Enteral Nutrition and Feeding Tubes

• Clients receive nutritional support if they cannot eat or drink due to illness, surgery, or injury.
• Nutritional support is also given to clients who cannot eat enough to meet their nutritional needs.

Enteral Nutrition

• Enteral nutrition delivers nutrients into the gastrointestinal tract via a feeding tube.
• A nasogastric (NG) tube is for temporary use.
• With a NG tube, a feeding tube is inserted through the nose into the stomach.
• A gastrostomy tube is also known as a G-tube.
• A doctor surgically creates an opening in the stomach for a gastrostomy tube.
• A jejunostomy tube involves inserting a feeding tube into the small intestine.
• Percutaneous endoscopic gastrostomy (PEG) tubes are for long-term use.
• In a PEG tube, a doctor inserts the feeding tube with an endoscope

Formulas

• The doctor orders the type of formula, the amount, and the timing for tube feeding.
• Formula is provided at room temperature.
• It can be administered continuously or intermittently over 24 hours.

Preventing Aspiration

• Aspiration is a major risk associated with tube feedings.
• Maintain the head of the bed at 15-30 degrees at all times.
• Use Fowler's position when fluid is running and for 1 to 2 hours afterward.
• Avoid the left side-lying position, as it prevents stomach emptying.

Other Risks of Tube Feeding

• Report the following observations at once: nausea, discomfort during feeding, vomiting, distended abdomen, coughing, complaints of indigestion/heartburn, redness/swelling/drainage/odor/pain at the ostomy site, fever, signs and symptoms of respiratory distress, increased pulse rate, complaints of flatulence, or diarrhea.

Comfort Measures for Tube Feeding

• Clients with feeding tubes are usually NPO which can cause dry mouth, dry lips, and sore throat and discomfort.

IV Therapy

• Intravenous (IV) therapy delivers fluids through a catheter inserted into a vein
• Doctors order IV therapy to: Replace minerals/vitamins lost due to illness/injury, provide sugar for energy, and give drugs and blood.
• Nurses are responsible for IV therapy.
• Laws and institutional guidelines vary laws of others in IV therapy.
• You should know employer's policies related to your role in IV therapy.
• As an HCA, help clients receiving IV therapy with hygiene and activity needs and report any site concerns.

IV Therapy Sites

• Peripheral and Central venous sites are used
• Peripheral IV sites are away from the center of the body, generally in the arm.
• Central IV sites are close to the heart, usually in the neck.
• Central sites are used to give large amounts of fluid and for long-term IV therapy.
• Central IV can be used to give drugs that may irritate peripheral veins.

IV Therapy Complications

• Local complications at the IV site: Bleeding, puffiness/swelling, pale or reddened skin, complaints of pain at/above the IV site, hot/cold skin near the site, and leaking of fluid from the site.
• Systemic, involving the entire body: Fever, itching, drop in blood pressure, tachycardia (pulse rate more than 100 beats per minute)/irregular pulse, cyanosis, changes in mental function/loss of consciousness, difficulty breathing (dyspnea)/shortness of breath, decreasing/no urine output, chest pain, nausea, and confusion.