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Questions and Answers
What is the primary purpose of routine irrigation of the tube with H2O?
What is the primary purpose of routine irrigation of the tube with H2O?
What should be discarded after 24-48 hours?
What should be discarded after 24-48 hours?
What is the likely cause of the patient's stomach cramps and nausea in the scenario?
What is the likely cause of the patient's stomach cramps and nausea in the scenario?
What should be assessed regularly to prevent complications?
What should be assessed regularly to prevent complications?
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Why should the patient's mouth be cared for every 2 hours?
Why should the patient's mouth be cared for every 2 hours?
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What should be done before and after feeding and with medications?
What should be done before and after feeding and with medications?
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What is the primary reason for irrigating the feeding tube before medication administration?
What is the primary reason for irrigating the feeding tube before medication administration?
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What should the healthcare provider do if unable to install fluid during irrigation?
What should the healthcare provider do if unable to install fluid during irrigation?
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How often should the irrigation container be changed?
How often should the irrigation container be changed?
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What should the healthcare provider assess for during dressing changes?
What should the healthcare provider assess for during dressing changes?
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What is a sign of possible complication that the healthcare provider should monitor for?
What is a sign of possible complication that the healthcare provider should monitor for?
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Why is it important to maintain good oral hygiene in clients with feeding tubes?
Why is it important to maintain good oral hygiene in clients with feeding tubes?
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What should the healthcare provider do when clamping or kinking the feeding tube?
What should the healthcare provider do when clamping or kinking the feeding tube?
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What is the primary reason for monitoring the external length of the feeding tube?
What is the primary reason for monitoring the external length of the feeding tube?
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How often should the exit site be cleaned?
How often should the exit site be cleaned?
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What is the advantage of using a small bowel feeding?
What is the advantage of using a small bowel feeding?
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Why is it important to check the pH of an aspirate at the bedside?
Why is it important to check the pH of an aspirate at the bedside?
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What should the nurse do if bedside methods create any doubt regarding the location of the feeding tube?
What should the nurse do if bedside methods create any doubt regarding the location of the feeding tube?
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Which of the following is a sign that the nurse should be notified by the NAP?
Which of the following is a sign that the nurse should be notified by the NAP?
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What is the primary purpose of using an enteral pump in enteral nutrition?
What is the primary purpose of using an enteral pump in enteral nutrition?
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What is the most common type of enteral nutrition?
What is the most common type of enteral nutrition?
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Why is it important to verify the feeding tube's position after initial x-ray film confirmation?
Why is it important to verify the feeding tube's position after initial x-ray film confirmation?
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What is the primary consideration when selecting a type of tube and placement method?
What is the primary consideration when selecting a type of tube and placement method?
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What is the main difference between a nasogastric tube and a nasojejunal tube?
What is the main difference between a nasogastric tube and a nasojejunal tube?
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What type of feeding tube is placed directly into the small intestine through the abdomen?
What type of feeding tube is placed directly into the small intestine through the abdomen?
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Why might a nasogastric tube be used for short-term feeding?
Why might a nasogastric tube be used for short-term feeding?
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What is a common complication of tube feeding?
What is a common complication of tube feeding?
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What is the main advantage of using a small bowel feeding tube?
What is the main advantage of using a small bowel feeding tube?
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What is the primary indication for using a nasogastric tube?
What is the primary indication for using a nasogastric tube?
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What type of feeding tube is commonly used for patients with severely delayed gastric emptying?
What type of feeding tube is commonly used for patients with severely delayed gastric emptying?
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What is the optimal choice for direct enteral access through the abdominal wall?
What is the optimal choice for direct enteral access through the abdominal wall?
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What is the primary difference between Gastrostomy tubes and Jejunostomy tubes?
What is the primary difference between Gastrostomy tubes and Jejunostomy tubes?
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What is the primary advantage of using a Gastrostomy tube over a Nasogastric tube?
What is the primary advantage of using a Gastrostomy tube over a Nasogastric tube?
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How is the placement of a Gastrostomy tube confirmed?
How is the placement of a Gastrostomy tube confirmed?
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What is the primary reason for verifying the external length of the feeding tube?
What is the primary reason for verifying the external length of the feeding tube?
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What is the primary indication for using a Jejunostomy tube?
What is the primary indication for using a Jejunostomy tube?
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What is the primary indication for the placement of a nasogastric tube?
