venous access
device
– Example – subclavian IV route

Question 51

PPN

Answer 51

Used for short tem or
supplemental support
• Can be given peripherally
• Requires adequate venous
access
– Example – PICC line