NR 449 Week 3 Individual Assignment: APA Review Paper
Individual APA Review Assignment
Chamberlain University
Evidence based practice
1. When
... [Show More] administering medications through a feeding tube, it is recommended that sustained/extended-release drugs should be avoided. Crushing these medications can result in rapid release of a large amount of product at one time, resulting in erratic blood levels and possible toxic levels of the drug (Guenter & Boullata, 2017).
2. The gold standard for checking feeding tube placement is radiography; an electro-magnetic tube-placement device (ETPD) is sometimes used in lieu of an x-ray for this purpose. However, many cases have been reported where clinicians failed to recognize tube misplacement in the respiratory tract of patients. “Thus, one must continue to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings” (Metheny & Meert, 2017, p. 157).
3. Between 2013-2015, the database reported that there had been 25 cases of feeding tubes inadvertently placed in the respiratory tract using ETPD; 17 of these cases resulted in pneumothorax (Metheny & Meert, 2017).
4. Guenter and Boullata (2013) assessed nurses’ knowledge of evidence-based guidelines for administering medications per feeding tube in patients receiving enteral feedings and preventing complications such as tube clogging and drug-nutrient interactions.
5. Similarly, McIntyre & Monk (2014, p. 549) reviewed the literature “to determine gastrointestinal absorption of medications administered via post-pyloric enteral feeding tubes.”
6. An educational intervention for care of gastrostomy tubes was developed for nurses from two nursing homes because there were approximately 22 long-term feeding tubes replaced monthly because they were clogged or dislodged (Shipley, Gallo, & Fields, 2016).
7. In the 4 months after nurses were educated about long-term management of feeding tubes, the number of gastrostomy tubes replaced from two nursing homes decreased from 38-19 cases (Shipley et al., 2016).
8. After initiation of a nurse-led enteral feeding protocol, “more patients achieved their caloric target within a shorter time after admission to the ICU” (Orinovsky & Raizman, 2018, p. 42).
9. ICU patients received a higher daily volume of tube feeding and fewer interruptions of feeding after the nurse-led protocol was implemented (Orinovsky & Raizman, 2018).
10. About 24 % of hospitalized pediatric patients require a nasogastric tube (NGT) and about 18% of those patients are in a pediatric intensive care unit (Lyman, 2017).
11. Although the gold standard for verifying nasogastric tube placement has been an abdominal radiograph, pediatric health care providers have long been concerned about the long-term cumulative effects of radiation exposure (Lyman, 2017).
12. Blockages of feeding tubes are frequently the result of inadequate flushing or poorly crushed medications being administered through the tube (Thompson, 2017).
References
Guenter, P., & Boullata, J. (2013). Drug administration by enteral feeding tube. Nursing2013, 43(12), 26-35.
Lyman, B. (2017). Ask the expert: Nasogastric tube placement in critically ill pediatric patients. Critical Care Nurse, 37(6), 86-87.
McIntyre, C. M., & Monk, H. M. (2014). Medication absorption considerations in patients with postpyloric enteral feeding tubes. American Journal of Health-System Pharmacy, 71, 549-556.
Metheny, N. A., & Meert, K. L. (2017). Update on effectiveness of an electromagnetic feeding tube-placement device in detecting respiratory placements. American Journal of Critical Care, 26(2), 157-161.
Orinovsky, I., & Raizman, E. (2018). Improvement of Nutritional Intake in ICU Patients via a Nurse-Led Enteral Nutrition Feeding. Critical Care Nurse, 38(3), 38-44.
Shipley, K., Gallo, A. –M., & Fields, W. (2016). Is Your Feeding Tube Clogged? Maintenance of Gastrostomy and Gastrojejunostomy Tubes. MEDSURG Nursing, 25(4), 224-228.
Thompson, R. (2017). Troubleshooting PEG feeding tubes in community settings. Journal of Community Nursing, 31(2), 61-66. [Show Less]