CC2 Exam 3
enteral feedings *** - Used to meet nutritional requirements when patient cant eat or doesn't eat
enough
- GI tract must be functional because formula is delivered into it
- May be formulated to meet specific nutritional needs
- May be given as a bolus or continuous infusion via pump
- Different points of entry
o NG/OG from mouth or nose into stomach, Temporary
o PEG/G tube/J tube may rest in points past the stomach like the duodenum or jejunum, Long term
enteral feeding admin (not on blueprint) *** - Confirm placement before use and again if the tube is
moved or replaced. Mark with ink or tape where the tube exists the nose
- Assessment prior to admin: Check tube has not moved, GI assessment, Verify presence of bowel
sounds, shape and feel of abd, pain/tenderness, Check residual gastric contents (Follow facility policy on
when to withhold feeding), Return contents to stomach
- Hob 30-45 degrees during continuous or intermittent feeding for at least 30-60 mins after feeding to
lessen risk for aspiration
- Administer feeding solution at room temp to decreased GI upset and do not heat the formula in the
microwave
- Pause feeding prior to administering meds through the tube and flush with water before med admin
enteral feedings nursing assessment *** Assessments q4 hr:
· asses patency Q4: flush with water before/after feedings if not on continuous fluids to loosen any
excess that may clog up tubes
· Assess shape & feel of abdomen (assess for tenderness upon palpation)
· Abdominal x-ray before initial feeding
· Auscultate bowel sounds (all bowel quadrants)
,· Stability of tube: look at marker outside of tube
· Monitor I/O & daily weight
· Glucose checks first 24 hr typically q 4-6hrs
enteral feeding complications *** GI upset
- consider change in formula, decrease rate or volume of infusion, increase amount of free water (for
constipation), admin formula at room temp
Dumping syndrome
- Results from rapid emptying of formula into small intestine, which causes a fluid shift
- May manifest as dizziness, tachycardia, diaphoresis, pallor
Metabolic issues: dehydration, hyperglycemia, electrolyte imbalance, fluid overload, refeeding
syndrome, weight gain
- Provide adequate free water (balance between dehydration and overload), consider change in formula,
monitor labs (electrolytes, glucose), monitor weight, treat hyperglycemia with insulin
Mechanical issues: tube migration, aspiration, problems at the insertion site, clogged tube
-To prevent aspiration: Confirm placement prior to feedings, keep HOB elevated to at least 30 degrees
during and until 30-60 min after feeding is complete
- Flushing: flush with at least 30 ml water Q4H during continuous infusion, before and after bolus
feedings, and between medications
- Unclogging: use gentle pressure to flush with warm water (30-50 ml water in 60 ml syringe), use
products designed to unclog tubes/dissolve clotted formula
- Do not mix medications with formula
Aspiration of formula can lead to aspiration pneumonia which can be life threatening! Always confirm
tube placement and keep HOB elevated to at least 30 degrees
- If you suspect aspiration
· Stop the feeding
· Suction airway
· Provide Oxygen
,· Auscultate breath sounds
· Chest x-ray
· Watch for increase in temperature, other signs of systemic
enteral feeding interventions *** - Check patency q 4 hrs and before and after use of tube for feeding
- if you need to lay pt down turn feeding off
- HOB at least 30-45 once resumed feeding and up to at least 1 hr after feeding
- Check placement q shift
Aspirate and test the pH of stomach contents
- pH < 4 = tube is in the stomach (gastrostomy tube)
- pH > 6 = tube is in the jejunum (jejunostomy tube)
- Residual checks for NG tubes
parenteral feedings *** - Used to meet nutritional requirements when patient's GI tract is NOT
functioning or when they cannot consume sufficient nutrients orally or enterally
- Nutrition is supplied intravenously
- Total Parenteral Nutrition (TPN) must be given through a central line
- Peripheral Parenteral Nutrition (PPN) may be given through a peripheral line (this is a short-term
option for patients who require shorter-term support and a lower caloric requirement)
