Page 422 - Nutrition Essentials for Nursing Practice
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410 U N I T 3 Nutrition in Clinical Practice
Table 15.7 Troubleshooting Nutrition-Related Problems in Tube-Fed Patients (continued)
Potential Problem Rationale Nursing Interventions and Considerations
Dehydration Excessive protein intake → com- Switch to a formula with less protein; increase
Fluid overload pensatory increase in urine water intake, if possible.
Constipation output to excrete nitrogenous
Gastric rupture wastes Provide additional water.
Clogged tube Test for glucose in the urine; notify physician
Inadequate fluid intake
Anxiety Glycosuria (glucose in urine) of glycosuria of 3ϩ or 4ϩ.
Administer insulin if ordered by physician.
Excessive use of water to flush Switch to a continuous drip method to avoid
tube
giving a high-carbohydrate load with each
Formula too dilute feeding.
Low residue content of formula
Use only 30–50 mL of water to rinse tubing
Inactivity after each feeding.
Dehydration
Check formula preparation for proper
Obstruction dilution.
Dangerous retention of feeding
Increase residue content if appropriate
in the stomach related to gas- (i.e., change to a formula with added fiber
tric atony or obstruction or increase fruits and vegetables in a
blenderized diet).
Feeding heated formulas
Improper cleaning of tube Encourage ambulation as much as possible.
Deprivation of food → lack of Monitor intake and output; add free water
sensory, social, and cultural if intake is not greater than output by
satisfaction from eating 500–1000 mL.
Stop feeding and notify physician.
Check for residual before beginning each
feeding; observe for signs of impending
gastric rupture: distention, epigastric and
upper quadrant pain, nausea, a large
residual; if observed, discontinue feeding
immediately and notify the physician.
Do not heat formula.
Replace the feeding tube and bag every
12–24 hours.
Flush the tube before and after each
infusion (regardless of method) with
30–50 mL of water; if flushing fails to
remove clog, the tube must be removed
and replaced.
High-viscosity formulas (i.e., blenderized tube
feedings or commercial formulas that
provide 1.5–2 cal/mL) should be infused by
pump and possibly through a large-bore
feeding tube to prevent clogging.
If possible, consider switching to a less
calorically dense formula.
Because it is desirable to use the smallest size
tube, viscous formulas may be delivered by
a pump to help prevent clogging.
Allow oral intake of food that the client
requests, if possible; if oral intake is contra-
indicated, allow the client to chew his/her
favorite food without swallowing.
If possible, liquefy and add the client’s
favorite food to the tube feeding.
