What are the advanatages of enteral feeding?

Less expensive
Less risk for sepsis
Maintain the integrity of the intestinal mucousa

• Inability to consume adequate food
• Increased nutritional requirements
• Must bypass the mouth
  • Tumor
  • Dysphagia
  • decreased LOC

1. Gavage: feeding/nutrition
2. Lavage: removal of stomach contents for lab or washing out of toxins
3. Decompression: gastric rest, prevent N/V, reduce strain on suture line, and treatment of a bowel obstruction

An important thing to remember about the "pig tail" is...

What do use to irrigate with if your client has overdosed?

What are the two types of large bore NGT's? How can you distinguish between the two?

How can you check the placement of an NGT? Which is least reliable?

Aspirate gastric contents
Air rush/insufflation (least reliable)

• Keofeed (NG tube for feeding only)
• Gastric tube (G-tube)
• Percutaneous endoscopic gastronomy tube (PEG)
• Jejunostomy (J-tube)

1. Aspirating gastric contents
2. Measuring pH
3. Air rush/bolus
4. Xray (most reliable)

• Always check placement
• Keep the HOB up at all times during feeding and medication admistration

• Causes
  • Antibiotics
  • possible C-diff, hyperosmolar formula
• Interventions
  • Decrease the volume/rate
  • dilute or change formula
  • keep clean
  • continuous feeding
  • lactose free formula
  • r/o fecal impaction
  • ADD FIBER

• Increase fiber
• Increase water
• Increase activity
• Stool softeners

• Use liquid medication
• Irrigate tube with water before and after giving medication
• DO NOT give medications that are "enteric coated" through the tube
• Give only one medication at a time

• check residuals
• decrease fat in the formula
• consider a J-tube
• look at stomach slowing medications like reglan

• Infection around the tube site: cleanse with soap and water every shift and as needed.
• Topical antibiotics as ordered
• Assess for s/s of infection
• request ET or wound care specialists

• Correct and monitor electrolyte levels
• Start slow
• Watch Pulse, I&O, and electrolytes
• Avoid overfeeding

1. Bolus- represents a normal feeding pattern
2. Continuous- controlled continuous delivery via infusion pump
3. Cyclical- daytime and noctime feedings (night is a continuous delivery)

Determine residual and verify placement (residual above 100 requires immediate action); Assess for abdominal distension, BS, N/V; Flush after feeding with 100ml water; HOB up during all feeding; deliver feedings slow with gravity

You are checking the residual on your client and when you pull back on the plunger all you get in your syringe is air. What is happening?

Renal failure, CHF, ...

• Daily weight and I&O
• BM's
• Tolerance to feeding
• Residuals 
• Oral hygiene (lube lips, rinse mouth out)
• Keep nostrils clear
• Watch for c/o sore throat
• Body image

What is it called when you bypass the gut to deliver a feeding?

A TPN (Total Parenteral Nutrition) is infused through a small peripheral vein. True or False?

Name one of two types of central lines.

1. Central Venous Catheter
2. Peripherally Inserted Central Catheter (PICC)

Electrolytes, vitamins, minerals, insulin, and pepcid are all given when the nurse determines the need. True or False?

Every liter of fluids given during TPN has how many kcals?

What are some interventions to prevent infection during TPN?

• Inspect the container and solution
• Refrigerate except when using (warm it up to give it, do not microwave or boil)
• Filter in the line
• Change tubing, bottle, filter every 24h
• Inspect insertion site and change dressing every 72h (or per protocol)
• Use sterile technique

Air embolism
Hyperglycemia
Hypoglycemia

• Air embolism is a large amount of air in the vascular system that will occlude circulation.
• S/S- SOB and feeling of impending doom (the patient, not the nurse!)

• Keep all connections taped and clamped
• when disconnecting or removing, have client lay flat and perfrom the valsalva meneuver

• Clamp the infusion
• Lay the client on the left side in the trendelenberg position
• Provide Oxygen
• Call the doctor immediately

• Lare amounts of serum glucose (blood glucose)
• S/S- polyuria, polyphagia, polydypsia

• low blood sugar due to excess insulin
• S/S- cool, diaphoretic, tachycardia, anxious, weak, shaky, hunger, confusion

You are client is recieving TPN, what might cause hypoglycemia in you client?

• Chem profile every 48h or per protocol
• VS
• Fingersticks every 4-6h
• I&O
• Correct flow rate (important to check freq)
• Patency of catheter
• Never interrupt the flow

• Pyrosis is Heartburn
• Interventions- small meals, HOB up after meals, avoid fatty or spicey foods, avoid eating on the run, and don't overeat.

• Avoid certain drinks, foods, medications, and chemicals
  • Alcohol
  • Acidic juices, Citrus fruits
  • Nicotine
  • Fatty/Spicey foods
  • Tomatoes
  • Chocolate
  • BCP, Sedatives, Antihistimines

A client has N/V, what are some concerns you may have for this client?

• Protect the airway
• check for annoying sights or smells
• deep breathing
• avoid abrupt movement
• limit food intake
• avoid negative comments about food
• protect the airway
• cool wash cloths on the neck and forehead
• rinse mouth after emesis
• antiemetics (CNS depressant)

They do not chew their food as well and the body is unable to break down large chunks so the carbs are left undigested!

• Increase fiber slowly
• Note any milk tolerance
• Prevent consitipation (stool traps gas)
• Identify problematic foods
• Ambulate or ANAL TUBE
• Eat slow and chew better
• No straws or gum
• Avoid carbonated beverages

What causes diarrhea?

• Infections to the GI
• Lactose intolerance
• Spoiled foods
• Stress
• Cyctic fibrosis and other malabsorptive diseases

• Treat the cause
• High fiber
• Antidarrheals

What are some things we can do for constipation?

• Increase fluids
• Increase fiber
• Ambulate
• Relax
• Follow routine
• Avoid laxatives
• Do not put off urge- it is the #1 cause