Category / Primary Body System:

Gastrointestinal / Nutritional Support

Problem:

Patient is at risk for complications due to feeding tube placement.

Goal:

The patient’s tube will remain patent for 90 days.

Plan/Approach:

1. Bed Elevation:

   • Step: Keep the head of the bed elevated 30-45 degrees at all times.
   • Rationale: Elevating the head of the bed helps prevent aspiration, a common complication in patients with feeding tubes.
   • Actions: Adjust the bed to maintain the required elevation consistently. Recheck the bed elevation during each shift.

2. Intake and Output Monitoring:

   • Step: Record intake and output.
   • Rationale: Monitoring fluid balance is essential to assess hydration status and the effectiveness of feeding.
   • Actions: Document all fluid intake and output accurately, reviewing totals each shift to ensure balance.

3. Medication Administration:

   • Step: Administer medications via tube as ordered.
   • Rationale: Ensuring accurate and timely administration of medications is crucial for the patient's treatment and recovery.
   • Actions: Prepare and administer medications through the feeding tube, following prescribed guidelines. Ensure the tube is flushed before and after medication administration.

4. Laboratory Monitoring:

   • Step: Monitor labs as ordered.
   • Rationale: Regular lab tests help track the patient’s nutritional status, electrolyte balance, and overall health, identifying any issues early.
   • Actions: Schedule and review lab tests as ordered, noting any abnormalities and reporting them to the healthcare provider.

5. Aspiration Precaution:

   • Step: Monitor patient for signs and symptoms of aspiration and notify MD/NP as needed.
   • Rationale: Early detection of aspiration signs prevents serious respiratory complications.
   • Actions: Observe the patient for coughing, choking, or respiratory distress during and after feedings. Report any concerns immediately.

6. Water Flushes:

   • Step: Administer free water flushes as ordered.
   • Rationale: Regular water flushes help maintain tube patency and ensure adequate hydration.
   • Actions: Flush the feeding tube with the prescribed amount of water before and after feedings and medications. Document each flush.

7. Tube Patency Checks:

   • Step: Check tube for patency each shift.
   • Rationale: Ensuring the tube remains clear and functional prevents feeding interruptions and complications.
   • Actions: Verify tube patency by checking for resistance during flushing and feeding. Address any blockages as per protocol.

8. Infection Monitoring:

   • Step: Monitor tube site for signs and symptoms of infection each shift.
   • Rationale: Early detection of infection at the tube site is critical for prompt treatment and preventing systemic infection.
   • Actions: Inspect the tube insertion site for redness, swelling, discharge, or pain. Document findings and report any signs of infection.

9. Tube Site Care:

   • Step: Administer treatment to the tube site as ordered.
   • Rationale: Proper care of the tube site prevents infection and ensures the site remains clean and healthy.
   • Actions: Clean and dress the tube site according to prescribed protocols. Apply any topical medications as ordered.

10. Dietary Consultations:

    • Step: Arrange dietary consultations as needed.
    • Rationale: Professional dietary advice ensures the patient receives adequate and appropriate nutrition through the feeding tube.
    • Actions: Schedule consultations with a dietitian to review and adjust the patient's nutritional plan. Implement any dietary changes as recommended.