parenteral composition *** - Amino acids (protein) & dextrose make up the base solution (along with
sterile water)
- Electrolytes, vitamins, and trace elements are added according to patient's needs
- Lipids (fats) may be added to the solution OR given as a separate intermittent infusion
parenteral prioritization *** - Always administer via infusion pump to prevent accidental fluid overload
- Use tubing with a micron filter for TPN
, - Gradually adjust the flow rate to allow the body to adjust and then keep it consistent. Increasing the
rate can lead to overload or hyperosmolar diuresis
- Never stop TPN abruptly
- Discontinuation is done gradually to prevent rebound hypoglycemia
- If for any reason TPN solution is not available, administer dextrose in water until TPN can be resumed
(may be D10W or D20W...10%-20% dextrose)
- Never give medications through the same line
parenteral interventions *** - Assess VS Q4H or as ordered
- Assess lung sounds and respiratory status frequently for signs of volume overload
- Assess labs and monitor blood glucose levels as ordered
- Daily weight and I&O
parenteral nursing interventions/complications *** Infection/Sepsis
- May be a result of contamination during catheter insertion, contaminated solution (high concentration
of dextrose=fuel for bacteria)
- Use sterile technique during dressing changes (dressing changes per policy). Maintain sterility of
infusion and infusion site
- Monitor for S/S of infection (fever/chills, elevated WBCs, redness at cath insertion site)
- Change infusion bag and tubing every 24 hours or per facility policy
Metabolic issues: hyper/hypoglycemia, electrolyte imbalance, fluid overload
- Monitor blood glucose as ordered and administer sliding scale insulin to treat hyperglycemia
- Insulin may be added to the solution by pharmacy
- Administer additional dextrose to treat hypoglycemia
- Monitor daily weights and I&O status
Mechanical issues: catheter misplacement leading to pneumo/hemothorax,thrombosis, air embolism
- Pressure changes during tubing exchanges or tubing left open to air can lead to air embolism
enteral feedings *** - Used to meet nutritional requirements when patient cant eat or doesn't eat
enough
- GI tract must be functional because formula is delivered into it
- May be formulated to meet specific nutritional needs
- May be given as a bolus or continuous infusion via pump
- Different points of entry
o NG/OG from mouth or nose into stomach, Temporary
o PEG/G tube/J tube may rest in points past the stomach like the duodenum or jejunum, Long term
enteral feeding admin (not on blueprint) *** - Confirm placement before use and again if the tube is
moved or replaced. Mark with ink or tape where the tube exists the nose
- Assessment prior to admin: Check tube has not moved, GI assessment, Verify presence of bowel
sounds, shape and feel of abd, pain/tenderness, Check residual gastric contents (Follow facility policy on
when to withhold feeding), Return contents to stomach
- Hob 30-45 degrees during continuous or intermittent feeding for at least 30-60 mins after feeding to
lessen risk for aspiration
- Administer feeding solution at room temp to decreased GI upset and do not heat the formula in the
microwave
- Pause feeding prior to administering meds through the tube and flush with water before med admin
enteral feedings nursing assessment *** Assessments q4 hr:
· asses patency Q4: flush with water before/after feedings if not on continuous fluids to loosen any
excess that may clog up tubes
· Assess shape & feel of abdomen (assess for tenderness upon palpation)
· Abdominal x-ray before initial feeding
· Auscultate bowel sounds (all bowel quadrants)
,· Stability of tube: look at marker outside of tube
· Monitor I/O & daily weight
· Glucose checks first 24 hr typically q 4-6hrs
enteral feeding complications *** GI upset
- consider change in formula, decrease rate or volume of infusion, increase amount of free water (for
constipation), admin formula at room temp
Dumping syndrome
- Results from rapid emptying of formula into small intestine, which causes a fluid shift
- May manifest as dizziness, tachycardia, diaphoresis, pallor
