Ati Review 6j6rr

GI ATI

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BY: Saidel Elizondo

Enteral Feeding Tube   Delivery of a nutritionally complete feeding directly into the stomach, duodenum, or jejunum  Used for total feeding as supplementation for poor oral intake  3 types  Small-bore nasogastric feeding tube  Small-bore nasointestinal/jejunostomy tube  Percutaneous endoscopic gastrostomy (PEG)

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Checking for placement   Auscultating for placement is NOT considered reliable  Use an x-ray to initial placement of the nasogastric or nasointestinal tube  Gastric PH 1.5-4  Intestinal PH 6  Respiratory PH > 7  hold/stop feeding if residual >100 ml for intermittent or continuous feeding; do Not return residual

Small-bore nasogastric feeding tube

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 X-ray for placement  Check PH before feeding or every 4 hours on continuous feeding  Maintain semi-fowler while feeding  Replace tube every 4 weeks

Small-bore nasointestinal/jejunostomy tube

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 Used to provide nourishment or to remove gas and liquid drainage  X-ray  Assess length  Check residual volume greater indicates upward migration

 Ph 6  Maintain semi-fowler

complications      

Refeeding syndrome can be life-threatening Bleeding Infection Abdominal distention: N/V/D constipation Hyponatremia, hyperkalemia

PEG tube

 Assess  skin integrity  Residual volume  Allow feeding to infuse slowly ( by gravity)  Flush with 30 ml warm water before and after feeding  Maintain Semi-Fowler’s position 1 to 2 hr after feeding

Parenteral Nutrition

  IV istration hypertonic intravenous solution (glucose, insulin, minerals, lipids, electrolytes, and other essential nutrients)  2 types  Partial and total

Partial or Peripheral nutrition (PPN)

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 Used client cannot take enough nutrients  PICC line or large distal arm vein

Total parenteral nutrition (TPN)

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 intensive nutritional for extended periods of time  Central vein (can ister high levels of glucose)  Used for solutions that contain hypertonic glucose and amino acids, composed of dextrose  Used with non-functioning GI tracts and those who are NPO for >7days

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Contributing factors

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Severe burns Chronic pancreatitis GI mobility disorders Short bowel syndrome Malabsorption disorders

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Nursing interventions

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Monitor for infection from central line Dressing change requires strict surgical asepsis every 27 hrs Monitor for signs of systemic infection (aches, chills, fever, nausea, vomiting, weakness) Keep 10% dextrose/water available Prevent air embolism Change tubing every 24 hours Monitor glucose, electrolytes, fluid balance Monitor for fat overload syndrome (fat emulsions) Fever, increased triglycerides, clotting problems and multisystem organ failure, discontinue infusion and notify provider immediately **Must be weaned off before discontinuing** 

Resources   Axley, L. (2013). The comprehensive NCLEXRN review. Leawood, KS: ATI Nursing Education.