Professional Exam 3, other types of nutrition

Soft diet

• Eliminates foods that are hard to chew/digest

• Low in fiber and lightly seasoned

What are some foods in a soft diet

Pasta, mashed potatoes, yogurt, apple sauce, scrambled eggs

What is a mechanically soft diet

Regular food turned into altered consistency

Food is either ground or mashed

What is a pureed diet

Regular diet placed in a blender

What should the nurse suspect if a patient is NPO for more than 2-3 days

Possible nutritional support from enteral/parenteral nutrition

What should you do if a patient is NPO but needs PO meds

Check with physician

What does the nurse need an order for with an NPO patient

Ice chips and sips of water

What is enteral nutrition?

Placing tube through GI tract t administer formula

Is an HG tube short or long term

Short term

Is a G tube short or long term

Both

What is a bolus

Eating or administering formula all at once as opposed to continuous

When would an NG tube be contraindicated

• Dysfunctional gag reflex

• High aspiration risk

• Gastric stasis

• GERD

• Nasal injuries

• Unable to swallow

What are all patients with an NG tube at risk for

Aspiration

What is a levin tube

Flexible plastic tube with holes at the stomach end and connecter at opposing end

Where might an NG tube be placed with gastroparesis

Duodenum or jejunum (done by the dr not the nurse)

How is an NG tube placement confirmed

Xray

How long can an NG tube be used

up to 30 days

What is a G tube

• Gastrostomy tube

• Done in the OR

• Tube placed through an opening into the stomach

What is a PEG tube

percutaneous endoscopic gastrostomy

• Placement usually does not require anesthesia

What must a patient have to be able to get a G/J tube or PEG tube

intact and functioning GI tract

How should the nurse check for placement of an NG tube (not initial placement)

Assessing pH of aspirate

What is the normal stomach pH

<5.5

What is the intestinal pH

7>

What is the lung pH

6

What is residual?

Formula remaining within the stomach

How often should residual be checked for with intermittent feeds

Before each feeding

How often should residual be checked for with continuous feeds

4-6 hours

What can feeding on an already full stomach lead to

Aspiration

When should a feeding be stopped or delayed regarding residual

When it is more than 25% of the hourly rate

What should the HOB be elevated to when feeding

30 degrees or more

How long should the HOB be elevated after completing an intermittent feed

1 hour

What should be done with the feeding if patient needs to be turned or repo?

Pause feed

How often should time be flushed?

Flush with water every 4-6 hours

What should be documented when it comes to Is and Os regarding feeding

Document feeding volume and volume of flushes

Should medications be given when a feeding is ongoing

No

Can medications be mixed in with formula

No

If giving a med, how much warm water should go before the medication

10mL

How many meds should be given at a time

1

How much water should be flushed through tube after completing med admin

30-60mL

If pills can be crushed and put through tube, what texture should they be in

FINE powder

What are some ways to prevent aspiration

• Small frequent feedings

• Not over-sedating patient

• Checking bowel sounds, placement, and residual

What can be done to prevent a clogged tube

Flushing!!!

What should be done with a clogged tube

Try to push 30mL of water within a 50-60mL tube

If unsuccessful, call provider

How to avoid a clogged tube

• Completely crushing meds

• Giving meds 1 at a time

What should be assessed for every shift at the nares

• Skin breakdown

• Redness

• Blistering

How often should nares be moistened

4-8 hours

What should be done if patient has an NG tube and is on oxygen

Humidify if possible

How to prevent diarrhea while on an NG tube

start feeding at a slow rate

hOw often should delivery sets be changed

12-24 hours

How long should formula be hanging before being discarded

8 hours

When should opened and refrigerated cans of formula be discarded

After 24 hours

When should aseptic technique be used

With immunosuppresed or acutely ill patients

How to avoid stoma complications

• Clean skin every shift with soap and water and allow to dry

• Use topical antibiotics as ordered

• Assess for infection signs

• Request wound/stoma consult as needed

How to prevent an unplanned extubation

• Anchor tube with tape (for NG tubes)

• Frequently check on patient

• Measure external tubing length

• Restrain patient only if necessary with physicians order

What does parenteral mean

Outside of enteral system

What is parenteral nutrition

Nutrition via IV route

How is PPN given

Through peripheral line

How is TPN given

Through central line via subclavian vein

TPN assessment criteria

• Inability to absorb GI nutrition for more than 7-10 days

• Debilitating illness lasting more than 2 weeks

• Loss of >10% pre-illness weight

• Serum albumin less than 3.5g/dL

• Nitrogen loss via wound infection, fistula, abscess

• Renal/Hepatic failure

What is PPN

Peripheral parenteral nutrition

When in PPN used

Patients able to take minimal oral feedings

Short term

Does PPN have its own line

Yes

Can peripheral vessels take highly concentrated solutions

No

TPN solution

• Hypertonic

• 25% glucose

• Do not suddenly stop as hypoglycemia occurs

• If admin is disrupted, give 5-10% dextrose

• Monitor glucose

PPN solution

• Isotonic

• Less concentrated than TPN

• 10% glucose

• Fewer calories

Des parenteral solution need a dedicated line?

Yes

Should meds be added to parenteral nutrition after dispensed from pharmacy

NOOOO

Parenteral nutrition complications

• Pneumothorax, thromboembolism

• Infection/Sepsis

• Hyper/hypoglycemia

• Fluid, electrolyte, acid base imbalance

• Phlebitis

• Hyperlipedemia

What is some nursing care with parenteral nutrition

• Use a pump and tubing with a filter

• Q6 glucose checks

• Q4 vitals

• Be alert for sepsis

• Strict aseptic technique when changing tubing/dressing

• Secure connections

• Patient weight should not exceed 3lbs/week

• Assess serum protein/electrolyes

• Discard solution within 24 hours