What is the primary indication for the placement of a nasogastric tube?
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What type of feeding tube is usually used for administering medication and tube feeding?
What type of feeding tube is usually used for administering medication and tube feeding?
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Where is a G-tube or PEG tube typically placed?
Where is a G-tube or PEG tube typically placed?
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What type of tube is used for tube feeding and placed in the duodenum?
What type of tube is used for tube feeding and placed in the duodenum?
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What is the primary concern for patients requiring long-term tube feeding?
What is the primary concern for patients requiring long-term tube feeding?
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What is the primary responsibility of nursing care for patients with feeding tubes?
What is the primary responsibility of nursing care for patients with feeding tubes?
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What is the most serious complication associated with feeding tubes?
What is the most serious complication associated with feeding tubes?
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What type of feeding tube is used for tube feeding only?
What type of feeding tube is used for tube feeding only?
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What is the primary indication for using a Gastrostomy tube?
What is the primary indication for using a Gastrostomy tube?
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What type of feeding tube is commonly used for patients with severely delayed gastric emptying?
What type of feeding tube is commonly used for patients with severely delayed gastric emptying?
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What is the primary difference between Gastrostomy tubes and Jejunostomy tubes?
What is the primary difference between Gastrostomy tubes and Jejunostomy tubes?
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Why might a Nasogastric tube be used for short-term feeding?
Why might a Nasogastric tube be used for short-term feeding?
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What is the optimal choice for direct enteral access through the abdominal wall?
What is the optimal choice for direct enteral access through the abdominal wall?
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What type of feeding tube is usually used for administering medication and tube feeding?
What type of feeding tube is usually used for administering medication and tube feeding?
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Where is a G-tube or PEG tube typically placed?
Where is a G-tube or PEG tube typically placed?
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What is the primary concern for patients requiring long-term tube feeding?
What is the primary concern for patients requiring long-term tube feeding?
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Which of the following is a primary indication for using a nasogastric tube?
Which of the following is a primary indication for using a nasogastric tube?
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What is the primary difference between a nasojejunal tube and a jejunostomy tube?
What is the primary difference between a nasojejunal tube and a jejunostomy tube?
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Which of the following is a characteristic of a gastrostomy tube?
Which of the following is a characteristic of a gastrostomy tube?
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What is the primary advantage of using a jejunostomy tube over a nasogastric tube?
What is the primary advantage of using a jejunostomy tube over a nasogastric tube?
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Which of the following is a type of feeding tube that is placed directly into the small intestine through the abdominal wall?
Which of the following is a type of feeding tube that is placed directly into the small intestine through the abdominal wall?
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What is the most serious complication associated with tube feeding?
What is the most serious complication associated with tube feeding?
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Which of the following is an indication for the placement of a nasogastric tube?
Which of the following is an indication for the placement of a nasogastric tube?
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What type of feeding tube is usually used for administering medication and tube feeding?
What type of feeding tube is usually used for administering medication and tube feeding?
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Where is a G-tube or PEG tube typically placed?
Where is a G-tube or PEG tube typically placed?
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What type of feeding tube is used for tube feeding only and placed in the duodenum?
What type of feeding tube is used for tube feeding only and placed in the duodenum?
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What is the primary concern for patients requiring long-term tube feeding?
What is the primary concern for patients requiring long-term tube feeding?
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What is the primary responsibility of nursing care for patients with feeding tubes?
What is the primary responsibility of nursing care for patients with feeding tubes?
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What is the most serious complication associated with feeding tubes?
What is the most serious complication associated with feeding tubes?
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What type of feeding tube is used for tube feeding and placed in the small intestine through the abdominal wall?
What type of feeding tube is used for tube feeding and placed in the small intestine through the abdominal wall?
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What can cause the skin around the tube to erode?
What can cause the skin around the tube to erode?
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What is a common complication of tube feeding that can occur if the feeding rate is too rapid?
What is a common complication of tube feeding that can occur if the feeding rate is too rapid?
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What should be done to prevent occlusion of the tube?
What should be done to prevent occlusion of the tube?
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What can cause diarrhea in a patient receiving tube feeding?
What can cause diarrhea in a patient receiving tube feeding?
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What should be done to prevent tube displacement?
What should be done to prevent tube displacement?
