Chapter 28

Enteral Nutrition and

Intravenous Therapy

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 Nutritional Support
 The doctor may order nutritional support or IV
therapy to meet food and fluid needs for:
 Clients who cannot eat or drink because of illness,
surgery, or injury
 Clients who have problems eating or refuse to eat
or drink
 Clients who cannot eat enough to meet their
nutritional needs
 Gavage (tube feeding)

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 Enteral Nutrition (1 of 7)
 Enteral nutrition is giving nutrients into the
gastro-intestinal tract through a feeding tube.
 Nasogastric (NG) tube
• A feeding tube is inserted through the nose into the
stomach.
 Nasointestinal tube
• A feeding tube is inserted through the nose into the small
intestine.
 Gastrostomy tube (stomach tube)
• A doctor surgically creates an opening in the stomach.
• It is also known as a G-tube.

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Enteral Nutrition (2 of 7)

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Enteral Nutrition (3 of 7)

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Slide 5
Enteral Nutrition (4 of 7)

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 Enteral Nutrition (5 of 7)
 Jejunostomy tube
• A feeding tube is inserted into a surgically created
opening in the jejunum of the small intestine .
• Also known as a J tube
 Gastro-jejunostomy
• A tube connects the stomach to the small intestine.
• It is also known as a GJ-tube
 Percutaneous endoscopic gastrostomy (PEG)
tube
• The doctor inserts the feeding tube using an endoscope.

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Enteral Nutrition (6 of 7)

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Enteral Nutrition (7 of 7)

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 Scheduled and Continuous
Feedings (1 of 2)
 Formulas
 The doctor orders the type of formula, the amount
to give, and when to give tube feeding.
 A nurse gives the formula through the feeding
tube.
 Formula is given at room temperature.
 In some facilities, formula is kept cold with ice
chips around the container to prevent growth of
microbes.

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 Scheduled and Continuous
Feedings (2 of 2)
 Scheduled feedings (intermittent feedings)
are given at certain times—usually 4 times
per day.
 Continuous feedings are given over a 24-hour
period.
• A feeding pump is used (nasointestinal and jejunostomy
tube feedings are always continuous)

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 Preventing Problems Related to
Tube Feedings (1 of 2)
 Preventing Aspiration
 Aspiration is a major risk from tube feedings, and
can occur:
• During insertion
• From the tube moving out of place
• From regurgitation

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 Preventing Problems Related to
Tube Feedings (2 of 2)
 Preventing Aspiration
 To assist the nurse in preventing regurgitation and
aspiration:
• Position the person in a sitting or semi-Fowler’s position
before the feeding. Follow the care plan and the nurse’s
directions.
• Maintain the client in this position for 1 to 2 hours after
the feeding. Follow the care plan and the nurse’s
directions.
• Avoid the left side-lying position, as it prevents emptying
of the stomach.

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 Signs of Aspiration
 Aspiration is the inhalation of fluid or object
into the lungs.
 Can cause infection and breathing problems
 Indicated by:
• Coughing or choking during feeding
• Change in breathing from normal to difficult
• Wet gurgly voice
• Pale or bluish lips
 Stop feeding if aspiration occurs, ensure the client
is in sitting-up position, and call for help.

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Other Potential Problems Related
to Tube Feeding (1 of 2)
 Report the following observations at once:
 Nausea
 Discomfort during the feeding
 Vomiting
 Distended abdomen
 Coughing
 Complaints of indigestion or heartburn

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Other Potential Problems Related
to Tube Feeding (2 of 2)
 Report the following observations at once:
(cont.)
 Redness, swelling, drainage, odour, or pain at the
ostomy site
 Fever
 Signs and symptoms of respiratory distress
 Increased pulse rate
 Complaints of flatulence
 Diarrhea

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 Comfort Measures for Tube
Feeding (1 of 2)
 Clients with feeding tubes usually are not
allowed to eat or drink (NPO).
 Dry mouth, dry lips, and sore throat can cause
discomfort.
 Feeding tubes can:
 Irritate and cause pressure on the nose
 Change the shape of the nostrils
 Cause pressure ulcers
 You are never responsible for inserting
feeding tubes or checking their placement.
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 Comfort Measures for Tube
Feeding (2 of 2)
 If allowed, client can suck on hard candy or
chew gum (dry mouth and lips).
 Require frequent oral hygiene, and lubricant
for lips.
 Ice bag is applied externally to throat to
provide relief for sore throat.
 Tube holders are used to prevent pressure on
nose.
 Check care plan and consult supervisor

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 Intravenous Therapy (1 of 3)
 Intravenous (IV) therapy (IV infusion) is giving
fluids through a needle or catheter inserted
into a vein,
 Doctors order IV therapy to:
• Provide fluids when they cannot be taken by mouth
• Replace minerals and vitamins lost because of illness or
injury
• Provide sugar for energy
• Give medication and blood
• Provide hyperalimentation—solution is highly
concentrated in nutrients

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 Intravenous Therapy (2 of 3)
 Nurses are responsible for IV therapy.
 IV therapy is given in hospital, outpatient
care, subacute care, long-term care, and
home care settings.
 Laws and institutional guidelines vary
regarding the role of others in IV therapy.
 Know your employer’s policies related to your
role in IV therapy.

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 Intravenous Therapy (3 of 3)
 Peripheral and central venous sites are used.
 Peripheral IV sites are away from the centre of the
body.
 Central IV sites are close to the heart.
• The subclavian vein and the internal jugular vein are central
venous sites.
• The cephalic and basilic veins in the arm also are used.
 Catheters inserted into these sites are called peripherally
inserted central catheters (PICCs)—only doctors or
specially trained nurses can insert PICCs.
 Central venous sites are used for:
• Giving large amounts of fluid
• Long-term IV therapy
• Giving medications that irritate peripheral veins
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 Assisting With IV Therapy
 The most common IV site is the lower arm or
back of the hand.
 See Box 28.1: Safety Measures for Intravenous Therapy (p.
631)
 As a support worker, you help meet the
hygiene and activity needs of clients who are
receiving IV therapy.
 Seek assistance regarding the proper way to
ambulate safely for clients with an IV line.

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 Subcutaneous Infusion Therapy
 Those who need frequent injections may
experience discomfort and possible infections
around injection sites.
 Medication is given through a port (needle) which
is inserted into the client’s subcutaneous tissue
layer.
 IV tubing is connected to injection port then taped to
client’s skin.
 Ensure port or needle does not become
dislodged.

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IV Therapy Complications (1 of 2)
 Report all observations.
 Local—at the IV site:
• Bleeding
• Puffiness or swelling
• Pale or reddened skin
• Complaints of pain at or above the IV site
• Hot or cold skin near the site
• Leaking of fluid from the site

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IV Therapy Complications (2 of 2)
 Systemic—involving the entire body
• Fever
• Itching
• Drop in blood pressure
• Tachycardia (pulse rate more than 100 beats per minute); irregular
pulse
• Cyanosis
• Changes in mental function; loss of consciousness
• Difficulty breathing (dyspnea); shortness of breath
• Decreasing or no urine output
• Chest pain
• Nausea
• Confusion

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