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Enteral Nutrition & Medications NUR 152 Mesa Community College Gastrointestinal Tubes Nasogastric Tube Gastrostomy (PEG) (Percutaneous endoscopic) G-button (after healed) Jejunostomy Placed in the jejunum Enteral nutrition Solutions Blenderized Polymeric Monomeric Types of formulas Basic ↑ protein Elemental Diabetic Renal Pulmonary Fiber-containing Methods of Delivery Bolus Intermittent Drip Continuous Complications Administering a Tube Feeding Volume 2, Procedure 27-3A Copyright 2008 by Pearson Education, Inc. Administering a Tube Feeding Cont. Volume 2, Procedure 27-3 Nursing Process & Enteral Nutrition Obtain a baseline weight, vitals & labs Raise HOB at least 30 degrees (Semi-Fowler’s) Assess tube security & placement Aspiration & visualization of secretions & re-installment of secretions √ for pH < 6 (or per agency policy) Assess tolerance to feedings Check for residuals for continuous feedings every 4-6 hours (or depending on agency policy) Residual feedings should not be more that ~ 100mL or agency policy For intermittent feeding: no more than 50% of the previous feeding should remain Nursing Process & Enteral Nutrition Flush tube as indicated Before administering feeding Check expiration date Warm feeding to room temperature Hang the bag about 12 inches above insertion point, clamp tubing and add formula and then purge the tubing Attach to patient tubing & regulate the drip rate If syringe system, clamp tubing & add feeding to syringe, unclamp & slowly let in feeding Remain in fowlers position for at least 30 min. after feeding completed Nursing Process & Enteral Nutrition Monitor urine output & bowels sounds & vital signs Free water Change feeding bag daily (every 24 hrs) Always ensure client safety & comfort! Don’t forget to document! Enteral Medications Most drugs administered orally can be given enteral Medication is diluted with water Placement of tube is confirmed Medication delivered via gravity Flushed with water Care is taken not to insert large amounts of air Knowledge √ Documenting Nutrition The nurse has finished providing a tube feeding to a patient. The nurse should document all of the following except: A. Duration of the feeding B. Name of physician prescribing feedings C. Solution provided D. Patient’s tolerance of the feeding E. Amount of the feeding Documenting Nutrition 2 A patient receives several tube feeding each day. After documenting the patient’s assessment findings, and tolerance of the feeding, the nurse should also document the amount of feeding provided on the: A. Dietary consultation notes B. Intake and output record C. Vital signs record D. Nurses notes Feeding Tubes When feeding tubes are first positioned, verification is done by: A. Auscultation B. X-ray confirmation C. pH testing of gastric contents D. Confirmation of distal mark on feeding tube Tube Feedings Which of the following best describes a “bolus feeding”? A. Infusion of a feeding that is stopped for a specified time B. Small amounts are continually infused over a specified time C. Intermittent feeding of a specified amount of feeding at specified times D. Free water infused in-between feedings