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Study Notes
Enteral Nutrition
- Elevate HOB 30° to prevent aspiration
- Solution should be discarded after 24-48 hours
- Mouth care should be performed q2h
- Assess for side effects and skin integrity
- Administer H2O pre and post feeding, and with meds
Tube Irrigation
- Routine irrigation of the tube with H2O prevents occlusion
- Equipment needed: 60 ml syringe, water, towel, clean gloves, and stethoscope
- Irrigate routinely before, between, and after medication administration, and before intermittent feeding
- Change irrigation container every 24 hours or according to facility policy
Caring for the Site
- Dressings are changed daily and as needed
- Determine whether the exit site should be left open to air or if a dressing is indicated
- Assess exit site for tenderness, leakage, swelling, excoriation, infection, bleeding, or excessive movement of the feeding tube
- Clean skin around the exit site with warm water and mild soap or saline
- Rinse and dry site completely, and apply a dressing if prescribed
Ongoing Assessment and Monitoring
- Monitor for signs and symptoms of possible complications: SOB, vomiting, pain, redness and infection at site, abdominal distension, and loose stools
- Maintain good oral hygiene
- Verify feeding tube placement regularly, as the tip of the feeding tube can migrate into a different location
Verifying Feeding Tube Placement
- Use a combination of methods to monitor tube position during feeding, as no single bedside method is completely reliable
- Monitor the external length of the tube and observe the appearance, volume, and pH of fluid aspirated through it
- Test the pH of an aspirate at the bedside using pH paper to obtain information regarding the position of the feeding tube
- Obtain repeat x-ray film confirmation if bedside methods create any doubt regarding the location of the tube
Delegation and Collaboration
- Verification of tube placement cannot be delegated to PSW
- The nurse directs NAP to inform the nurse if patient respirations change, patient vomits, nasal skin irritation is present, or external length of tube changes
Administering Enteral Nutrition
- The most common type of enteral nutrition is gastric feedings
- Small bowel feeding may reduce the risk of aspiration
- An enteral pump is used to control the administration rate of small bowel and many continuous gastric feedings
Tube Feeding and Quality of Life
- Many patients associate tube feeding with low quality of life
- A multidisciplinary team can help patients and family caregivers use strategies to preserve or enhance quality of life
Maintenance of a Nasogastric Tube
- Provide oral and nasal hygiene
- Check location of external exit site and mark on tube
- Anchor tube to patient's gown to prevent displacement during routine care
- Report any signs of redness or irritation to the nares and provide comfort measures
Gastrostomy Tube (G Tube)
- Direct enteral access through the abdominal wall is optimal for tube feeding when duration is greater than 4 weeks or in situations where access via the nose or mouth is contraindicated
- Gastrostomy tube or Peg tube is commonly used for long-term tube feeding
Care of Gastrostomy or Jejunostomy
- Long-term tubes require endoscopic, radiologic, or surgical placement
- Post-insertion care may require specific nursing interventions
- Feedings delivered via a gastrostomy tube are relatively safe to administer, provided the patient has normal gastric emptying
Jejunostomy Tubes
- Indicated when risks for regurgitation and aspiration are especially high, such as in severely delayed gastric emptying or conditions like pancreatitis
- Placed directly into the small intestine
Verifying Feeding Tube Placement
- Monitor the external length of the tube
- Selection of tube type and placement method depends on anticipated duration of feeding and patient-related factors, such as gastric emptying and risk for pulmonary aspiration
Different Types of Tubes
- Nasogastric Tube: thin, soft tube made of plastic or rubber that is passed through the nose, down through the throat, and into the stomach
- Nasojejunal Tube: small tube passed through the nose and into the small bowel
- Jejunostomy Tube: soft, plastic tube placed through the skin of the abdomen into the midsection of the small intestine
- Gastrostomy Tube (G Tube): placed directly into the stomach or intestine
- Plastic Nasogastric Tubes: used for tube feeding and administering medications
- Small-bore Silicone Feeding Tubes: used only for tube feeding
- G Tube or Percutaneous Endoscopic Gastrostomy (PEG) Tube: used for tube feeding and administering medications
Indications for an NG Tube
- Aspiration of gastric contents
- Decompression
- Specimen analysis
- Gastric lavage in cases of poisoning or overdose of medication
- Nutritional support (usually less than six weeks in duration)
- Administration of medication
Patient-Centered Care
- Nursing responsibilities include caring for the tube, administering nutrient formula, and preventing complications
- Pulmonary aspiration is the most serious complication of tube feeding
