N105: Essentials of Nursing Care - Health Differences

Essentials of Nursing Study Guide

Principles for Administering a Tube Feeding Position the client in an eating position, the semi-Fowler’s position on the right side, to promote the flow into the GI tract and to prevent aspiration into the lungs. There are three types of enteral feeding: intermittent feeding, the use of a feeding bag or a pre-filled plastic bottle with a drip chamber (closed system), and a continuous enteral feeding pump (Kangaroo feeding pump). An intermittent feeding will last approximately 30 minutes. For continuous infusions, the tubing should be clamped every 4- 6 hours to measure the residual and verify tubing placement. Feeding solutions should not hang for more than 4-6 hours to prevent bacterial growth. Water is an important element to be included in the patient’s intake as it prevents dehydration from feedings (hyperosmolar solution). Monitor patient tolerance including respirations and abdominal cramping. Allow the fluid to flow slowly or by gravity and stop the flow for a minute or more if the patient has any difficulty. When completed, instill 50- 100ml water while preventing excess air from infusing to prevent obstruction. Principles for Administering a Gastrostomy or Jejunostomy Feeding: Flush the tube with only 15-30ml of water so the residual is approximately 50ml prior to feeding. Hold the feeding if the residual is 100ml. Instillation of the feeding is done by hand using a 60ml syringe and pouring the feeding into the syringe, while holding it no more than 12 inches above the stoma/tubing connection. Assessment includes: • auscultating bowel sounds every 4-8 hours to ensure intestinal activity • assessing for presence or absence of regurgitation after feedings • noting abdominal distension, which may indicate intolerance to the solution (measure girth) • lack of bulk in the feedings can cause constipation and concentrated solutions can cause diarrhea • monitor serum for Hct, BUN and sodium • monitor urine specific gravity and for sugar and acetone; these serum and urine indicators can point to imbalances in protein and fluid intake causing risk to the kidneys • assess elimination pattern, urine output, skin turgor, and weight (gain/loss) over time

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