Oo IIS Posse! Ar Molloy College NUR 209: Enteral Feeding Module Student Name: Gorohdlle Rui rotor: cl Dat 44 [5/20 ____— ab Instructor: Gse- Vase She D> Pp NUTRITIO: ISTROSTOMY, OR JEJUNOSTOMY TUB! WA GA R | Goal: E Provide enteral nutrition for patients who cannot swallow or Pir who have an esophageal obstruction STUDENT Ale «Provide nutrition to comatose or semicansciaus patients EXPECTATIONS S |s «Provide additional nutrients for patients who cannot orally — S |r consume adequate calor = INTERMITTENT, AND CONTINUOUS STUDENT INITIAL STEPS FOR BOLUS, INTERNE OE 1. Verbalize the Critical Elements: Side to demonstrate a. Gather supplies after verifying orders the procedire peony a b. Perform hand hygiene & don gloves if needed p i, Shadeat to ¢. Introduce self & identify patient using two identifiers eee eine 4. Explain the procedure to the patient Oe ne of f. Provide privacy and prepare environment = pe | f Document procedure and patient response as indicated : | A 2, Review chart for food allergies and provider's order for type, ‘amount, rate, route, and frequency of feeding, vo Semi-Fowler’s position by elevating head of bed at | Rationale: right side grees or assisting 1 a chair (High Fowler's 90 degrees). | —_ lying helps facilitate ‘or patient is unconscious, help | digestion to empty stomach. 3. Help patient least 30 to 45 de; If-an upright position is contraindicated patient to aright side-lying position with head elevated 30 degrees. \ When gathering supplies, verbalize the difference between Salem Sump and Levin Tubes. 4, Verbalize placement of tube via the following: a. Initial X-ray ’ Markings on the tube c. Aspiration to test pH using litmus paper if available (ph <5) Student should don clean gloves J 5. Check GRVs (Gastric Residual Volume) while wearing clean Student to verbalize the gloves by attaching a 60 mL (piston) syringe to the nasogastric tube. need to notify provider if. GRV exceeds 500 mL and to hold feeding. / ‘a Replace all gastric contents after residual check. (Flush with 30-60 mL of warm tap water/sterile water as per agency policy.) Reference: Craven, R. Hirnle, C., & Henshaw, J. (2021) Fundamentals of nursing: Concepts & competencies for practice. = (9th Ed.) Philadelphia, PA: Lippincott.Molt olloy College NUR 209: Enteral Feeding Module 6. Prepare corr ect amount . Toom temperature, and strength of formula, Formula should be ‘Student to verbalize that they have checked expiration date BOLUS OR INTERMITTENT FEEDING STUDENT EXPECTATIONS. 7. Remove ph a plunger fi i : tubing and tack oye iat (ison) sings. Clamp esi ‘Student to demonstrate using irrigation (piston) syringe. ail Fi imigatin (Piston) syringe with formula. Allow feeding to flow in stowly (10 15 minutes.) Raise or lower syringe to adjust flow rate by sy Ral ill syringe as needed without disconnecting, avoiding air m came bing ust a edn is completing ins be with 301060 water/sterile wat : i i taane fater as per agency policy. Do not allow air 10. Clamp gastric tube and disconnect from syringe. 1. Have patient remain in Fowler's or elevated side-lying position for 30-60 minutes after feeding. = AS 12, Label and clean reusable equipment according to agency policy. 13, Discard clean gloves and perform hand hygiene. 14, Document appropriately. STUDENT CONTINUOUS FEEDING EXPECTATIONS. Follow steps 1-6 7. Close roller clamp on feeding bag tubing, Pour in desired amount of formula. (Note: Hang no more than 3-4 hours worth of formula; check agency policy). Place label on bag with patient's name, date, formula and time feeding was initiated F &. Hang feeding bag on IV pole and open roller clamp tubing. Allow formula to flow through bag and tubing. ‘Student to demonstrate 9, Connect tubing to infusion pump and set rate and volume ordered by provider. programming rate and volume on the Kangaroo pump as prescribed on prewritten provider order. L Reference: Craven, R. Hirnle, C., & Henshaw, J. (2021) Fundamentals of nursing: Concepts & competencies for practice. (9th Ed.) Philadelphia, PA: Lippincott. 2— 10. Connect feeding bag tubing to patient's feeding tube and start pump. Molloy College NUR 209: Enteral Feeding Module mL of warm tap water/sterile water as per agency policy. 11. Patients receiving continuous feedings should have gastric residuals | Snedent to verbalize the checked every 4 to 6 hours, according to agency policy. After checking | need to notify provider if residual and replacing stomach content, fash the tubing with 30to 60. | GRV exceeds 500 ml. and to hold feeding. 30-60 minutes after the discontinuation of the feeding. i ie i i ior to patient lying position for the duration of the continuous feeding/or for at least. | minutes prior 10 Pt Hold feeding and wait 30 position change to prevent / 12. Have patient remain in Semi to High Fowler's or elevated side- aspiration. 13. Label and clean reusable equipment according to agency policy. 14, Discard gloves and perform hand hygiene. {__| 15. Document appropriately. Reference: Craven, R. Hirnle, C., & Henshaw, J. (2021) Fundamentals of nursing: Concepts & competencies for practice. Zz (9th Ed.) Philadelphia, PA: Lippincott.