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ENTERAL NUTRITION

Enteral Nutrition. EasySafeLess expensive. Delivery Options. Continuous via pumpIntermittent by gravityIntermittent by bolus with syringeCyclic feedings via pump. Nasointestinal/Nasogastric. PolyurethaneSmall diameterFlexibleRadiopaqueWeighted tipIntestineStylet. CloggedResidualObstructionDislodgedKinked.

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ENTERAL NUTRITION

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    1. ENTERAL NUTRITION Delivery of nutrients directly into the GI tract Functioning GI tract

    2. Enteral Nutrition Easy Safe Less expensive

    3. Delivery Options Continuous via pump Intermittent by gravity Intermittent by bolus with syringe Cyclic feedings via pump

    4. Nasointestinal/Nasogastric Polyurethane Small diameter Flexible Radiopaque Weighted tip Intestine Stylet Clogged Residual Obstruction Dislodged Kinked

    5. Gastrostomy/Jejunostomy Long term Placed surgically, radiologically, or endoscopically

    6. (PEG)- Percutaneous Endoscopic Gastrostomy No general anesthetic Minimal sedation Tube marked at exit site Before initial feeding- tube placement checked by radiography

    7. Basic Patient Care Principles Position Patency Tube position Residual volumes Formula Administration General considerations

    8. Position HOB elevated 30-45 degrees at ALL TIMES HOB elevated for 30-60 minutes after feeding

    9. Patency Intermittent Continuous

    10. Tube Position Check before each intermittent feeding or every 4 hours with continuous 1. Aspiration (gastric pH) 2. Air 3. X-ray

    11. Tube Position Methods Aspiration of stomach contents for pH 0-4 stomach 6 or higher check with X-ray Small intestine about 6 Respiratory 7 or lower

    12. Position Methods Auscultate air X-ray most accurate Before initial feeding and if any questions regarding placement

    13. Residual Volume Delayed gastric emptying Increased residual volumes-Increased risk for aspiration

    14. Formula Osmolality Room or body temperature

    15. Administration Rate is gradually increased and signs of intolerance are assessed

    16. General Considerations Daily weight I&O Blood glucose HCT, Platelets, BUN/Cr and Na

    17. General Considerations Supplies are good for 24 hours Label everything Hang only 4 hours of feeding Large bottles are good for 24 hours Never add meds to bag Clean technique, not sterile

    18. Actual Procedure Doctors order 8 Rs Check allergies Assess for bowel sounds, abdominal distention, palpate Respiratory baseline

    19. Procedure Check tube placement Check residual If greater than 100ml or more than the last hours feeding Re-instill residual by gravity Flush with 30-50ml water Administer or restart feeding Label everything

    20. Nursing Diagnoses Imbalanced nutrition: less than body requirements Impaired skin integrity R/T enzymatic action of gastric juices, diarrhea Risk for deficient fluid volume R/T diarrhea or inadequate intake of water with concentrated feeding

    21. Nursing Diagnoses Ineffective therapeutic regimen management R/T care required for. Risk for aspiration R/T enteral tube with tube feedings

    22. Complications Vomiting/Aspiration Improper tube placement Increased residual Aspiration

    23. Complications Diarrhea Too fast Hypertonic Meds Lactose intolerant Contamination Low fiber formula

    24. Complications Constipation Formula Poor fluid intake Meds

    25. Complications Fluid Volume Deficient Diarrhea Poor fluid intake High protein formula Hyperosmolar formula

    26. Complications Dumping Syndrome J-tube Rapidly distended jejunum with hypertonic food Fluid shift rapidly from vascular system to make it isotonic N/V, diarrhea, cramps, pallor, sweating, heart palpitations, fainting feeling

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