Title: Enteral Tube Feeding If the gut works, use it
1 Enteral Tube FeedingIf the gut works, use it
- Karen Merchant
- Cabrillo College
- May 1, 2007
- Modified from slides by
- Tomas Belnas, RN, MSN
2Purpose of NG Intubation
3 Patient Assessment
- LOC
- Ability to cooperate
- Swallow ability
- Medical diagnosis
- Lab values, VS, IO
- Past medical Hx
- Teaching needs
4A Small Bore Tube
Insertion similar to large bore tube
5Gastric and Intestinal TubesBlack Table 33-1, p
745
6Assessing GI Tube Placement
- Chest xray (prior to tube feeding start)
- Aspiration of gastric (pH4)or duodenal contents
(pHgt6) and pH paper - Traditional injection of air auscultation of
stomach or duodenum/jejunal with a stetoscope - Current Verify placement with Xray prior to
feeding
7Candidates for Total Enteral Nutrition
(TEN)Potter Box 43-9, p 1299 Black Box 31-2,
p 699
- Patients who can eat but cannot maintain adequate
nutrition by oral intake of food alone. - Patients who have permanent neuromuscular
impairment and cannot swallow. - Patients who do not have permanent neuromuscular
impairment but are critically ill and cannot eat
because of their condition.
8Methods of Administration of TEN
- Nasoenteric tube (NET)
- NG tube
- Nasoduodenal tube (NDT)
- Esophagostomy tube
- Enterostomal tube
- Gastrostomy tube (PEG)
- Dual access gastrostomy-jejunostomy tube
- Jejunostomy tube (PEJ)
9Types of Feedings
- Intermittent feeding
- Mosbys Nursing Skills CD-ROM,Intermediate Disk
2, 06NS - Continuous feeding
- Mosbys Nursing Skills CD-ROM, Intermediate Disk
2, 05NS
10Classification of Enteral Nutrition
ProductsPotter Table 31-4, p 700
11Procedures for Tube Feedings
- Pt. position HOB 30-450
- Turn off feeding when moving or transferring
patient - Prevents aspiration
- Tube position
- Gastric aspiration pH
- ?residual follow institutional policy for
replacement - Patency of tube
- Irrigate w/H2O before and after meds.
- Can order solution to declog tubing
12Keeping Enteral Feedings Safe
- ?formulas exp. date
- Wash hands/wear gloves
- Minimize breaks in the system Lopez valve
- Label the reservoir with Pt.s name, date/time
formula was hung - Change formula/admin. set q24 hr.
13Nursing Mgt. for Tube Feedings
- Verify placement before drug admin.
- Assess for BS before feeding
- Obtain residual value Q 4 hours
- Stop or reduce feeding rate if residual gt
policy/order allowed - Use liquid meds. rather than pills
- Dilute viscous liq. meds.
- Crush pills to fine powder
- Flush tube w/30 ml H20 q4-6 hr? patency
- Assess regularly for aspiration, hyperglycemia,
abd. distension, diarrhea, constipation, fecal
impaction
14Med. Administration via Feeding Tube
- Avoid giving elixirs or meds. w/pH lt4
- Dissolve meds. in 15-30 ml of warm H20
- DO NOT crush enteric-coated or time-release
- Admin. antacids Carafate in stomach only
- Hold feedings 1-2 hrs. before or after giving a
med. (Dilantin) that might have drug-nutrient
interation - NEVER add meds. directly to formula
- DO NOT use pigtail vent for irrigation or instill
fluid
15Nursing Diagnosis for TEN
- Risk for aspiration r/t enteral tube feedings
- Imbalanced nutrition less than body requirements
r/t enteral feeding problems AEB body weight than
ideal, diarrhea, abd. distention - Impaired skin integrity r/t enzymatic action of
gastric juices that may leak aound tube AEB red,
irritated tissue around tube - Risk for deficient fluid volume r/t diarrhea or
inadequate fluid intake
16Complications of TEN
- Clogged tube
- Displacement of tube
- Fluid imbalances
- Increased osmolarity
- Dehydration
- Electrolyte imbalances
17Unexpected Outcomes
18Gastrostomy Jejunostomy Site Care
- Performed q-shift or PRN
- Wash hands/wear gloves
- Remove old dressing note drainage
- Clean around site w/normal saline
- DO NOT use H2O2 unless ordered by MD
- Dry thoroughly apply new split drsg.
- Report to MD redness, swelling, abnormal
drainage, or pain at site c/o abd. Pain,
bloating, cramping or diarrhea
19Age-related Considerations
- Risk for aspiration d/t GERD, hiatal hernia,
?gag reflex - Fluid electrolyte imbalances
- Dehydration r/t
- Diarrhea
- Decreased thirst perception or impaired cognitive
function - Glucose intolerance
- Decreased ability to handle fluid volume (CHF)