Enteral Nutrition

In-class Questions: Week 4 – NG Tube Placement and Enteral Nutrition

NG Tube Placement

• What is an NG tube?
• What are the 2 major actions that an NG tube facilitates?
• In what clinical situations might an NG tube be ordered?
• In what clinical situations should you question an order to place an NG tube?
• What does the order NPO indicate?
• What is the standard, evidence-based practice for verifying NG tube placement?
• What assessment(s) should you make before placing an NG tube? (measure length, assess nasal patency)
• What three points are used to measure NG tube length to be inserted?
• What position should the client be placed in for NG tube insertion?
• How should the nurse instruct the patient to help as the NG tube is inserted? (sip water and swallow)
• What item should the nurse use to ensure the NG tube is not displaced after insertion? (securement device)
• What should you document following NG tube insertion?
• What instruction should be given to the patient before the NG tube is removed? (inhale rapidly and hold your breath)
• Is NG tube placement or removal a sterile/aseptic technique?
• A client with an NG tube set to low intermittent suction is at risk for what common complication? (electrolyte disturbance/imbalance)

Enteral Feeding

• Where are nutrients from enteral nutrition absorbed?
• What position should the patient be in when receiving enteral feedings?
• What actions should be taken before initiating a tube feeding?
• What is the most common complication of enteral feeding that occurs when a NG tube becomes displaced? (Aspiration)
• What kinds of tubes are used to give feeding or medication via the enteral route? (NG, OG, gastric tube, GJ tube)
• What is the most common reason for medical errors while giving medication?
• What should you do if the NG tube is currently at a different length than what was documented previously?
• How long do you need to listen for bowel sounds before concluding they are absent?
• What should you do if you assess your patient and find absent bowel sounds?
• What should you do first if your tube feeding pump is alarming?
• What should you do before and after giving any medication through an enteral tube?
• What actions should you take regarding medications to prevent tube clogging? (have the physician change orders to liquid medications whenever possible)
• Who should you call to determine if a particular medication is safe to be crushed?
• How often are residuals checked in a patient receiving enteral nutrition?
• What is refeeding syndrome? (Refeeding syndrome can happen when somebody who is malnourished begins feeding again. Causes electrolyte disturbances…especially phosphate deficiency. It’s caused by low stores of certain micronutrients in your body. Your stores are low when you have been malnourished. The most common nutrients involved are phosphorus, potassium and magnesium. When you begin refeeding, your cells demand these electrolytes to metabolize the food. This causes a severe shift in your body chemistry. The electrolytes you have move rapidly from your blood into your cells. But because you don’t have enough, this shift leaves low levels of them in your blood.)
• What should the nurse do if the client reports abdominal cramping right after tube feeding starts?
• What should you document following medication administration through an enteral tube?
• What body systems should you focus assessment on for patients receiving enteral nutrition and/or medications?

Dosage Calc Review

Converting fluid ounces to mL (or mL to fl oz)

Title: In-class Questions: Week 4 – NG Tube Placement and Enteral Nutrition

Introduction:

In the realm of healthcare, the proper placement and management of nasogastric (NG) tubes and enteral nutrition are vital aspects of patient care. These procedures are commonly employed in various clinical settings to provide essential support to patients who are unable to consume food or medication orally. This essay will delve into the questions posed during Week 4, shedding light on the significance and practical aspects of NG tube placement and enteral nutrition.

NG Tube Placement:

1. What is an NG tube? An NG tube, short for nasogastric tube, is a flexible tube inserted through the patient’s nose and down into the stomach. It is used for various medical purposes, including feeding and medication administration.
2. What are the two major actions that an NG tube facilitates? An NG tube primarily enables enteral feeding, which involves providing nutrients directly into the stomach, and medication administration via the same route.
3. In what clinical situations might an NG tube be ordered? NG tubes are commonly ordered in situations where a patient cannot ingest food or medication orally, such as after surgery, during critical illness, or when there is an obstruction in the digestive tract.
4. In what clinical situations should you question an order to place an NG tube? It is crucial to question NG tube orders in cases where alternative methods of nutrition or medication administration may be more appropriate, and when the potential benefits and risks of tube placement need careful consideration.
5. What does the order NPO indicate? The abbreviation NPO stands for “nil per os,” which means nothing by mouth. When a patient is ordered to be NPO, they should abstain from eating or drinking anything orally.
6. What is the standard, evidence-based practice for verifying NG tube placement? The gold standard for verifying NG tube placement is to perform an X-ray to confirm that the tube is in the stomach. Aspirating gastric contents and testing the pH level can also be used in conjunction with X-ray confirmation.
7. What assessment(s) should you make before placing an NG tube? (measure length, assess nasal patency) Prior to NG tube insertion, it is essential to assess the patient’s nasal patency to ensure clear passage for the tube. Measuring the correct length of insertion is also crucial to avoid complications.
8. What three points are used to measure NG tube length to be inserted? The three points used to measure NG tube length are the nose, ear, and the xiphoid process or the midpoint between the xiphoid process and the umbilicus.
9. What position should the client be placed in for NG tube insertion? The client should be in a semi-Fowler’s position (sitting up at a 30-45 degree angle) during NG tube insertion to facilitate tube passage into the stomach.
10. How should the nurse instruct the patient to help as the NG tube is inserted? (sip water and swallow) The nurse should instruct the patient to sip water and swallow during NG tube insertion to assist in guiding the tube down the esophagus and into the stomach.
11. What item should the nurse use to ensure the NG tube is not displaced after insertion? (securement device) To prevent displacement, a securement device (often adhesive tape or commercial securement devices) should be used to fasten the NG tube securely to the patient’s nose.
12. What should you document following NG tube insertion? Following NG tube insertion, it is essential to document the date and time of placement, the length of insertion, the method of verification, and any patient response or discomfort.
13. What instruction should be given to the patient before the NG tube is removed? (inhale rapidly and hold your breath) Patients should be instructed to take a deep breath and hold it as the NG tube is removed to minimize discomfort and prevent the tube from coiling in the esophagus.
14. Is NG tube placement or removal a sterile/aseptic technique? NG tube placement and removal are not typically considered sterile procedures; however, aseptic technique should be maintained to reduce the risk of infection.
15. A client with an NG tube set to low intermittent suction is at risk for what common complication? (electrolyte disturbance/imbalance) Clients with NG tubes on low intermittent suction are at risk of developing electrolyte imbalances, particularly hypokalemia, due to continuous removal of gastric contents.

Enteral Feeding:

1. Where are nutrients from enteral nutrition absorbed? Nutrients from enteral nutrition are primarily absorbed in the small intestine, specifically in the jejunum and ileum.
2. What position should the patient be in when receiving enteral feedings? Patients should be positioned in an upright or semi-Fowler’s position to prevent aspiration and facilitate proper digestion.
3. What actions should be taken before initiating a tube feeding? Before starting tube feeding, it is essential to check tube placement, assess residual volume, flush the tube with water, and verify the order and formula to be administered.
4. What is the most common complication of enteral feeding that occurs when an NG tube becomes displaced? (Aspiration) The most common complication of enteral feeding when an NG tube becomes displaced is aspiration, which can lead to respiratory distress and pneumonia.
5. What kinds of tubes are used to give feeding or medication via the enteral route? (NG, OG, gastric tube, GJ tube) Various types of tubes are used for enteral feeding or medication administration, including NG tubes, OG tubes (orogastric), gastric tubes, and GJ tubes (gastrojejunal).
6. What is the most common reason for medical errors while giving medication? The most common reason for medication errors during enteral tube medication administration is improper crushing or administration of medications not meant to be crushed.
7. What should you do if the NG tube is currently at a different length than what was documented previously? If the NG tube length is different from the previous documentation, it should be carefully measured and adjusted to the appropriate length, considering the potential displacement.
8. How long do you need to listen for bowel sounds before concluding they are absent? Bowel sounds should be auscultated for at least 5 minutes in each quadrant before determining that they are absent.
9. What should you do if you assess your patient and find absent bowel sounds? If bowel sounds are absent, the nurse should notify the healthcare provider and document the findings. It may indicate a potential complication that requires further evaluation.
10. What should you do first if your tube feeding pump is alarming? If the tube feeding pump is alarming, the nurse should assess the patient and the pump, ensuring there are no obstructions in the tubing, and verify that the formula is flowing properly.
11. What should you do before and after giving any medication through an enteral tube? Before and after administering medication through an enteral tube, the nurse should flush the tube with water to ensure the medication is properly delivered and to prevent clogging.
12. **What actions should you take regarding medications to prevent tube clogging? (have the physician change orders to liquid medications whenever possible)