Metabolic issues: dehydration, hyperglycemia, electrolyte imbalance, fluid overload, refeeding
syndrome, weight gain
- Provide adequate free water (balance between dehydration and overload), consider change in formula,
monitor labs (electrolytes, glucose), monitor weight, treat hyperglycemia with insulin
Mechanical issues: tube migration, aspiration, problems at the insertion site, clogged tube
-To prevent aspiration: Confirm placement prior to feedings, keep HOB elevated to at least 30 degrees
during and until 30-60 min after feeding is complete
- Flushing: flush with at least 30 ml water Q4H during continuous infusion, before and after bolus
feedings, and between medications
- Unclogging: use gentle pressure to flush with warm water (30-50 ml water in 60 ml syringe), use
products designed to unclog tubes/dissolve clotted formula
- Do not mix medications with formula
Aspiration of formula can lead to aspiration pneumonia which can be life threatening! Always confirm
tube placement and keep HOB elevated to at least 30 degrees
- If you suspect aspiration
· Stop the feeding
· Suction airway
· Provide Oxygen
,· Auscultate breath sounds
· Chest x-ray
· Watch for increase in temperature, other signs of systemic
enteral feeding interventions *** - Check patency q 4 hrs and before and after use of tube for feeding
- if you need to lay pt down turn feeding off
- HOB at least 30-45 once resumed feeding and up to at least 1 hr after feeding
- Check placement q shift
Aspirate and test the pH of stomach contents
- pH < 4 = tube is in the stomach (gastrostomy tube)
- pH > 6 = tube is in the jejunum (jejunostomy tube)
- Residual checks for NG tubes
parenteral feedings *** - Used to meet nutritional requirements when patient's GI tract is NOT
functioning or when they cannot consume sufficient nutrients orally or enterally
- Nutrition is supplied intravenously
- Total Parenteral Nutrition (TPN) must be given through a central line
- Peripheral Parenteral Nutrition (PPN) may be given through a peripheral line (this is a short-term
option for patients who require shorter-term support and a lower caloric requirement)
parenteral composition *** - Amino acids (protein) & dextrose make up the base solution (along with
sterile water)
- Electrolytes, vitamins, and trace elements are added according to patient's needs
- Lipids (fats) may be added to the solution OR given as a separate intermittent infusion
parenteral prioritization *** - Always administer via infusion pump to prevent accidental fluid overload
- Use tubing with a micron filter for TPN
, - Gradually adjust the flow rate to allow the body to adjust and then keep it consistent. Increasing the
rate can lead to overload or hyperosmolar diuresis
- Never stop TPN abruptly
- Discontinuation is done gradually to prevent rebound hypoglycemia
- If for any reason TPN solution is not available, administer dextrose in water until TPN can be resumed
(may be D10W or D20W...10%-20% dextrose)
- Never give medications through the same line
parenteral interventions *** - Assess VS Q4H or as ordered
- Assess lung sounds and respiratory status frequently for signs of volume overload
- Assess labs and monitor blood glucose levels as ordered
- Daily weight and I&O
parenteral nursing interventions/complications *** Infection/Sepsis
- May be a result of contamination during catheter insertion, contaminated solution (high concentration
of dextrose=fuel for bacteria)
- Use sterile technique during dressing changes (dressing changes per policy). Maintain sterility of
infusion and infusion site
- Monitor for S/S of infection (fever/chills, elevated WBCs, redness at cath insertion site)
- Change infusion bag and tubing every 24 hours or per facility policy
Metabolic issues: hyper/hypoglycemia, electrolyte imbalance, fluid overload
- Monitor blood glucose as ordered and administer sliding scale insulin to treat hyperglycemia
- Insulin may be added to the solution by pharmacy
- Administer additional dextrose to treat hypoglycemia
- Monitor daily weights and I&O status
Mechanical issues: catheter misplacement leading to pneumo/hemothorax,thrombosis, air embolism
- Pressure changes during tubing exchanges or tubing left open to air can lead to air embolism