- Patients requiring long-term tube feeding may feel a sense of loss regarding their ability to participate in life activities
- Emotional and psychological concerns are raised during tube feeding, and patients and family caregivers need reassurance and encouragement
- Nursing interventions such as providing oral hygiene and care of the nasal passage or tube insertion site promote patient comfort and reduce complications
Tube Feeding and Quality of Life
- Many patients associate tube feeding with low quality of life
- A multidisciplinary team can help patients and family caregivers use strategies to preserve or enhance quality of life
Maintenance of a Nasogastric Tube
- Provide oral and nasal hygiene
- Check location of external exit site and mark on tube
- Anchor tube to patient's gown to prevent displacement during routine care
- Report any signs of redness or irritation to the nares and provide comfort measures
Gastrostomy Tube (G Tube)
- Direct enteral access through the abdominal wall is optimal for tube feeding when duration is greater than 4 weeks or in situations where access via the nose or mouth is contraindicated
- Gastrostomy tube or Peg tube is commonly used for long-term tube feeding
Care of Gastrostomy or Jejunostomy
- Long-term tubes require endoscopic, radiologic, or surgical placement
- Post-insertion care may require specific nursing interventions
- Feedings delivered via a gastrostomy tube are relatively safe to administer, provided the patient has normal gastric emptying
Jejunostomy Tubes
- Indicated when risks for regurgitation and aspiration are especially high, such as in severely delayed gastric emptying or conditions like pancreatitis
- Placed directly into the small intestine
Verifying Feeding Tube Placement
- Monitor the external length of the tube
- Selection of tube type and placement method depends on anticipated duration of feeding and patient-related factors, such as gastric emptying and risk for pulmonary aspiration
Different Types of Tubes
- Nasogastric Tube: thin, soft tube made of plastic or rubber that is passed through the nose, down through the throat, and into the stomach
- Nasojejunal Tube: small tube passed through the nose and into the small bowel
- Jejunostomy Tube: soft, plastic tube placed through the skin of the abdomen into the midsection of the small intestine
- Gastrostomy Tube (G Tube): placed directly into the stomach or intestine
- Plastic Nasogastric Tubes: used for tube feeding and administering medications
- Small-bore Silicone Feeding Tubes: used only for tube feeding
- G Tube or Percutaneous Endoscopic Gastrostomy (PEG) Tube: used for tube feeding and administering medications
Indications for an NG Tube
- Aspiration of gastric contents
- Decompression
- Specimen analysis
- Gastric lavage in cases of poisoning or overdose of medication
- Nutritional support (usually less than six weeks in duration)
- Administration of medication
Patient-Centered Care
- Nursing responsibilities include caring for the tube, administering nutrient formula, and preventing complications
- Pulmonary aspiration is the most serious complication of tube feeding
- Patients requiring long-term tube feeding may feel a sense of loss regarding their ability to participate in life activities
- Emotional and psychological concerns are raised during tube feeding, and patients and family caregivers need reassurance and encouragement
- Nursing interventions such as providing oral hygiene and care of the nasal passage or tube insertion site promote patient comfort and reduce complications
NV and CRAMPS Complications
- Delayed gastric emptying can cause NV and cramps
- Formula that is too cold or has high osmolality can lead to NV and cramps
- Lactose intolerance can cause NV and cramps
BREAKDOWN Complications
- Skin around the tube can erode due to movement of the tube and moisture at the site
- Erosion can lead to infection and excessive granulation
OCCLUSION Complications
- Tube blockage can occur due to inadequate flushing, uncrushed medications, or reaction between medications and formula
- Ensure adequate flushing after each feeding and before and after medications to prevent occlusion
DISPLACEMENT Complications
- Tube displacement can cause coughing, vomiting, abdominal pain, and leaking at the site
- Tube placement must always be verified to prevent displacement
ASPIRATION Complications
- Aspiration can occur if feeding is too rapid, the patient is lying flat, or there are problems with peristalsis
- Aspiration can lead to fluid traveling into the lungs
- Often caused by an allergy or sensitivity to the formula
- Ensure rinsing and flushing of the feeding tube and bag
- Avoid hanging the feeding bag for more than 4 hours to prevent bacterial growth
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Description
This quiz covers the key elements of enteral nutrition, including prevention of aspiration and assessment of side effects, as well as tube irrigation techniques to prevent occlusion. It's essential for healthcare professionals to master these skills.
