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Nursing Skills

Test 4 - N/G Meds and Enteral Tubes Part 2

When would an enteral feeding tube be used? Administration of medications or feedings in those unable to take oral nutrition. (i.e. cancer, anorexia, neuromuscular disorders, etc.)
Type of enteral feeding tube is determined based on Length of time needed
Short term (less than 6 weeks) tube what two types of tubes could be selected? Nasogastric( NG) or nasointestional route is selected
The nasogastric tube goes from the ___ to the _____. The nasointestional goes from____ to the ______. Nose, stomach, Nose, small intestine
What in the NG tube allows for removal of gastric secretions and introductions of solutions into the stomach Hollow lumen
NG tube typically for short term management of nutritional situations during acute illness and recovery Nasogastric tube ( Small bore)
What are advantages of NG tube? (3) You are able to retain all functions of the stomach – manage chyme, use acidic environment to kill bacteria, prevents “dumping”syndrome
What are disadvantages of NG tube? (2) Aspiration or migration into the lungs
Advantages of nasointestional tube? minimal risk for aspiration
Disadvantages of nasointestinal tube? type of dumping syndrome may develop because of the pyloric valve in the stomach, which normally slows transit of food into the intestine.
Used for extended length of enteral feeding Long term feeding tube
For long term enteral feeding, there is a surgical creation of an _______ in the intestines by incision through the _________. This procedure is called an ____. Artificial fistula, abdominal wall,enterostomy
Can the artificial fistula be placed along various points along the GI tract? Yes
Type of long term feeding tube that is placed endoscopically and does not require surgery Percutaneous endoscopic gastrostomy (PEG)
Can a PEG be inserted and removed safely at bedside or in an outpatient setting? Yes
What is an advantage of the PEG? Economical
How do you care for a G tube if it is newly inserted versus if it is established? New Insertion - with sterile saline Established - with warm soap and water
What do you do if a G tube is leaking? (2) Check tension of tube. If there is too much slack between the internal guard and the external bumper, fluid can leak out of site ( it should not be able to move up on tubing more than an inch). Make sure the balloon is inflated fully.
Most NG patients will be ____________ thus need frequent __________ to protect mucus membranes and the teeth. Mouth breathers, oral hygiene
Tubes require ___________of the exit site until healing occurs. surgical asepsis
The G tube bumper requires ____________ to relieve pressure on the skin. daily rotation
Delivery of nutrients through a gastrointestinal tube Enteral Feedings
Do clients who receive enteral feedings have a compromised GI tract? No, it is functional
What are the benefits of enteral vs parenteral? Enhance utilization of nutrients , Maintain gut integrity via GI stimulation, Lower infection compared to vascular access for Parenteral , More cost effective, Lower complications (safer)
When administering a tube feeding, what system will you assess and what will you assess for? Abdominal assessment – distension, bowel sounds, palpation, pain, tenderness, nausea
How do you verify placement of intial insertion of enteral feeding tube? radiographic examination
When do you verify position of enteral feeding tube after initial insertion? (2) Before beginning a feeding or instilling liquids, and at a regular interval during continuous feedings
What is the best way for determining correct internal placement of a feeding tube? pH
NH tubes can ____ when negative pressure is applied secondary to being ____. Collapse, less rigid
Aspiration can be dependent on where the ____ is in relation to the ______. Port, gastric contents
What are three ways to externally verify the placement of an NG tube? Permanent markings on tube, secured tape on nose, documented length of tube from tip of nose to end of tubing
How do you aspirate PH? (4) Obtain 5-10 mL aspirate, look at color, appearance and pH of aspirate
How do you measure the pH of the aspirated GI contents? by dipping the pH strip into the fluid or by applying a few drops of the fluid to the strip.
What pH level would indicate that the tube is in the stomach? With H2 blockers? 0 to 4, with H2 blockers could be 4-6
What is the pH of the lungs Greater than 7
Is it okay to insert air to auscultate routinely for verification of placement? No!
When tube feeding, at what angle should the head of the bed be at during and for one hour after feeding? 30-45 degrees
Notify MD if residual is consistently more than ____ or the policy at the healthcare facility that you are at. 100 cc’s
Flush enteral feeding tube before and after feeding with 30 mL water using a 60CC syringe ( no smaller)
Specific amount given several times a day via gravity through a large bore syringe. Bolus tube feeding
How is the rate of a bolus tube feeding regulated? What is the standard? By the height the large bore syringe is held. 18” above patient
What are the complications of using a bolus tube feeding? Dumping syndrome due to high osmolarity
Type of feeding given over 1-2 hours several times a day using a tube feeding pouch with tubing and clamp to regulate the flow Intermittent ( can be given by gravity pump)
Type of feeding fed via infusion pump over 20-24 hours Continuous
What should you do after each use of the bolus? Rinse the syringe
When using the bolus, what should you do with the can itself? Wipe off with alcohol wipe, allow to dry, check expiration date and go through five rights
With intermittent, when do you clean the bag and tubing? After each feeding
With intermittent and continuous, how often do you change syringe, bag and tubing Every 24 hours or per agency policy
With intermittent and continuous, up to how long can feeding hang? up to 24 hours depending on type of container-feeding cans are usually hung over 4 hours, or per agency policy , shorter time for pediatric formulas
What are ways that contamination can be prevented? Wash hands, Wear non-sterile gloves, Wear a mask if you have a cold, Don’t add new formula to old, Use system medication ports for med. Administration, Swab off medication port with alcohol before administering medications,goggles
Before giving medications enterally, assess the abdomen for contraindications for medication administration
Before giving medications enterally, be aware of ant Fluid restriction
How is enteral medicine prepared? It is crushed, disoloved or liquified and mixed with 5-10 mL of warm tap water
Before preparing an extended release med or capsule for enteral administration, what should you do? Check with pharmacist
After preparing enteral medications, what should you do? Remove clamp from the tube and use the recommended procedure for checking tube placement and residual(readminister). Follow appropriate policy with residual amount
When administering enteral medications use plunger from ___cc syringe and connect to ___, the patient should be in bed in ______ position 60, tubing, fowler’s
How much water should you flush with prior to administering enteral meds. Adults? Children? 13-30 mL, 5-10 mL
Can you give more than one enteral medicine at a time? No
How much water should be instilled between each medication that is being administered enterally? 10 mL
How much water should be instilled after all medications have been taken enterally? 30-60 mL
To prevent tube clogging, don’t mix meds with TF formulas
Make sure you have the proper type of med for the enteral route—try to get ___ form. Liquid
When do you use NG flushing/Irrigation When tube patency is in doubt
What type of patients will often need NG flushing/irrigation? Needed with patients on NG feedings and frequent medication administration as contents may become thick or medication can clog tube if not flushed appropriately.
Created by: anastasia158