continuous tube feeding. Which actions should the nurse take? Show Answer & Explanation Solved by verified expertRated Helpful nec nec facilisis. Pellentesque dapibus efficitur laoreet. Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Donec aliquet. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. Pellentesque dapibus ef
Unlock full access to Course Hero Explore over 16 million step-by-step answers from our library Subscribe to view answer Step-by-step explanation s an ipsu or n or n dictum vit onec nec facilisis. Pellentesque dapibus efficitur laoreet. Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Donec aliquet. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nam l P T. 2013 Oct; 38(10): 575-576. Problem: Giving medications through a feeding tube can be fraught with errors that occur more often than they are reported or recognized. These mistakes are often the result of administering drugs that are incompatible with administration via a tube, of not preparing the medications properly, and of using faulty techniques.
These inaccuracies can result in an occluded feeding tube, a reduced drug effect, or drug toxicity. These potential adverse outcomes can lead to patient harm or even death. Health care practitioners should not assume that a medication intended to be taken by mouth can be safely administered through a feeding tube. The drug’s physical and chemical properties control its release and subsequent absorption. These
specific delivery mechanisms may be altered or destroyed if the drug is given through a feeding tube, reducing its effectiveness or increasing the risk of toxicity. Oral quinapril (Accupril, Pfizer) tablets, for example, contain the excipient magnesium carbonate (a nontherapeutic filler, binder, buffer, and preservative). Crushing a quinapril tablet and dissolving it in water for enteral administration allows the carbonate to increase the pH of the solution,
causing the drug to rapidly degrade into a poorly absorbed metabolite. Drug absorption depends on the drug’s solubility and ability to permeate the intestinal mucosa. The distal end of the feeding tube can be in the stomach, duodenum, or jejunum. Many drugs must be administered into the stomach or duodenum so that they can be properly dissolved by gastric juices, bile, and pancreatic enzymes and can be fully
absorbed through the intestines. Thus, drugs like warfarin (which is absorbed high up in the small bowel) and oral iron (which is dissolved in the stomach and absorbed in the duodenum) might not be properly absorbed if they are administered via a jejunostomy tube. Oral medications that are intended to be taken by mouth must be prepared for enteral administration. Tablets must be crushed and diluted, capsules must
be opened so the contents can be diluted, and even many commercially available liquid forms of drugs should be further diluted before being administered enterally—a practice not well known to all practitioners. Many immediate-release tablets can be safely crushed into a fine powder and diluted before they are administered. However, sublingual, enteric-coated, and extended-release (ER) or delayed-release medications should not be crushed. In addition to destroying the
drug’s protective coating, crushed enteric-coated tablets tend to clump and clog feeding tubes. Crushed sublingual, ER, or delayed-release drugs can lead to dangerous and erratic blood levels as well as dangerous side effects. Unfortunately, the variety of suffixes that manufacturers use to denote ER and delayed-release formulations (CD, CR, ER, LA, SA, SR, TD, TR, XL, and XR)—or the absence of these suffix designations, such as with morphine sulfate ER capsules (Avinza,
Pfizer) and oxycodone controlled release (OxyContin, Purdue Pharma)—makes it difficult to quickly determine whether a drug can be safely crushed. In these examples, the medications should not be crushed or dissolved. Crushing drugs such as bosentan (Tracleer, Actelion) or finasteride (Proscar, Merck) or opening miglustat (Zavesca, Actelion) capsules may expose pregnant nurses to
powder that can cause serious birth defects. Some orally disintegrating tablets, such as lansoprazole (Prevacid SoluTab, Takeda) must not be crushed because they contain enteric-coated microgranules. Some capsules contain both immediate-release and ER or delayed-release granules. With liquid-filled capsules, it is difficult to ensure that all the liquid has been removed so that the correct dose can be given. Using commercially available liquid forms of drugs or other preparations used to make oral suspensions may seem like a safe alternative, but some forms, such as Prevacid Oral Suspension Packets, might not be appropriate when given by a feeding tube. Also, excipients in some oral solutions and suspensions, such as sweeteners, gums, stabilizers, and suspension agents, can increase viscosity and osmolality, which can lead to side effects (e.g., diarrhea) as well as other problems, such as clogging of the tubes or undelivered medication left in the tube. WRONG ADMINISTRATION TECHNIQUEMost nurses rely primarily on their own experience and on that of their coworkers for information about preparing and administering enteral medications. Because few nurses rely on pharmacists, nutritionists, or printed guidelines, a variety of improper techniques and an overall lack of consistency have often been the result. The most common improper administration techniques include mixing multiple drugs together to give at the same time and failing to flush the tube before giving the first drug and between giving subsequent drugs. Appropriate administration techniques must be used to prevent incompatibility (between medications and the feeding formula) and tube occlusions. However, information about drug compatibility with feeding formulas is limited and might not be applicable to different formulations of the same drug or drugs within the same class. For example, liquid morphine in a 2-mg/mL concentration decreases the pH of the feeding formula and results in a precipitate, but a 20-mg/mL concentration does not. Problems of compatibility between the formula and the drug can result in tube occlusions. Incompatibility between drugs being given together can also be a problem, particularly if two or more drugs are crushed and mixed together before they are administered. Mixing two or more drugs together, whether in solid or liquid forms, creates a brand-new, unknown entity with an unpredictable mechanism of release and bioavailability. Proper flushing of the tube before, during, and after each drug administration can help prevent problems. Safe Practice Recommendation: Within each organization, an interdisciplinary team of nurses, pharmacists, nutritionists, and physicians should work together to develop protocols for administering drugs through enteral feeding tubes. Protocols should address using appropriate dosage forms; preparing the drugs for enteral administration; administering each drug separately; diluting the drugs as appropriate; and flushing the feeding tube before, between, and after drug administration. The Enteral Nutrition Practice Recommendations, a comprehensive guide developed by an interdisciplinary task force in 2009,1 is available on the American Society for Parenteral and Enteral Nutrition’s (A.S.P.E.N.) Web site.2 This information is of great value if it is read in its entirety. A step-by-step guide of safe recommendations follows.
REFERENCES1. Bankhead R, Boullata J, Brantley S, et al. A.SP.E.N. Enteral nutrition practice recommendations. J Parenter Enteral Nutr. 2009;33:122–167. [PubMed] [Google Scholar] 2. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Patient safety initiatives. Available at: www.nutritioncare.org/safety. Accessed August 26, 2013. Articles from Pharmacy and Therapeutics are provided here courtesy of MediMedia, USA What are the drug Administration guidelines for enteral drugs?Safe administration of medicines via enteral feeding tubes. never mix drugs. use disposable tablet crushers (not pestle and mortar) to crush one medicine at a time and wash between crushes. ... . flush with an appropriate volume of water before administering another drug. ... . repeat until all drugs have been administered.. What are nursing considerations when administering an enteral feeding?When beginning enteral feedings, monitor the patient for feeding tolerance. Assess the abdomen by auscultating for bowel sounds and palpating for rigidity, distention, and tenderness. Know that patients who complain of fullness or nausea after a feeding starts may have higher a GRV.
What is the correct technique for administering an enteral feeding?Using a syringe for a bolus feed
Holding the syringe and enteral tube straight, pour the prescribed amount of feed into the syringe. Let it flow slowly through the tube e.g. 250ml over 20 minutes. Pour the prescribed amount of water into the syringe and allow to flow through to flush the feeding tube appropriately.
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