Question

enteral nutrition Questions 5-7 please

PN 200 Fundamentals of Nursing II Enteral Nutrition MM had abdominal surgery and received D5/W and D5/0.45% Na Cl for four days. A nasogastric tube was inserted for enteral nutrition. It was determined that MM's GI tract was intact and functional 1. Which of the above solutions was isotonic? Which was hypotonie? 2. State the rationale why the IV was allowed to run for 4 days 3. Why would MM receive enteral nutrition? Is enteral nutrition needed for long term or short term therapy? 4. Differentiate between Ensure enteral solution and other forms of enteral solution. 5. MM is at risk for complications related to enteral nutrition, Discuss potential complications, and give specific interventions for the complications you have listed. (List 4 mechanical complication and 4 physical complications of enteral thera as the interventions for each complication listed) 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 9/19

Does not need to be in essay format

Answer 1

5. mechanical and physical complications of enteral feeding :

1. pulmonary aspiration

• keep the head end of the bed (30 -45 degree ) elevated during feeds and upto 1 hour after feeds.
• iso osmotic feeds to be provided
• assess the gastric residual periodically
• administer pro motility agents as prescribed

2. Tube clogging

• flush the feeding tube before and after each bolus feed
• use the correct size feeding tube. Avoid using small bore tubes.
• during continuous feeds, flush the tube with about 30 ml water every 4 hours
• if the tube is clogged, unclog by initially instilling warm water under slight manual pressure
• if the clog is not relieved by the above mentioned procedure, sodium bicarbonate may be instilled to clear the clog.

3. tube malposition

• Trained personnel must only insert the feeding tube
• check for correct placement.
• monitor and document the marking on the tube where it exits from the nares or the mouth. if there are no markings then mark with an indelible ink where the tube exits the nares or the mouth.
• observe for symptoms of malposition which includes coughing and gagging and intervene if they occur.

4. dislodgement of tube

• secure the tube at the site of exit.
• secure the distal portion of the tube with sufficient slack to prevent accidental pulling out.
• choose the right tube size for insertion

Physical complications of enteral nutrition

1. nasopharyngeal discomfort

• secure the tubing to avoid excess tube movement that may cause irritation to the nasal mucosa.
• provide mouthcare with mouthwashes to prevent drying of the oral mucosa due to mouth breathing.
• sucking ice chips also allows the oral mucosa to remain hydrated.

2. intracranial insertion

• soft and pliable feeding tubes to be used for insertion
• periodic checking of tube placement

3. gastroesophageal reflux

• provide prokinetics, proton pump inhibitors or sucralfate as prescribed.
• administer feeds in upright position (head end elevated to 30 -45 degree) .

4. tracheoesophageal fistula

• choose the right size of tube for insertion
• monitor for complications

6. methods of delivery of enteral nutrition :

method	description	interventions
infusion	The feed is delivered using a pump at a set rate .	check the gastric residual volume(GRV) before initiating each infusion The gravity feed infusion can only be used with prepyloric feeding tubes.
continuous	continuous feeding is feeds delivered over 16- 20 hours.	GRV must be checked before starting the infusion and every 4 to 8 hours. stop the feeds of the residual volume is more than 500ml change the feeding system every 24 hours use a closed feeding system
intermittent	feeds delivered using pumps over a period of time with breaks	check teh GRV every 4 to 6 hours chenge the feeding system every 24 hours and use a closed system to prevent formula contamination.
bolus feeding	feeds provided over a period of 10 to 30 minutes at periodic intervals usually 4-6 times a day. the delivery of feeds is usually 100 mls to 300mls.	check GRV before feeds feeds must be given as tolerated flush the tube with 30 ml water before and after each feeding.

7. Rationale for chnaging MM's feeding method from Bolus to continuous feeding L:

• MM is immobile and recovering post surgery hence continuous feeding will be tolerated well by MM.
• The likelihood of nausea, vomiting ,abdominal distension are more during bolus feeds as compared to continuous feeding.
• since MM has resumed feeds after 4 days and may not tolerate rapid infusions of large amount of feeds (bolus feeds), continuous feeding method is desirable as it is started at a low rate and is advanced slowly to achieve the gaol rate.