chapter005tubefeed
DESCRIPTION
Learn about the GI system and tube feedingsTRANSCRIPT
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 5Advanced Nutrition Skills
Chapter 5Advanced Nutrition Skills
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
OrgansOrgans
• Mouth- Saliva( deglutination)+Teeth-(mastication)=bolus
• Tongue-uvula -
Esophagus-peristalsis-cardiac sphincter
• Stomach- 1-4 hrs. to break down→ chyme
• Small intestine- absorbs nutrients & fluid
• Large intestine-absorbs H2O-rectum-anus – e-coli
• Liver- breaks down toxin, make bile
• Gall bladder-store bile
• Pancreas
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Disorders of the GI system:Disorders of the GI system:
• Inflammatory bowel disease (IBD) irritable bowel syndrome (IBS). It includes: Crohn's disease and ulcerative colitus.
• Crohn's disease occurs anywhere in GI tract & affects every layer of tissue.
• Ulcerative colitus typically occurs in the colon & rectum & affects only the innermost layer of tissue
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
UlcerUlcer
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Bulimia Bulimia
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AnorexiaAnorexia
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Obesity-Obesity-
• Overweight: over ideal body by < 20%.
• Obese: over ideal body weight by >20%.
• Morbidly obese: over ideal body weight by> 100 lbs. severe threat to health & life.
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• Diarrhea • Constipation
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TermsTerms
• NG
• G-tube
• TPN
• Aspiration
• Residual
• Placement
• Bowel sounds
• Auscultation
• peristalsis
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Enteral NutritionEnteral Nutrition
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Reasons for an NGReasons for an NG
• Remove fluid from abdomen to decrease n/v, gas or obstruction
• Dx. Diseases
• Clean out stomach (overdose)
• Provide feeding
• Bowel obstructions
• Surgery of stomach/intestines
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Nasogastric or Nasointestinal TubeNasogastric or Nasointestinal Tube
• Enteral nutrition/ tube feeding- is formula-like fluid delivered through a tube that is in nose
• Naso-gastric tube- nose to stomach
• Naso-intestinal tube-nose to small intestine
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Risks Associated With Nasogastric/Nasointestinal TubesRisks Associated With Nasogastric/Nasointestinal Tubes
• Used short time b/c irritating to nose & throat
• Easily displaced if pt. coughs, vomits, or pulls on the tube
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Risks Associated With Nasogastric/Nasointestinal Tubes (cont.)Risks Associated With Nasogastric/Nasointestinal Tubes (cont.)
• Sores inside the nose
• Irritation & crusting of mucus around the nostrils
• If tube goes into the lungs- difficulty breathing, aspiration pneumonia, respiratory arrest, or death
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Ways to Confirm Proper Tube Placement-Check placementWays to Confirm Proper Tube Placement-Check placement
• Measure length of tube outside the nostril - end of the tube. Make sure length has not changed since the tube inserted.
• Aspiration of stomach content
• Air bolus
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QuestionQuestion
Tell whether the following statement is true or false.
It is not important to check naso-gastric tube placement after insertion.
A. True
B. False
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AnswerAnswer
B. False
It is very important to always check placement of the naso-gastric tube. If the naso-gastric tube is not in the proper place, patient could aspirate feeding, causing coughing, discomfort, pneumonia, and even respiratory arrest.
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Gastrostomy or Jejunostomy Tube Gastrostomy or Jejunostomy Tube
• A gastrostomy tube ( G-tube) surgically inserted into the stomach through abdomen (a percutaneous endoscopic gastrostomy [PEG] tube)
• A jejunostomy tube- inserted into the jejunum (part of the small intestine) surgically
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Gastrostomy or Jejunostomy Tube (cont.)Gastrostomy or Jejunostomy Tube (cont.)
• Long term use
Check for redness or drainage
Clean with mild soap & water,
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Three Ways of Administering Enteral Nutrition Three Ways of Administering Enteral Nutrition
• Syringe: inserted feeding tube & formula poured into syringe.
• Feeding bag: feeding bag hangs on an IV pole. (gravity)
• Feeding pump: The tubing from the feeding bag is threaded through the feeding pump
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Which feeding tube is inserted into the small intestine through a small incision?
A. Gastrostomy
B. Jejunostomy
C. Nasogastric
D. Endotracheal
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AnswerAnswer
B. Jejunostomy
The jejunostomy tube is inserted into the jejunum (part of the small intestine) through a surgically made opening in the abdomen.
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Schedules for Enteral Feedings Schedules for Enteral Feedings
• *Bolus intermittent feeding: receive a large amt. over a short amt. of time.
• *Continuous feeding: receives formula constantly, 20 to 24 hrs/ day; use a feeding pump
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Packaging for Enteral Feeding Formulas Packaging for Enteral Feeding Formulas
• Cans
• Packets
• “Ready to hang” bottles
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Possible Complications of Enteral FeedingPossible Complications of Enteral Feeding
• Aspiration
• Heath care–associated (noscomial) infection
• Dehydration
• “Dumping syndrome”
• Contamination
• Clogging of tube
• Security of tube
• Kinked tube
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Report to the Nurse ImmediatelyReport to the Nurse Immediately
• Coughing or wheezing
• Diarrhea or constipation
• Difficulty breathing
• Fever
• Low reading on pulse oximeter
• Abdominal pain or bloating
• Cyanosis
• Dry mucus membranes
• Nausea or vomiting
• Decreased or very concentrated urine
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TF rulesTF rules
• If bolus give over 10-20 min.
