tubefeedingtest with lines for answers..docx

Tube Feeding The gastrointestinal system breaks food down into basic nutrients that nourish the body with proteins, vitamins, minerals, water, carbohydrates, and fats. After food is chewed and swallowed, it moves down the esophagus and enters the stomach. Once in the stomach, food is broken down fur...

Tube Feeding The gastrointestinal system breaks food down into basic nutrients that nourish the body with proteins, vitamins, minerals, water, carbohydrates, and fats. After food is chewed and swallowed, it moves down the esophagus and enters the stomach. Once in the stomach, food is broken down further by powerful stomach acids. From the stomach, the food travels into the small intestine where it is emulsified into nutrients that can enter the bloodstream through tiny hair-like projections. The excess food the body does not need or cannot digest becomes waste and is eliminated from the body. Client’s may require assistance with oral or tube feedings. Gastrostomy tubes (also called G-tube or PEG tube) are placed by a surgeon through a small opening called a stoma that is made in the wall of the abdomen. The procedure to create the opening is called an ostomy. 1. Gather supplies • Gloves • Formula at room temperature • 60 ml syringe/bottle • Water for flushing 2. Wash and dry hands 3. Place equipment on a clean surface 4. To prevent aspiration, ALWAYS position the patient with head up at least 45 degrees. 5. Place towel or washcloth under the tube 6. Put on gloves 7. Observe area around tube; hold feeding and call family member and supervisor if there is: • Abdominal swelling/pain • Obstruction of the tube • Dislodged tube 8. Measure prescribed formula Tube feeding is administered using a syringe and either of the following methods: METHOD A: POURING FORMULA INTO THE SYRINGE 1. Open the feeding tube • Fold over and pinch or clamp the end of the feeding tube to stop the flow, then uncap the tube. 2. Attach the syringe to the end of your feeding tube. Unfold or unclamp the tube to start the flow. 3. Pour the formula into the syringe. Let the formula flow into the tube by gravity. Continue refilling the syringe until the entire feeding is given. 4. After feeding, flush the feeding tube with 60 mL of water. 5. Close or recap your feeding tube 6. Clean, rinse and dry the supplies. 7. Wash your hands METHOD B: POUR FORMULA INTO A CLEAN CONTAINER AND DRAW THE FORMULA INTO THE SYRINGE 1. Open the feeding tube • Fold over and pinch or clamp the end of the feeding tube to stop the flow, then uncap the tube 2. Attach the syringe to the end of the feeding tube 3. Gently push the formula into the tube with the syringe plunger 4. Take the syringe off the tube – fold over and pinch or clamp the end of the feeding tube to stop the flow and recap the tube. 5. Repeat steps until the entire feeding is given. 6. After feeding, flush the feeding tube with 60 mL of water. 7. Close or recap your feeding tube 8. Clean, rinse and dry the supplies. 9. Wash your hands ASPIRATION This information explains what can be done to prevent aspiration when administering a tube feeding. Aspiration is when food or liquid goes into the airway instead of the esophagus. The esophagus is the tube that carries food and liquid from the mouth to the stomach. Aspiration can happen when eating, drinking, or tube feeding. It can also happen when vomiting. A person may be at risk of aspiration if he or she has trouble swallowing. This is because food or liquid can get stuck in the back of the throat and go into the airway. Aspiration can lead to pneumonia, respiratory infections (infections in the nose, throat, or lungs), and other health problems. Signs of Aspiration Signs of aspiration include Coughing Choking Gagging Throat clearing Vomiting. You should watch for these signs before, during, and after you administer a tube feed. Preventing Aspiration Follow these guidelines to prevent aspiration when you’re administering a tube feeding. To help prevent aspiration, it’s important to pace tube feedings. Follow the guidelines below during your feedings to make sure you’re not taking in more than you can digest: 1. Don’t infuse more than 360 milliliters (mL) of formula per feeding. 2. Infuse each feeding over at least 15 minutes. When to Contact a Healthcare Provider Have a family member contact a healthcare provider for any of the following: 1. Any signs of aspiration, such as coughing or gagging 2. A fever of 100.4° F (38° C) or higher 3. Trouble breathing 4. Wheezing 5. Painful breathing 6. A cough with mucus The minimum competency evaluation must be documented and maintained in the trainee's personnel file and must include: • a score of 100% on a written multiple-choice test that consists of situational questions including the criteria in the previous screen and an evaluation of the trainee's judgment and understanding of the essential skills, risks, and possible complications of a g-tube feeding • a skills checklist demonstrating that the trainee has successfully completed the necessary skills for a g-tube feeding; and • documentation of an accurate demonstration of the g-tube feeding performed by the trainee. The person responsible for the training must document the successful demonstration of the g-tube feeding by the trainee and the trainee's