Question

Bob is NPO(nothing by mouth), has a nasogastric tube in place, is receiving full-strength Isocal formula at 80ml/hr, and has an order to receive a liquid suspension medication.

How would you prepare this tube feeding?

What assessments and nursing considerations are important for patients who receive tube feedings? What complications should the nurse be aware of?

Before,

During,

and After  

Describe process for administering Ms. Round her liquid suspension medication

Answer 1

1 When different types of medications are administered,each type is given separetely using a bolus method that is compatible with the medications preparation.The tube is flushed with 30 to 50 ml of water after each dose and this fluid is recorded as intake.For liquid form no specific preparation is required.

2 A preliminary assessment of the patient who requires a tube feeding includes several considerations such as

• What is the patients nutritional status ,as judged by ciurrent physical appearance,dietary history,and history of recent weight loss?
• Are there any existing chronic illness or factors that will increase metabolic demands on the body?
• What is the patients hydration status?
• Are fluid requirements being met?
• Are the patients kidneys functioning normally?
• Does the dietary prescription fullfill the patients needs?

Nursing considerations

• Assess tube placement,patients position and formula flow rate.
• Determine the patients ability to tolerate the formula.
• Observe for signs of dehydration.
• Replace any formula administered by an open system evey 4 hours with fresh formula.
• Monitor intake output.
• Weigh the patient twice weekly.
• Change the tube feeding container and tubing every 24 to 72 hours.

3 Some of the potential complications associated with enteral nutrition are

• Mechanical complications include obstruction of the tube with medications or pills,irritation of or erosion into nasal or gastric tissue with the associated risk of bleeding,infection or perforation ,pulmonary injury during pacement and displacement of the tube with the associated risk of aspiration.To minimize these complications,tubes should be flushed frequently with water,tubes should be soft and well lubricated for insertion,and tube position should be verified before use.
• The risk of aspiration is decreased by postpyloric tube placement ,elevation of head of the bed,use of smaller feeding tubes,eliminatio of drugs that decrease lower esophageal sphincter tone and frequent checks of tube feeding residuals
• Frequent monitoring of blood glucoseand urine output and judicious use of blood and urine testing can detect these and lead to appropriate alterations in the feedings to prevent or treat these complications as they arise.

3During the administering of medications.

• Wash hands and wear gloves.
• Resecure and refix the tape holding the enteral feeding tube in position.
• Close any ports to ensure there is airtight seal.
• Check the position of the tube.
• Check whether the enteral feeding tube is patent by flushing it with 30 to 50 ml of water using a 50 ml oral,enteral or catheter tipped syringe.
• check the prescription of drug dose,route,frequency and site of administration.
• Draw the the requireddose of the suspension intoan approprite syringe and place the syringe in a clean reciever.
• Prepare a flush of water and label it .the tubes should be flushed ,before,during and after drug administration.
• Check the patients identity.Attach the syringe to the port on the enteral feeding tube and administer the flush ,then the suspension.
• Flush immediately with an appropriate amount of water and leave it clean and dry.