Enteral Nutrition

Front 1

Vomiting and aspiration: Improper tube placement

Back 1

Replace tube in proper position. Check tube position before beginning feeding and q8h if feedings are continuous.

Front 2

Vomiting and aspiration: Delayed gastric emptying, increased residual volume

Back 2

Hold feeding 1hr; then, if residual volume is less than before, resume feeding.

Front 3

Vomiting and aspiration: Aspiration risk

Back 3

Keep head of bed elevated to 30-45 degree angle. Have pt sit up on side of bed or in the chair. Encourage ambulation unless contraindicated.

Front 4

Vomiting and Aspiration: Contamination of formula

Back 4

Refrigerate unused formula and record date opened. Discard outdated formula every 24hr. Discard formula left standing for longer than manufacturer's guidelines: 8-12hr for ready-to-feed formulas (cans) or 4hr for reconstituted or closed system as per manufacturers guidelines.

Front 5

Diarrhea: Feeding too fast, hypertonic formula, or medications

Back 5

Evaluate the number and volume of stools (if greater than three to five per day or >500ml), consider pt's medical history, and assess abdomen for distension or pain. Contact physician, consider medications , and rule out infection (c. diff).

Decrease rate of feeding. Change to continuous drip feedings. Check for drugs that may cause diarrhea (ex: antibiotics).

Front 6

Diarrhea: Contamination of formula or tubing

Back 6

Change tubing q24h. Follow manufacturer's guidelines for maximum length of time formula can be at room temperature.

Front 7

Diarrhea: low-fibre formula

Back 7

Change to formula with more fibre

Front 8

Diarrhea: Tube moving distally

Back 8

Properly secure tube before beginning feeding. Check before each feeding or at least q24h if feedings are continuous.

Front 9

Constipation: Low fiber

Back 9

Consult health care provider for change in formula to one with higher fiber content. Obtain bowel routine order

Front 10

Constipation: Poor Fluid intake

Back 10

Increase fluid intake if not contraindicated. Give free water as well as formula. Give total fluid intake of 30ml/kg body weight.

Front 11

Constipation: medications

Back 11

Check for medications that may cause constipation

Front 12

Constipation: impaction

Back 12

Perform rectal examination to check and manually remove feces if present

Front 13

Dehydration: Excessive diarrhea, vomiting

Back 13

Decrease rate or change formula. Check drugs that pt is receiving, especially antibiotics. Take care to prevent bacterial contamination of formula and equipment.

Front 14

Dehydration: Poor fluid intake

Back 14

Increase intake and check amount and number of feedings. Increase amount of intake if appropriate.

Front 15

Dehydration: High-Protein formula

Back 15

Change formula

Front 16

Dehydrations: Hyperosmotic diuresis

Back 16

Check blood glucose levels frequently. Change formula

Front 17

Nursing Management: feeding tubes

Back 17

1. Check tube placement before feeding and before each drug administration.

2. Assess for bowel sounds before feeding

3. Use liquid medications rather than pills, as appropriate. (dilute viscous medications; chack to see if medications are intended to be taken with meals; avoid adding medications to enteral feeding formula)

4. If it is necessary to use tablets, be sure to crush drugs to a fine powder to prevent clogging feeding tubes.

5. Follow general principles of tubing feeding (e.g., bed elevation, checking gastric residual volume, and flushing tube with water).

6. Assess regularly for complications (e.g. aspiration, diarrhea, abdominal distension, hyperglycemia, constipation and fecal impaction).

Front 18

What are some ways you can decrease the risk of enteral feeding misconnections?

Back 18

1. Teach visitors and nonclinical staff to notify nurse if an enteral feeding line becomes disconnected.

2. Teach visitors and nonclinical staff not to reconnect enteral feeding lines.

3. Do not modify or adapt IV or feeding devices, because this may compromise the safety features incorporated into their design.

4. When making a reconnection, the nurse should routinely trace lines back to their origins and then ensure that they are secure.

5. When pt arrives on a new unit or setting or during shift-to-shift handoff, nurses should recheck connections and trace all tubes.

6. Route tubes and catheters that have different purposes in unique and standardized directions (ex. Iv lines should be routed toward the pt's head, enteral lines should be routed toward the feet).

7. Package together all parts needed for enteral feeding and reduce the availability of additional adapters and connectors. This will minimize the availability of dissimilar tubes or catheters that could be improperly connected

8. Label or color-code feeding tubes and connectors, and educate staff about the labelling or color-coding process in the institution's enteral feeding system.

9. Be sure to identify and confirm the solution's label, because a three-in-one parenteral nutrition solution can appear similar to an enteral nutritions formulation bag. Label the bags with large, bold statements such as "warning! for enteral use only - not for IV use."

10. Ensure that all connections are made under proper lighting conditions.

Front 19

What is Dumping syndrome? and what are some of the clinical manifestations of it?

Back 19

When the feeding in the GI tract pulls water to create an equilibrium in the osmolarity.

As a result, you feel full, nauseous and have diarrhea.

Dehydration, hypotension and tachycardia can result in dumping syndrome.

Front 20

What are the interventions for Dumping syndrome?

Back 20

Slow the rate to allow absorption of the formula

Notify the MD and nutritionist.

Front 21

How can you prevent dumping syndrome?

Back 21

-Keep the formula at room temperature

-When introducing tube feedings, begin with a slow, continuous drip

-keep pt in semi-Fowler's for the 1hr after infusion ends

-Minimize water flush volumes

Front 22

Constipation or fecal impaction