After completing the chapter, you will be able to accomplish the following:

1. Assist a patient with eating.
2. Confirm placement of a nasogastric feeding tube.
3. Administer a tube feeding.
4. Care for a gastrostomy tube.

• Assessment
• Clinical Decision Making/Clinical Judgment
• Nutrition
• Safety

• aspiration
• calories
• dysphagia
• gastrostomy tube
• jejunostomy tube
• nutrients
• nutrition
• percutaneous endoscopic gastrostomy (PEG) tube
• percutaneous endoscopic jejunostomy (PEJ) tube

Good nutrition is vital for life and health. Important nutrients, found in food, are needed for the body to function. A varied diet is necessary to provide all of the essential nutrients that a person needs. Poor nutrition can seriously decrease a person's level of wellness. An adequate diet provides a balanced intake of all essential nutrients in appropriate amounts. Details related to appropriate dietary intake can be found in the Dietary Guidelines for Americans 2020-2025 at https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials. Refer to information found in Fundamentals of Nursing, 10th edition, or a nutrition text for details related to sources, functions, and significance of carbohydrates, protein, and fat. Nurses incorporate nutrition into all aspects of thoughtful person-centered nursing care and are involved in all aspects of nutritional care.

Because of the significant influence that adequate nutrition plays in restoring and maintaining health and disease prevention, the nurse integrates nutritional assessment into the care of the patient (Fundamentals Review 11-1). Factors that may affect nutritional status are discussed in Fundamentals Review 11-2.

This chapter addresses skills necessary to care for patients with nutritional needs, including assisting a patient with eating, confirming the placement of a feeding tube, administering a tube feeding, and caring for a gastrostomy feeding tube. Nasogastric tubes are also used to decompress or to drain unwanted fluid and air from the stomach, monitor bleeding in the gastrointestinal (GI) tract, to remove undesirable substances (lavage), or to help treat an intestinal obstruction. Insertion and removal of nasogastric tubes for feeding and any of these other purposes is accomplished using essentially the same procedure and is discussed in Chapter 13.

1. Explore the patient's usual food preferences and habits. Choose foods that the patient prefers from facility menus. In addition, encourage Ms. Williams' family/caregivers to bring favorite foods from home. Food choices should focus on foods that are easy to eat and nutrient dense. Provide rest periods before mealtimes, so she is not overly tired. Assist the patient to a comfortable position for meals, help her with hand hygiene, and ensure she has clean dentures in place, and her glasses, as appropriate. Encourage her family/caregivers to visit during mealtimes, to provide as normal a social environment as possible. Cut food and open packages as necessary, to limit the amount of exertion by the patient. Suggest she eat small portions, keeping some food items to snack on as the day progresses. Frequent small servings are not as tiring. Allow enough time for the patient to chew and swallow the food adequately. The patient may need to rest for short periods during eating. If Ms. Williams is agreeable, feed her a portion of the meal, to avoid overtiring.
2. Assess the patient's level of comfort every 4 hours and PRN. Offer analgesic as prescribed. Offer oral hygiene at least every 4 hours or more often. Discuss the potential for topical analgesic, such as analgesic throat spray, with the health care team. Reassess pain after interventions. Assess the patient's oral and nasal mucous membranes, as well as nasal skin, at least every shift. Ensure the device anchoring the tube is not pulled taut, creating pressure on the nose. Resecure the NG tube with new commercially prepared device or tape every 24 hours; clean skin thoroughly and apply skin barrier. Resecure in a slightly different position to prevent excessive pressure in one area of nostril.
3. Patients who are caring for a gastrostomy tube at home should understand the care of the tube, tube site, nutritional feeding routine, and potential adverse effects, with the accompanying actions. Provide Cole and his family/caregivers with the date his tube was placed, the procedure used to place the tube, the tube size, how the tube is anchored, and the calibration measurement at skin level or the length of the external tube. Discuss, provide written information, and obtain a return demonstration for the care of the tube and tube site, as well as the feeding procedure. Teaching should include the formula type, frequency, rate of infusion, checking tube placement, and checking gastric residual, based on prescribed therapeutic regimen. Review infection control measures, such as handwashing before starting, refrigerating formula between use, disposing of unused formula after 24 hours, and measuring out only 4 hours of formula at a time. The length of the tube or calibration mark at the skin should be checked prior to each feeding or use of the tube. Cole should be in a sitting position for the feeding and for 1 hour afterward. Skin care for tube site includes washing the area with the cleansing agent identified by the health care team, rinsing, and patting dry. Cole should assess the site daily for swelling, redness, and drainage. Cole and his family/caregivers should verbalize an understanding of these instructions, as well as a knowledge of signs and symptoms that should be communicated to the health care team. These include the presence of nausea or vomiting, pain, and fever. Cole and his family/caregivers should also understand proper procedure if the gastrostomy tube should come out or become dislodged.