Enteral Nutrition - Essex County College Nursing School

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Transcript Enteral Nutrition - Essex County College Nursing School

Gastro-Intestinal
Tubes & Enteral
Nutrition
NURS 108
Majuvy L.Sulse MSN, CCRN
Enteral Feeding
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Nutrients given via the GI tract
Easier to give especially for home care
Types:
 Polymeric-1 to 2kcal/ml-milk based blenderized foods
prepared by the dietary or at home
 Modular-3.8 to 4kcal/ml-single and incomplete formulas
 Elemental-1 to 3kcla/ml predigested nutrient formulas for a
partially functional GI to absorb
 Specialty formulas-1 to 2 kcal/ml-formulas designed to
meet specific needs in certain illness.
Feeding Tubes
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Nasoenteric tubes (NET)- usually for short term <4 weeks
 Nasogastric (NGT) Nasointestinal-doudenal or jejunal (NDT/NJT)
Surgically placed (enterostomal) gastrostomy & Jejunostomy
tubes-long term use
Endoscopic
 gastrostomy (PEG)
 Jejunostomy (PEJ)-bypass stomach in presence of gastric
disease, UGI obstruction, abnormal gastric or doudenal
emptying
Feeding Tubes
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Nasointestinal tubes are longer than NG tubes and are
indicated to medically treat an obstruction of the small
intestine in someone who's a very poor surgical risk. They rely
on a weighted distal end and peristalsis to advance the tube
along the intestinal tract in an attempt to relieve the
obstruction
Feeding tubes
Indications for Enteral feedings
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Inadequate oral intake
 Continuous feedings
 CVA
 Difficulty swallowing-absence of gag reflex
 Anorexia Nervosa
 Severe depression
 Local trauma or critical illness
Prolonged intubation
Gastrointestinal disorders
 Fistulas, IBD, mild pancreatitis
Indications for Enteral feedings
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Neurological and mascular disorders
 Brain neoplasm
 CVA
 Dementia
 Myopathy
 Parkinson’s disease
Cancer
 Upper GI
 Head & Neck
Nursing Management
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Patient position
 HOB 30-45 degrees
Patency of tube
 Irrigate with water before and after each feeding (if intermittent) or
medication administration
Tube position
 Check tube placement before each feeding and drug administration
 Xray –most accurate assessment of placement
 Aspirate gastric contents
 Check pH contents-less than 5 indicative of stomach contents
 Check every 4-8 hours with continuous feedings
 Check for bowel sounds
Nursing Management
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Formula
 Given at room temperature
 Amount in bag should not exceed 4 hours or per policy
 Labeled with date and time initially used
 Aspirate contents & measure amount-if volume is >200 ml
with signs of intolerance, hold feeding for an hour and
recheck residual volume. Aspirate should be re-instilled.
Nursing Management
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Feeding administration-rate & volume increased gradually to
minimize side effect as nausea & diarrhea. Water flushes or
boluses given
 Feeding pump-continuous
 Gravity method-intermittent-volume is usually 200500/feeding
Nursing care
 Daily weights or as per policy
 I/O
 Blood glucose
 Oral care
Complications related to Tube
Feedings
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Vomiting or aspiration
 Improper tube placement
 Delayed gastric emptying
 Contamination of formula
Diarrhea
 Feeding too fast, hypertonic formula, medications
 Lactose intolerance
 Contamination of formula
 Low fiber formula
Complications related to Tube
Feedings
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Constipation
 Formula components
 Poor fluid intake
 Drugs
 Impaction
Dehydration
 Excessive diarrhea
 Poor fluid intake
 Hyperosmotic diuresis
 High protein formula
Nursing diagnosis
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Imbalance nutrition: less than body requirements
 Weight monitoring to make caloric adjustment
 Progress slowly to avoid gastric distention
 Gradually add high calorie foods to maintain weight
Impaired skin integrity related to enzymatic action of
gastric juices
 Assess skin daily for signs & symptoms of irritation
 Apply protective skin barrier
 Strict handwashing
 Patient & family teaching
Nursing diagnosis
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Risk for aspiration
 Positioning
 Aspirate gastric contents before feeding
Disturbed body image related to presence of feeding tube
 Encourage expression of feelings
 Acknowledge patient fears
 Provide correct information
Nursing diagnosis
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Risk for deficient fluid volume/volume overload
 Monitor mucous membranes & skin turgor, VS, I/O
 Provide adequate fluid intake
 Reinstill gastric contents to prevent electrolyte losses
Ineffective therapeutic regimen management
 Give detailed information and return demonstration
techniques to validate learning
Legal & Ethical Issues
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Withholding food & fluids-what happens if clients
are not able to make decisions or make their
wishes known????
 Review
what is known about tube feedings especially
risks & benefits
 Review medical facts about the client
 Obtain the opinion of all stakeholders in this situation
 Delay any action until consensus is achieved
Decompression Tubes
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Occasionally, a tube can be used for acute treatment of active
bleeding from esophageal or gastric varices. Two types are
most common:
* The Sengstaken-Blakemore tube has a large balloon to
compress the esophagus and a smaller one to anchor the tube
and exert pressure against varices in the distal esophagus and
the cardia of the stomach. It has three lumens-one each to
inflate the balloons and one attached to suction to aspirate
gastric contents. To suction secretions above the esophageal
balloon, an additional tube, such as a Salem sump tube, is
placed in the proximal esophagus.
* The Minnesota tube is similar to the Sengstaken-Blakemore tube, but it also has an esophageal aspiration lumen
that eliminates the need for an additional drainage tube.
Decompression Tubes
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Gastric tubes-commonly used NG tubes that are
placed for GI decompression or drainage..
 Salem sump- The Salem sump has two lumens, one for
drainage and one for air. The drainage lumen is usually
connected to low continuous suction. At times, however,
higher levels may be needed. The air vent keeps the tube
away from the stomach wall to prevent damage to the
mucosa
 The single-lumen Levin tube is typically connected to
intermittent low suction for the same purpose.
Decompression Tubes
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Intestinal Tubes mercury-filled balloon at the distal end. These
tubes are rarely used today because the balloon could rupture and
leak mercury. The newer Andersen tube, with a pre-weighted
tungsten tip, is a safer option
 Miller Abbot tube-A long 10’ (3 m) double-channel intestinal
tube. Inserted through a nostril, the tube is passed through the
stomach into the small intestine. Used for sampling
gastrointestinal fluid or for therapeutic aspiration to relieve
intestinal distension.
 Cantor tube- 10’ single-lumen tube with a suction port in the
lumen to aspirate contents
 Harris Tube- short around 6’single lumen also to relieve
distention, Y end allows lavage of intestinal tract
 Dennis tube-10’ 3 lumen: irrigation, drainage & balloon inflation
Andersen tubes