Page 421 - Nutrition Essentials for Nursing Practice
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C H A P T E R 1 5 Feeding Patients: Oral Diets and Enteral and Parenteral Nutrition 409
Table 15.7 Troubleshooting Nutrition-Related Problems in Tube-Fed Patients
Potential Problem Rationale Nursing Interventions and Considerations
Aspiration Feeding infused into the lung Confirm proper placement of the feeding tube
Gastroesophageal reflux by radiograph prior to initiating a feeding.
Diarrhea
Impaired cough reflex Elevate the bed’s headboard 30–45 degrees
Nausea (Discontinue the Delayed gastric emptying during feeding and for approximately
feeding. Administer Infusion of a formula that is too 1 hour afterward.
antiemetics if ordered
by the physician.) cold Consider a nasointestinal or jejunostomy
Bacterially contaminated formula feeding.
Distention and bloating
Feeding rate too rapid Monitor gastric residuals.
Switch to a continuous drip delivery method.
Volume of formula too great
Side effect of antibiotics or other Give canned formulas at room temperature.
Warm refrigerated formulas to room tempera-
medications
Malplacement of feeding tube ture in a basin of warm water.
Feeding rate too rapid
Volume of formula too great → Follow handwashing and sanitation protocol.
Refrigerate unused formula promptly.
delayed gastric emptying Discard opened cans within 24 hours.
Flush the tubing as per protocol.
Feeding too soon after intubation Hang formulas for less than 6 hours.
Anxiety Change extension tubing every 24 hours.
Initiate and advance feedings as per protocol.
Intolerance to a specific formula,
especially high-fat formulas For existing feedings, decrease the rate to the
level tolerated and then advance at half the
High-fat content of formula original increment (e.g., 12 mL/hour instead
Decrease in gastrointestinal of 25 mL/hour).
function, especially among Feed smaller volumes more frequently or
critically ill clients switch to continuous drip method.
Consider a high-calorie formula if problem
persists.
Investigate drugs used for possible causes/
possible alternatives.
Administer antidiarrheals as ordered.
Check the position of the tube.
Slow the rate of feeding; switch to a
continuous drip method of delivery.
Check gastric residual and notify the
physician if Ͼ100 mL.
Reduce the volume and then increase gradually.
If distention is contributing to nausea,
encourage ambulation.
Allow approximately 1 hour between
intubation and the first feeding.
Explain the procedures to the client and
encourage questions.
Allow client to verbalize his/her feelings;
provide emotional support.
Switch to a different formula.
Switch to lower-fat formula.
Check for active bowel sounds; switch to a
hydrolyzed formula if bowel sounds are
hypoactive.
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