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

2
Purpose of NG Intubation
3
Patient Assessment

• LOC
• Ability to cooperate
• Swallow ability
• Medical diagnosis
• Lab values, VS, IO
• Past medical Hx
• Teaching needs

4
A Small Bore Tube
Insertion similar to large bore tube
5
Gastric and Intestinal TubesBlack Table 33-1, p
745
6
Assessing 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

7
Candidates 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.

8
Methods 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)

9
Types of Feedings

• Intermittent feeding
• Mosbys Nursing Skills CD-ROM,Intermediate Disk
  2, 06NS
• Continuous feeding
• Mosbys Nursing Skills CD-ROM, Intermediate Disk
  2, 05NS

10
Classification of Enteral Nutrition
ProductsPotter Table 31-4, p 700
11
Procedures 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

12
Keeping 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.

13
Nursing 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

14
Med. 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

15
Nursing 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

16
Complications of TEN

• Clogged tube
• Displacement of tube
• Fluid imbalances
• Increased osmolarity
• Dehydration
• Electrolyte imbalances

17
Unexpected Outcomes
18
Gastrostomy 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

19
Age-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)