• Elevate HOB 30 degrees during & @ least 30 min after feeding
• Check placement- before feeding
• air bolus- 10-15 cc air
• aspiration of GI contents
• If intermittent check residual – if > ½ last feed call RN
• Monitor glucose/dip all urines
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TF rules con’tTF rules con’t
• I/O
• Mouth care q 2 hrs
• Secure tube
• Give TF @ room temp- cold causes cramping/diarrhea
• Hang TF no more than 24 hours
If con’t mix 8 hours at a time
Clean bag after each use
Hang new bag/tubing q 24 hours
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TF rules con’tTF rules con’t
• Irrigate (flush) before & after use
• Clamp NG when not being used (decrease clogging)
• Clean g-tube: soap/ h2o or ½ peroxide/h20
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ChartingCharting
• 250 cc TF given @ ½ str. ( 125 cc TF/125 cc H2O) per NG per Dr. Jones. Placement verified with 5 cc air bolus & aspiration of GI contents. No residual, elevated HOB to 30 degrees. Pt. tolerated s n/v. M Snyder RN notified of infusion. Instructed pt to keep HOB elevated @ 30 degrees for ½ after feeding.
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NG chartNG chart
• D/C NG per Dr Jones. Emptied gastric suction for 250 cc dark green foul smelling secretions. Guiac positive. Notified S. Smith RN pt. c/o nausea. Instructed pt. to take sips of water & call RN if vomiting occurs.
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Total Parenteral NutritionTotal Parenteral Nutrition
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How TPN Differs From Enteral Nutrition How TPN Differs From Enteral Nutrition
• TPN bypasses digestive tract & delivers nourishment directly to bloodstream & isn’t digested.
• TPN-administered through central line into one of the two large veins that empty directly into the heart.
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How TPN Differs From Enteral Nutrition (cont.)How TPN Differs From Enteral Nutrition (cont.)
• TPN -a solution that contains nutrients in their smallest form.
• Patients who receive TPN are very ill, injured, or may be recovering from surgery, especially gastrointestinal,& may not be able to tolerate food in the digestive tract.
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Nursing Assistant’s RoleNursing Assistant’s Role
• Check dressing over CVL is clean & dry
• Notify the RN if drsg becomes wet, soiled, or loose
• Monitor the patient’s blood glucose levels
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Monitoring Glucose LevelsMonitoring Glucose Levels
• TPN very concentrated & contains high glucose
• Delivered directly into bloodstream, causing difficulty monitoring & regulating the blood glucose level
• Monitored q 6 hrs
• Pts taken off TPN should continue to have their glucose levels checked for hypoglycemia
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QuestionQuestion
What tests are performed on a regular basis on all glucose meters?
A. Pressure tests
B. Glucose tests
C. Quality control
D. Fluid levels
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AnswerAnswer
C. Quality control
Quality control tests are performed regularly on all blood glucose meters to ensure that the readings they give are accurate.
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GuidelinesGuidelines
• Definitions:
Continuous- TF runs all
the time
Bolus: (intermittant) one time feeding
• Shift times for I &O
Day shift:
after 0600- 1400
Evening shift:
after 1400-2200
Night shift:
after 2200-0600
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MATHMATH
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How to find total amount of food How to find total amount of food
• Amount in a shift?
Amount order per hour x hours infused= total shift amount
Example: 30 cc/hour x 8 hours= 240 cc
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Total amount in 24 hoursTotal amount in 24 hours
• add amount infused/per shift together
• example;:
• Days- 30 cc/hr x 8 hours= 240 cc
• Evenings- 25 cc/hr x 8 hours= 200 cc
• Nights- 50 cc/hour x 8 hours= 400 cc
•Total amount = 840 cc/24 hr
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Tube feeding StrengthsTube feeding Strengths
Some Tube feeds are too strong for a patient therefore they are diluted as follows:
¼ str.=.25
½ str.=.50
¾ str.= .75
* Only mix enough for a shift or the amount you are currently giving
• To calculate str. Multiply amount needed by str.
• Example:
40 cc/hour x 8 hr=320cc
320 cc x .25 str=80ccTF
320cc-80 ccTF=240H20
For this you would mix80 cc TF & 240 H20 for a total of 320 cc total feed for your 8 hour shift
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Intake and Output ( I&O)Intake and Output ( I&O)
• Total infusion :
• If it is a bolus you do not X by any hours
• If it is continuous infusion X by # of hours infusion is running in your shift ( if TF is shut off for 2 hours, you X by 6 hours instead of 8)
• Do not forget to add flushes
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Bolus (intermittant) feedingsBolus (intermittant) feedings
• Bolus feeding is a one time feed- it is generally a small amount
• The order may read give 1 can of ensure
• 1 can = 240 cc
• So you would give 240 cc for that feeding
• If the order says give 300 cc at ¾ str. You need to dilute
• Example:
• 300cc x .75=225 cc TF
• 300cc- 225 TF=75 ccH2O
• You give 225 cc TF mixed with 75 cc H2O
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FlushesFlushes
• Sometimes the TF order will include an order to flush NG with water before & after TF infusion- remember to calculate this into the intake when doing I&O
• Example: Give 50 cc bolus of pedialyte per NG flush with 10cc H2o before and after infusion
• What is the total intake:
• 50cc TF + 10 cc H2O bolus before + 10 cc H2O bolus after= 70 cc total intake for shift