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Questions and Answers
Which of the following is NOT a complication associated with PEG/PEJ tube feeding?
What is the appropriate position of the head of the bed (HOB) during tube feeding to minimize complications?
What method of enteral feeding involves administering nutritional formula at prescribed rates and intervals according to patient tolerance?
In the context of PEG/PEJ tube care, which practice is essential to prevent wound infections?
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Which of the following conditions is an indication for parenteral feeding?
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During tube feeding, which of the following symptoms may indicate excessive fluid shift or osmotic imbalance?
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What is a critical nursing action when administering tube feedings to prevent aspiration pneumonia?
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Which of the following is the primary concern when assessing gastric residual volume (GRV) during enteral feedings?
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Which of the following symptoms is a common complication of NG/enteral feeding?
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What should be avoided to maintain the proper function of the tube during feeding?
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Which of the following is an important consideration when monitoring tube feeding for potential complications?
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What complication might arise from improper management of tube feeding formulas?
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Which method of enteral feeding involves quantified timing and volume to optimize gastrointestinal response?
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How does dumping syndrome manifest during tube feeding?
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Identify the most likely clinical response when assessing a patient’s tolerance of enteral formula.
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What should NOT be included when ensuring proper management of tube feedings?
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What is a primary nursing action when assessing gastric residual volume (GRV)?
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In the context of PEG/PEJ planning, what is essential for enhancing a patient’s body image?
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What potential complication can occur from tube displacement during enteral feeding?
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Which of the following is not a typical indication for parenteral feeding?
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Which complication is characterized by the movement of gastric contents too quickly into the intestine?
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What condition might indicate the need for parenteral feeding due to a significant deficit?
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Which of the following practices helps maintain tube function and prevent complications during enteral feeding?
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What is a potential sign of inadequate nutrition assessment during tube feeding?
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Which patient condition is considered appropriate for intermittent bolus feedings?
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What is an essential nursing practice when managing enteral feeding to prevent infection?
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What is the primary indicator to monitor for complications in patients receiving tube feedings?
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What nursing action is crucial when checking the gastric residual volume (GRV)?
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In the context of parenteral feeding, which situation is a clear indication for its use?
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Which of the following is a condition that necessitates careful monitoring during enteral feeding due to risk of complications?
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Study Notes
PEG/PEJ Tube Care
- Meet nutritional needs.
- Prevent infection: hand hygiene, proper dressing, monitor dressing, maintain skin integrity around insertion site, stabilize disc to prevent skin breakdown.
- Enhance body image.
- Monitor for complications: wound infection, cellulitis, leakage, GI bleeding (be mindful of tube position during repositioning), premature dislodgment.
- Nursing process includes evaluation and documentation.
Enteral Feeding Assessment
- Assess tube placement, patient tolerance of formula and amount, clinical response, signs of dehydration, blood glucose levels, gastric residual volume (GRV), intake/output (I&O), and weekly weights.
- Dietician consultation is recommended.
Indications for Enteral Nutrition
- Conditions include alcoholism, chronic depression, anorexia nervosa, chronic illness, psychiatric or neurological disorders, cancer therapy (radiation, chemotherapy), coma, stroke, head injury, neurological disorders, neoplasms, convalescent care post-surgery/illness, debilitation, gastrointestinal problems (fistula, short-bowel syndrome, pancreatitis, Crohn's disease, ulcerative colitis, malabsorption), hypermetabolic conditions (burns, trauma, sepsis, AIDS, organ transplantation), maxillofacial or cervical surgery, oropharyngeal/esophageal paralysis, and preoperative bowel preparation.
Tube Feeding Administration Methods
- Tubes: nasogastric, nasoenteric, gastrostomy, or jejunostomy (long-term).
- Methods: intermittent bolus feedings (gravity infusion), continuous infusion, cyclic feeding (weaning).
NG/Enteral Feeding Complications
- Diarrhea, nausea/vomiting, gas/bloating/cramping, dumping syndrome (rapid gastric emptying causing abdominal pain, relieved by defecation), aspiration pneumonia, tube displacement/obstruction, nasopharyngeal irritation, hyperglycemia, dehydration, and azotemia (elevated BUN and serum creatinine).
Maintaining Nutrition Balance & Tube Function
- Maintain head of bed (HOB) at 30-45 degrees.
- Use a 30 mL or larger syringe for feeding administration.
- Administer feedings at the prescribed rate and method, according to patient tolerance.
- Measure GRV before intermittent feedings and every 4-8 hours during continuous feedings.
- Administer water before and after each medication and feeding, every 4-6 hours, and when feeding is interrupted.
- Do not mix medications with feedings.
- Do not hang more than 4 hours of feeding in an open system (increased bacterial contamination risk).
