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Nursing Management
Feeding preparations
To
prepare for an enteral feeding the nurse should pour the formula into the pouch
and verify the feeding tube position by auscultating during injection of air
the resident’s head should be elevated 30 if possible and the delivered tubing
should be attached to the feeding tube. At the end of feeding tube the tube
should be flushed with 30 to 60 ml of water and the pouch and tubing should be
washed thoroughly.
NURSING CARE PLAN
The nursing care plan should focus on
stabilizing and improving the resident’s nutrition status. More over the
complications of enteral feeding should be avoided. In addition, the nurse
should help the resident to achieve as much independence as possible in
delivering feedings.
NURSING IMPLEMENTATION
The nurse should, in consultation
with the physician and dietitian, regularly evaluate the resident, the success
of the enteral feeding program, and the resident’s ability to accept oral
feeding. In addition, the nurse is usually responsible for the following
interventions
.
Placing the tube
.
Maintaining the tube
.
Administering formula
.
Monitoring resident’s response t
o feedings
TUBE
SELECTION
Smaller
tubes are more comfortable and may cause less nasal trauma. Larger tubes may be
necessary if the formula is thick or does not flow easily, but a tube measuring
14 F should not be used. Moreover, tubes made of “nonreactive “ materials such
as silicone or polyurethane rubber should be used for optimal comfort
flexibility.
TUBE
INSERTION
An NG tube should be measured before
insertion by extending it from the bridge of the resident’s nose down to the
bridge of the resident’s nose down to the xiphoid process. The nurse should
estimate the length will vary among each resident Once the tube has been
placed, its position can be checked by injecting air through the tube while
ausculatiing with a stethoscope.Gastrostomy
tubes are usually inserted by a physician The nurse should teach the patient
about the procedure and describe the feedings to be administered.
CARE
OF INSERTED TUBES
Care
of the enteral feeding tubes is important, since infection and tube
displacement may occur. The skin around the tube should be cleaned every day.
The tape should be replaced whenever it becomes loosened or soiled, as
prevention of tube dislodgement is important. In indication the nurse should
carefully observe the tube for leaks, cracks or tears.Dressing
that are used, around gastrostomy sites should be changed and cleansed daily.
Karaya powder may be used to protect skin from leakage of gastric juices from
the gastrostomy site
MANAGEMENT OF
COMPLICATIONS
Complications
of enteral feedings may include the following:
.
Pulmonary aspiration - Diarrhea
.
Fluid volume deficit or excess
- Metabolic derangements
Hyperglycemia -
Electrolyte imbalances
Most
of these complications can be managed through the following nursing
interventions:
.
Observation of food placement -
Tube maintenance
.
Proper method of formula delivery -
Frequent assessment of status an d
response to feeding
.
Monitoring of physical and - Laboratory
data
. Consultation with
physician and dietitian
It is important, to remember not to
administer medications through the enteral tube if possible as these may clog
the tube. It may be possible to administer some medications if they are
prepared in fluid form.
SUMMARY
Enteral
feeding are usually, administered to individuals whose nutrition is,
compromised ad whose digestive tracts are able to absorb nutrients. The nurse,
who has a great deal of responsibility in the administration of enteral
feedings, should carefully observe the resident for a change in status and
nutrition level.
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