competency to perform this task in the trainee's file. • a description of the g-tube placement, including its purpose. • infection control procedures and universal precautions to be followed when performing g-tube feedings. • a description of conditions that must be reported to the client or the primary caregiver, or in the absence of the primary caregiver, to the agency, supervisor, or the client's physician, which includes a plan to be implemented if the g-tube comes out or is not positioned correctly to ensure that medical attention is provided within one hour. • review of a written procedure for g-tube feeding. The written procedure must be equivalent to current acceptable nursing standards of practice • conditions under which g-tube feeding must not be performed; and • demonstration of a g-tube feeding to a client. TUBE FEEDING COMPETENCY 1. When administering a tube feeding, the patient should be elevated to at least how many degrees? a. 20 b. 10 c. 0 d. 45 ____________ 2. The feeding tube should be flushed with water before and after administering formula through the feeding tube. a. True b. False _____________ 3. The RN should be called if the area around the stoma is: a. Red b. Swollen c. Has yellow drainage __________________ d. Any of the above 4. A patient is receiving a tube feeding and begins cough, gagging, and vomiting. The care giver understands that these are symptoms of: a. Aspiration b. Normal response to feeding c. Patient being difficulty __________________ d. Patient does not like the taste of the feeding 5. A caregiver is going to begin a tube feeding, when she notices that the tube has become dislodged. What should the caregiver do? a. Do not give the feeding, have the patient’s family contact the doctor immediately, and report to your supervisor b. Administer the feeding as usual c. Attempt to reinsert the tube _________________ d. Do nothing 6. A caregiver should NEVER attempt to reinsert a feeding tube that has become dislodged from the patient. a. True _____________________ b. False 7. The small opening into the patient’s body where the tube is inserted is called a stoma. a. True ________ b. False 8. When should handwashing be done when administering a tube feeding? a. Before beginning the feeding b. After finishing the feeding c. Hand washing is not required _________ d. Both before and after the feeding 9. After the procedure, the caregiver should document how much water and formula the patient received as well as how the patient tolerated the feeding. a. True b. False ________ 10. The area around the stoma should be kept clean and dry. a. True b. False __________ 11. There are 2 methods of tube feeding: pour the formula into the syringe or put the formula in a clean container and draw it up with the syringe. a. True b. False _________ Tube Feeding Check Off Trainee: ___________________________________________________________ Nurse/Trainer: ______________________________________________________ Explanation and Return Demonstration of procedure Y/N Date Try to make feeding feel like a mealtime if possible 1. Gather supplies o Gloves o Formula at room temperature o 60 ml syringe/bottle o Water for flushing 2. Wash and dry hands 3. Place equipment on a clean surface 4. To prevent aspiration, ALWAYS position the patient with head up at least 45 degrees. 5. Place towel or washcloth under the tube 6. Put on gloves 7. Observe area around tube; hold feeding and call supervisor if there is: o Abdominal swelling/pain o Obstruction of the tube o Dislodged tube 8. Measure prescribed formula 9. For Bolus Feeding: METHOD A: POURING FORMULA INTO THE SYRINGE a) Connect 60 ml syringe to end of G-tube b) Fill syringe with 60ml of water and hold upright, elevated above the stomach c) Unclamp tube and allow water to infuse d) Pour prescribed amount of formula into tube and allow it to infuse slowly e) Fill syringe with 60ml of water to flush Explanation and Return Demonstration of procedure Y/N Date f) Close clamp g) Disconnect syringe h) Dry area around the stoma METHOD B: POUR FORMULA INTO A CLEAN CONTAINER AND DRAW THE FORMULA INTO THE SYRINGE a) Open the feeding tube b) Fold over and pinch or clamp the end of the feeding tube to stop the flow, then uncap the tube c) Pull up formula into the syringe d) Attach the syringe to the end of the feeding tube e) Gently push the formula into the tube with the syringe plunger f) Take the syringe off the tube – fold over and pinch or clamp the end of the feeding tube to stop the flow and recap the tube. g) Repeat steps until the entire feeding is given. h) After feeding, flush the feeding tube with 60 mL of water. 10. If the following occur during feeding STOP IMMEDIATELY and call family member and supervisor: o Gagging o Vomiting o Coughing o Abdominal Swelling o Change in skin color o Difficulty breathing 11. Keep patient in feeding position with head elevated for 30 min after feeding 12. Clean all equipment thoroughly and allow to air dry 13. Remove gloves 14. Wash hands 15. Document how much formula and water were given and how the patient tolerated the procedure. (Tolerated well, etc). Demonstration reviewed and approved by the RN or trainer UAP signature/date_______________________________________________ Nurse/Trainer signature /date_____________________________________________