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Enteral feeding

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Subido el 12 de febrero de 2018 por Mercedes C.

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This skill is enteral feedings. This is a skill that we have to do for people that cannot 00:00:04
eat by mouth and usually it's long term when we're doing the gastrostomy tube. You can 00:00:09
also do it by the nasal gastric tube, but since most of our folks in the nursing centers 00:00:13
where we'll be going this semester are gastrostomy tubes, then we're going to be doing it through 00:00:17
the gastrostomy tube. The first thing you want to do is check the chart again and you're 00:00:22
looking to see what type of formula, is it full strength, the amount, the time, the frequency 00:00:26
of it. Also, you want to look and see how they've been tolerating it before, because 00:00:31
if they've had issues with residual as far as how much was left in their stomach before 00:00:35
you start the feeding each time, then you might want to take and be extra careful about 00:00:40
what you give them and how you assess them. Not that we wouldn't be careful anyway. Once 00:00:45
I get through with the chart again, I've checked the allergies, worried about latex again, 00:00:49
I'm worried about food allergies. In this case, we're going to give Ensure, and we're 00:00:52
going to give 50 milliliters of Ensure this time when we come down. And sometimes the 00:00:56
The doc will order specific water, when we should give water and how much. 00:01:00
So you always want to look at that also. 00:01:05
Okay, now you want to go and wash your hands and gather your supplies. 00:01:07
We're going to use a stethoscope because we may need to listen to lungs in the abdominal area. 00:01:10
You're also going to have a pad to protect them so if we spill, we don't get them wet. 00:01:15
Gloves, we have the Ensure here, and then we have regular tap water. 00:01:20
And it's Tippett, not hot, not cold water that you've got there. 00:01:23
And we've got our pH paper to check placement. 00:01:27
And we also have an irrigation bottle with a syringe here. 00:01:30
Come down to the room. 00:01:35
You want to take and come in. 00:01:37
You want to identify your patient. 00:01:38
This is Mrs. Johnson. 00:01:39
I'm Ruth Miller. 00:01:41
I'm going to be giving you two feeding to you today, 00:01:42
so I want to explain everything I'm going to be doing to her before we start. 00:01:44
Then I want to provide privacy. 00:01:48
If you haven't done so, you may want to go ahead and do a quick abdominal assessment. 00:01:51
Again, you're listening for bowel sounds 00:01:56
because you always want to have bowel sounds if you're going to be feeding someone. 00:01:57
Okay, once you get finished with that, you want to look at the general skin color 00:02:01
to know what their normal skin color is in case they run into trouble 00:02:04
because if we run into trouble with this skill, 00:02:07
it's going to be aspirating into the lung, abdominal distension. 00:02:09
So do a respiratory assessment, color, how well they're breathing, 00:02:12
and how often they're breathing, 16 to 20 a minute, nice, easy, regular, no distress, 00:02:16
and the abdominal area for distension. 00:02:22
Once you get through with that, then you want to go ahead and gather everything you've got. 00:02:24
What I've got here is I want to hit and measure the water out, and I want to hit and measure the Ensure out. 00:02:29
Ensure lots of times will come in a 240-milliliter can. 00:02:34
If you're not going to use it all, you can take and put a cup of tape over it and save it for eight hours. 00:02:39
But normally, as a rule of thumb, what we don't use, we usually toss out. 00:02:44
So now we've explained what we're going to do, and she's happy to go along with us. 00:02:49
We're going to go ahead and get our gloves on. 00:02:56
Very important that we put the head of the bed up, and she's in an up position, so that's good. 00:02:59
Only expose what we need to, and I've got the curtain pulled, so I still try not to expose any more than I have to. 00:03:05
And in this case, this is our gastrostomy tube here, and I want to go ahead and move everything over so I'll be able to reach it. 00:03:12
Now, what you want to do here is to take and instill 30 milliliters of air, and I'm going 00:03:25
to clamp this off. 00:03:38
This is just like the nasal gastric tube. 00:03:39
Every time you take the plug out, you want to clamp it off so they don't wind up sucking 00:03:41
a bunch of air in their tummy and getting distended. 00:03:45
Once I get this in, I can open it up. 00:03:48
Now put your cap, your plug, on the bed, because otherwise if you don't, you're going to be 00:03:51
chasing it around in the floor. 00:03:56
Now we want to go ahead and put these in. 00:03:58
