Question

differentiate methods of delivery of enteral nutrition, describe nut

6. Differentiate methods of delivery of enteral nutrition, Describe nursing interventions for each delivery method you have listed. 7. State the possible rationale for changing MM's enteral nutrition from bolus method to continuous feeding Reviewed 12/18

Answer 1

6. Enteral feeding is the delivery of hydration and nutrients anywhere along the GI tract

Types :-

- nasogastric feeding (NG)

placement of a tube for nutrient ingestion via the nose (short term)

- operative gastrostomy (OG)

surgical placement of a tube through the abdominal wall directly into the stomach for nutrient ingestion or suctioning out gastric contents

- percutaneous endoscopic gastrostomy (PEG)

endoscopic placement of a tube through abdominal wall directly into the stomach for nutrient ingestion or suctioning out gastric contents

- jejunostomy (j tube)

surgical placement of a tube for nutrient ingestion through the abdominal wall directly into the jejunum (part of intestine)

- percutaneous endoscopic jejunostomy (PEJ)

endoscopic placement of a tube for nutrient ingestion through the abdominal wall directly into the jejunum

#. Nursing interventions :-

Procedure: Nursing Actions

-Review prescription & purpose, plan for drainage or suction & understand the need for placement for diagnostic purposes

-Identify client & explain procedure

-Evaluate client's ability to assist and/or cooperate

-Perform hand hygiene

-Set up equipment:

Nasogastric tube- selected according to indication

Tape- to secure dressing

Gloves

Water Soluble lubricant

Cup of water & straw

Catheter- tipped syringe, usually 30 to 60 mL

Basin- to prepare for gag induced nausea

pH test strip or meter- to measure gastric secretions for acidity

Stethoscope- to check placement

Disposable towel- to maintain a clean environment

Clamp or plug- to close tubing after insertion

Suction apparatus- if continuous or intermittent suction is needed

Gauze square- to cleanse outside of tubing after insertion

Safety pin and elastic band- to secure tubing & prevent erroneous removal

Position a disposable towel & basin

Provide privacy

*Intraprocedure: Nursing Actions

-Nurse may require assistance with clients who are confused or disoriented

-Assist client to high-Fowler's position (if possible)

-Assess the nares for best position/route: assess whether or not client has had any nasopharyngeal surgery or septal deviation to determine which naris to use

-Administer topical anesthetic

-Measure tubing- from tip of nose, to top of ear lobe, to tip of the xiphoid, and mark with adhesive tape

-Put gloves on

-Lubricate tip of tubing

-If client is able, have her hold the cup of water with straw in place, and tell her that she will be told when to drink

-Have client hyperextend her head back

-Gradually insert tube

-When resistance is met, apply gentle pressure downward, and proceed beyond curve of nasopharynx

-Have client lean her head forward and begin sipping as insertion continues. Swallowing helps feed the tubing downward toward stomach

-When tubing reaches mark, anchor the tube suing tape or nasogastric claim

-Placement check:

Ask client to talk

Inspect posterior pharynx for coiled tubing

Aspirate gently to collect gastric contents & observe color

Test pH (4 or less is expected)

Confirm placement with an x-ray as prescribed

-Injecting air into tube & when listening over abdomen is not a acceptable practice

-If tube is not in stomach, advance it 5 cm & repeat placement check

-When placement is confirmed, secure tube to nose using tape

-Clamp nasogastric tube or connect it to appropriate suction device

-If client vomits, clear airway & provide comfort prior to continuing

-Salem sump tubing has a blue pigtail for negative air release. Do not insert any substances into blue pigtail, as it will break seal and tubing will leak

Post Procedure: Nursing Actions

The insertion & maintenance of nasogastric tube is nursing responsibility; but measuring output, providing comfort, & giving oral care can be delegated

Discontinuation/removal

-Inform client of order & process, emphasizing that removal is less stressful than placement

-Perform hand hygiene & don gloves

-Remove safety pin from gown, & remove tape-anchoring tube to nose

-Disconnect tubing from suction & claim it

-Provide facial tissues for client

-Instruct client to take & hold deep breath

-Remove tubing with steady continuous pull while client is hold her breath

-Measure & record any drainage

-Clean nares & provide oral care

-Ensure client is confortable

-Dispose of equipment

-Document all relevant information including:

Tubing removal & condition of tube

Volume & description of drainage

Abdominal assessment, including inspection, auscultation, palpation, & percussion

-Last & next bowel movement & urine output

7. To meet the increased demand of MM

Safe and cost effective, preserves GI integrity

Preserves the normal sequence of intestinal and hepatic metabolism

Maintains normal insulin and glucagon ratios