NUR 201 - Nutrition and Enteral Tube Feedings Study Notes

Basic Nutrients

  • Nutrients delivered to the GI tract include two broad categories:
    • Nutrients that supply energy: Carbohydrates, Protein, Lipids (fats)
    • Nutrients that regulate body processes: Vitamins, Minerals, Water

Factors Affecting Nutrition

  • Stage of Development
  • Health Status
  • Medications
  • Economic status
  • Culture and religion
  • Negative experiences
  • Gender
  • Alcohol use

Food Intake

  • Decreased food intake can lead to Anorexia
  • Increased food intake can lead to Obesity

Nutritional Assessment

  • Health History
  • Physical Assessment
  • Labs

Nursing Interventions

  • Teaching
  • Continuous monitoring
  • Stimulate appetite
  • Assisting with eating
  • Provide oral nutrition
  • Provide long-term nutrition

Diets

  • NPO (nothing by mouth)
  • Clear liquid
  • Full liquid
  • Pureed
  • Mechanical soft
  • Dysphagia
  • High/low fiber
  • Consistent carb
  • Soft/low residue
  • Low sodium
  • Low cholesterol
  • Renal diet
  • Regular

Enteral Nutrition: Tube Types and Indications

  • Short or long term nutritional support
  • Nasogastric (NG) tube
    • Disadvantages (not specified in the handout)
  • Gastrostomy tube (into the stomach)
  • Percutaneous Endoscopic Gastrostomy (PEG)
  • Jejunostomy tube (into the jejunum)
  • Indications for enteral nutrition

Nasogastric (NG) Tube

  • Pathway concepts (diagram-oriented): End of nasogastric tube → Nasal cavity → Nasogastric tube → Oesophagus (gullet) → Stomach

Gastrostomy Tube

  • Esophagus → Stomach

PEG Tube

  • Esophagus → Stomach
  • Endoscope
  • Balloon
  • Gastrostomy tube
  • Cross-section of the stomach
  • PEG Procedure
  • Skin

Jejunostomy Tube

  • Nasoduodenal tube
  • Nasojejunal tube
  • Nasogastric Tube
  • Gastrostomy Tube
  • Jejunostomy Tube

Enteral Nutrition: Feeding Schedules

  • Intermittent
  • Bolus
  • Continuous
  • Cyclic

Enteral Nutrition: Formulas

  • Polymeric
  • Modular
  • Elemental
  • Specialty formulas: Nepro, ENSURE, PecliaSure

NG Tube Placement

  • Check placement of tube before/during feedings
  • Confirmation methods (several):
    • X-ray – best confirmation
    • Check pH of the contents
    • Aspiration of contents/visualization
    • Measurement of the tube
    • AIR BOLUS – Not recommended
  • When to check/document placement? (as per protocol in hand-out)

NG Tube Feeding Musts

  • Keep Head of Bed (HOB) elevated
  • Replace container/equipment
  • Check residual
  • Monitor for abdominal distention
  • Monitor blood glucose
  • Monitor for dehydration (input/output)
  • Monitor BUN and Creatinine
  • HIGH NITROGEN (note: high nitrogen status concerns are acknowledged)

NG Tube Feedings: Practical Considerations

  • Check dates of feeding solution
  • Tube feedings at room temperature
  • Flush tube before and after feeds: at least 30 mL of tap water before; at least 30 mL after to prevent clogging

Procedures

  • Bolus feeds
  • Continuous feeds
  • Uses a feeding pump
  • See ATI Skill Module (training reference)

Complications of Tube Feeding

  • Aspiration
  • Large residual for NG feed
  • Nasal erosion
  • Diarrhea (common problem)
  • Nausea/Vomiting
  • Distention
  • Skin irritation/breakdown
  • Mouth discomfort
  • Dumping syndrome

Nursing Interventions for G/J Tubes

  • Placement check via length of the tube
  • Assess bowel sounds
  • Elevate HOB > 30 degrees
  • Aspirate for residual – hold if > 10\,\text{mL} for intestinal feeds
  • Administer slowly; if not via pump, over 15 or more minutes
  • Assess/clean stoma
  • Oral care per shift
  • Monitor blood sugar every 6 hours