We're going to listen anywhere around the gastrostomy tube, and you want to push it 00:04:01
in quickly. 00:04:05
And what you should hear is the gastric sound, you'll hear a swoosh. 00:04:06
Now we want to aspirate back, and we're going to say that this time, checking the residual, 00:04:11
how much is left from the last feeding. 00:04:18
like maybe about 5 milliliters. When I pull this out, because now I need to check the 00:04:20
pH, again I've got it clamped, I'm going to plug it off and leave it right there. I will 00:04:25
take my pH paper here and just hold it over the garbage can, shoot a little bit of the 00:04:31
gastric contents on it, and again compare it to my paper here, and it looks like we're 00:04:37
at a 4, 4.5, that's our pH. So that's great because that's a good indication that we're 00:04:44
in the abdomen. We only have 5 cc's back of residual, that's how much that was left from 00:04:51
the last feeding, which is good. Your book recommends anything 200 or above to clamp 00:04:56
the tubing and the hole or to follow your policy wherever you're at working. Now, the 00:05:01
next thing we want to do, and we usually let all of this run by gravity. We don't want 00:05:07
to force anything into the abdominal area. Again, clamp it off. Put your plug over on 00:05:13
the table. We're going to insert this. Now, this is an open system that I've got here. 00:05:20
And what I'm going to do is add 30 of water. And the reason why I'm doing that is to make 00:05:25
sure it'll flush what I aspirated back up through and that everything's going to go 00:05:31
through fine. Okay, the higher I hold it, the quicker it'll run. Okay, I try to clamp 00:05:36
it off so that they do not get any air. She looks fine. It looks like everything is working 00:05:42
well. Now I am going to turn this around and I am going to put 50 ml of Ensure in. She 00:05:47
has got a little multivitamins here too it looks like. You can kink it off to slow it 00:05:54
up or raise it and lower it. If you look right here where my finger is, you can see how fast 00:05:59
it is going down. You can talk with her while you are standing there, you know, how was 00:06:07
the night? What did you watch on TV? When was the last time you saw your children? Were 00:06:11
they in yesterday? Just anything to help pass the time. But you want to run this in, and 00:06:15
it should take about one to two milliliters every couple of seconds to go in. And as you 00:06:21
can see, when I raise it, it runs fast. When I lower it and kink it, it slows it up. And 00:06:26
when I get down to about two to three milliliters, I'm going to clamp it off because I don't 00:06:32
want a bunch of air in her tummy. I'm going to follow off with 30 milliliters of water, 00:06:35
And I got this from my chart from the order. 00:06:42
Now, when this goes in, I'm going to let it run all the way down to there. 00:06:45
And then I'll clamp it off. 00:06:53
Okay, there you go. 00:06:55
Clamp it off. 00:06:57
Make sure she's still doing okay, feeling all right. 00:07:01
Stomach looks good. 00:07:05
Respirations look good. 00:07:06
Skin color looks good. 00:07:07
I'll clean all of this up and put this back, put her gown down, pull everything up here. 00:07:09
See if she needs anything. 00:07:15
if there's anything that she needs. 00:07:17
If she doesn't, then I'll put the bed back down in the low position. 00:07:19
It's best to leave the head of the bed elevated for 30 minutes after you feed someone. 00:07:23
If you think about it, you wouldn't go to bed right away after you finish eating a heavy meal. 00:07:27
So leave the head of the bed in the high fowler's position, which is most crucial. 00:07:32
When lawsuits come over this particular scale, 00:07:36
it's usually because we didn't put the bed up high enough and they aspirated, 00:07:38
or we put the bed back down too soon in the head of the bed and they aspirated. 00:07:42
So, the head of the bed needs to stay up for at least 30 minutes until she set time to 00:07:45
digest some of it, and then you can come back in 30 minutes to check her and make sure it's 00:07:49
all right and put the head down. 00:07:54
In the meantime, though, go ahead and clean everything up. 00:07:56
Anything left over gets put in the commode. 00:07:59
The syringe gets washed out, which is regular tap water, and then it should be in a bag 00:08:03
that's left apart and put in a bag to dry, and we change these syringes out in the irrigation 00:08:09
tray itself every 24 hours. Okay, everything's cleaned up. She doesn't need anything else. 00:08:14
I'll wash my hands and I'll go and document now. 00:08:20
Subido por:
Mercedes C.
Licencia:
Dominio público
Visualizaciones:
70
Fecha:
12 de febrero de 2018 - 15:45
Visibilidad:
Público
Centro:
IES BENJAMIN RUA
Duración:
08′ 24″
Relación de aspecto:
1.80:1
Resolución:
854x474 píxeles
Tamaño:
176.90 MBytes

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