Maintaining Normal Bowel Elimination
- Select appropriate TF formula considering fiber, osmolality, and fluid content.
- Prevent contamination by maintaining a closed system and not hanging more than 4 hours of TF in an open system.
- Maintain proper nutritional intake.
- Address diarrhea appropriately.
- Avoid cold TF and administer slowly to prevent dumping syndrome.
Parenteral Feeding
- Provides nutrients intravenously.
- Indications: ≥10% weight loss compared to pre-illness weight, inability to eat orally or via tube, major infection/fever/trauma/burns/surgery, prolonged pre/post-operative needs.
- IV access: Peripheral Parenteral Nutrition (PPN) – less hypertonic, incomplete nutrition; Total Parenteral Nutrition (TPN) – full calories, more dextrose, central venous catheter, administered slowly.
- Dextrose solutions >10% cannot be administered peripherally due to phlebitis risk.
- Lipids are used to protect veins and provide fat.
- PPN typically used for 5-7 days.
- Nursing interventions: maintain nutrition, infection prevention, encourage activity (when possible), patient education, monitor I&O, glucose levels, weight, CBC, platelets, magnesium, and phosphorus.
PEG/PEJ Care
- Meet nutritional needs.
- Prevent infection via hand hygiene, proper dressing, monitoring, and maintaining skin integrity around the insertion site.
- Enhance body image.
- Monitor for complications like wound infection, cellulitis, leakage, GI bleeding, and premature dislodgment.
- Document findings as part of the nursing process evaluation.
Enteral Feeding Assessment
- Assess tube placement, patient tolerance of formula and amount, clinical response, signs of dehydration, blood glucose levels, gastric residual volume (GRV), intake and output (I&O), and weekly weights. Consult a dietician as needed.
Indications for Enteral Feeding
- Conditions include alcoholism, chronic depression, anorexia nervosa, chronic illness, psychiatric or neurologic disorders, cancer therapy, coma, stroke, head injury, convalescent care, gastrointestinal problems (fistula, short bowel syndrome, etc.), hypermetabolic conditions (burns, trauma, etc.), maxillofacial or cervical surgery, oropharyngeal or esophageal paralysis, and preoperative bowel preparation.
Tube Feeding Administration Methods
- Tubes: Nasogastric, nasoenteric, gastrostomy, or jejunostomy (long-term).
- Methods: Intermittent bolus (gravity infusion), continuous infusion, and cyclic feeding (for weaning).
NG/Enteral Feeding Complications
- Diarrhea, nausea/vomiting, gas/bloating/cramping, dumping syndrome (rapid gastric emptying causing abdominal pain), aspiration pneumonia, tube displacement/obstruction, nasopharyngeal irritation, hyperglycemia, dehydration, and azotemia (nitrogenous waste buildup indicating kidney injury).
Maintaining Nutrition Balance & Tube Function
- Maintain head-of-bed (HOB) at 30-45 degrees.
- Use a 30 mL or larger syringe for administration.
- Administer feedings at the prescribed rate and method, according to patient tolerance.
- Measure GRV before intermittent feedings and every 4-8 hours during continuous feedings.
- Administer water before and after each medication and feeding, every 4-6 hours, and when feedings are interrupted.
- Do not mix medications with feedings.
- Do not hang more than 4 hours of feeding in an open system to prevent bacterial contamination.
Maintaining Normal Bowel Elimination
- Choose appropriate TF formula considering fiber, osmolality, and fluid content.
- Prevent contamination by using closed systems and not hanging open systems for more than 4 hours.
- Maintain proper nutritional intake; assess and treat diarrhea.
- Avoid cold TF and administer slowly to prevent dumping syndrome.
Parenteral Feeding
- Provides nutrients intravenously.
- Indications: 10% weight loss compared to pre-illness weight; inability to ingest food orally or by tube; major infection, fever, trauma, burns, major surgery; prolonged pre/post-operative needs.
- IV access: Peripheral Parenteral Nutrition (PPN) - less hypertonic, incomplete nutrition; administered peripherally. Total Parenteral Nutrition (TPN) - full calories, more dextrose; administered centrally via central venous catheters. Dextrose solutions over 10% cannot be administered peripherally.
- Lipids are given to protect veins and provide a fat source.
- Patients are typically on for 5-7 days.
- Nursing interventions include monitoring I&O, glucose levels, weight, CBC, platelets, magnesium, and phosphorus.
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Description
This quiz focuses on the essential aspects of PEG/PEJ tube care and enteral nutrition assessment. It covers infection prevention, nutritional needs, monitoring complications, and indications for enteral nutrition. Test your knowledge on patient care practices and the nursing process related to these feeding methods.
