How often should a gastric pH be tested for NG tubes
every 4 hours for continuous feeding or before every feeding
nursing considerations for Small-bore NG feeding tubes
- obtain an x-ray to determine placement
- Maintain Semi-fowler’s position while feeding is infusing
- Assess residual in the stomach and refeed the residual unless it exceeds the maximum
- provide nose and mouth care
- replace tube every 4 weeks
What should a nurse do if the residual exceeds 100mL for intermittent feedings or 2 hours of continuous feeding?
Hold or stop the feeding; DO NOT refeed aspirate; notify the provider
Nursing Considerations for PEG
- assess skin integrity
- Assess residual volume
- allow feeding to infuse slowly (raise/lower syringe)
- flush with 30 mL warm water before and after feeding
- Maintain semi-Fowler’s position 1-2 hours after feeding
What is Parenteral Nutrition?
IV administration of a hypertonic IV solution made up of glucose, insulin, minerals, lipids, electrolytes, and other essential nutrients. Used when the client cannot effectively use the GI tract for nutrition
PPN
- Partial or Peripheral Parenteral Nutrition
- Used when a client can eat, but cannot take in enough nutrients to meet needs
- Administered through a large distal arm vein or PICC line (given “peripherally”)
TPN
- Total Parenteral Nutrition
- Used when the client requires intensive nutritional support for an extended time period
- Delivered through a Central vein
What contributing factors could cause the need for parenteral nutrition?
- GI mobility disorders
- inability to achieve or maintain adequate nutrition for body requirements
- Short bowel syndrome
- Chronic pancreatitis
- Severe burns
- Malabsorption disorders
Nursing interventions for parenteral nutrition
- confirm placement by chest x-ray
- monitor Central line insertion site for local infection
- Maintain strict surgical asepsis for dressing change (every 72 hours)
- Change tubing and remaining TPN every 24 hours
- Monitor for signs of systemic infection
- Monitor glucose, electrolytes, and fluid balance
- prevent air embolism
- use the infusion pump
- keep 10% dextrose/water available
- For clients receiving fat emulsions, monitor for fat overload syndrome
What are the sx of fat overload syndrome?
- fever
- increased triglycerides
- clotting problems
- multisystem organ failure
