STUDENT NAME: _________________________

ENTERAL NUTRITION and KANGAROO PUMP

REQUIRED READING:
Perry, A. and Potter, P. (2014). Clinical Nursing Skills and Techniques, 8th ed., Mosby-Elsevier,
pp. Enteral Nutrition-775 – 795 and Administering Medications-500 – 504.

Required Audiovisual:
A Guide for Nurses, Part 1: Tube Identification, in Enteral Feeding Tubes 1 (Medcom Inc., 2006),
11:19 mins http://mcom.alexanderstreet.com.library.icc.edu/view/1665665
A Guide for Nurses, Part 2: Administering Formula and Medication in Enteral Feeding Tubes
Episode 2 (Medcom Inc., 2006) 9:13 mins
http://mcom.alexanderstreet.com.library.icc.edu/view/1665666/play/true/
KANGAROO ePUMP™ Enteral Feeding Pump In-Service Video .
http://www.kangarooepump.com/Epump/pagebuilder.aspx?webPageID=131032&topicID=131032

STUDY GUIDE QUESTIONS:

1. What is “enteral nutrition”?

2. The anticipated duration of enteral feeding determines the type of tube utilized to deliver
the feedings. Summarize the tube types based on the feeding duration.

3. Besides inserting the feeding tube, what is the nurse’s role in enteral feeding?

4. What are the ethical issues associated with enteral nutrition/tube feedings?

Skill 31-2 *** page 782*** Verifying Feeding Tube Placement

5. Why should the nurse verify the feeding tube position?

6. After the initial x-ray verification, how often should the nurse check the feeding tube position?

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7. Identify the techniques to detect feeding tube dislocation.

8. Can the verification of tube placement be delegated to nursing assistive personnel?

9. What can lead to dislocation of the feeding tube?

10. What medications can alter the pH thereby diminishing the usefulness of pH as a
verification of tube position?

11. What is the level of asepsis used during tube feeding verification?

12. List the three steps to verify tube placement and the results that indicate proper
placement.


o

o
o
o

13. What should the nurse consider when there isn’t any gastric aspirate?

14. Once the tube placement is verified, what should the nurse do next?

Skill 31-3 ***page 786*** Irrigating a Feeding Tube

15. What are the most common causes of feeding tube occlusions?

16. Identify the aspects of enteral feeding that the nurse can delegate to assistive
personnel.

17. When should feeding tubes be irrigated?

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18. What solution and amount of solution is used for irrigation?

19. Why are alternative flushing solutions such as cola and fruit juices not a good choice for
feeding tube irrigation?

20. How often should the irrigation solution and trays be changed?

21. What should the nurse do when unable to instill fluid?

Skill 31-4 ***page 788*** Administering Enteral Nutrition

22. Briefly, identify three indications for enteral feeding.
1)
2)
3)

23. Identify abnormal findings the nurse should request the assistive personnel to report.

24. Should bowel sounds be present prior to initiating enteral nutrition?

25. What lab values should the nurse assess prior to initiating enteral nutrition?

26. The nurse is caring for a patient receiving enteral nutrition by gastrostomy tube following
a hemorrhagic stroke. Identify an appropriate Nursing Diagnosis for this patient.

27. How is the administration of enteral feedings like a medication administration?

28. Why should the nurse have the formula at room temperature?

29. What position is the patient placed for administering enteral feedings?

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30. Gastric volume residual (GVR) provides valuable information regarding the patient’s
tolerance to the type and volume of the feeding solution (are they absorbing the formula?).
Complete the following information regarding checking gastric volume residual:
30.1 How often does the nurse check the gastric volume residual?

30.2 How does the nurse determine the amount of gastric residual?

30.3 After measurement, what does the nurse do with the aspirated gastric contents?

30.4 Under what circumstances would the nurse hold the tube feeding?

30.5 After checking, GRV, what does the nurse do to prevent the tube from clogging?

31. How is the rate of administration controlled for the different feeding methods:
Intermittent Gravity Drip Feedings:
Continuous Drip Feedings:

32. How can the nurse evaluate the effectiveness of the tube feeding?

33. A patient with enteral nutrition develops diarrhea 3 or more times in 24 hours, what
actions should the nurse take?

34. The nurse documented the following for a tube feeding, what other data if any should be
included. 01-20-2013 0920 G-tube placement confirmed, pH 4 with 8 ml green aspirate.
G-tube flushes easily with 30 ml tap water. Isocal feeding initiated 20 ml/hour per
Kangaroo pump.

35. The patient is expected to be discharged in a few days and will continue intermittent tube
feedings at home. What are important points to teach the patient/family member?

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Skill 21-2 ***page 500*** Administering Medications Through an Enteral Feeding Tube

36. Complete the missing information in the following statements regarding medication
administration through an NG or g-tube. (Many health care facilities do not allow
medication administration through a j-tube.)
36.1 Preferably, medications administered by enteral tubes should be in ____________.
36.2 If liquid form is not available, the nurse will need to modify the medication tablet
by ___________________________________________.
36.3 Medications that cannot be modified and therefore cannot be administered by
enteral tubes are: ___________________________________________________
_________________________________.
36.4 Crush tablets using a ____________.
36.5 Dissolve tablet powder in _____________________________.
36.6 Capsules containing granules or gelatin can be opened by ___________________
__________________________________.
36.7 Gelcaps can also be dissolved __________________________________________.
36.8 To administer more than one medication, give each ____________ and flush
______________________________ with _____________________________.
36.9 Follow last dose of medication with __________________________________.
36.0 To prevent aspiration, keep the ________________________________.after
administering the medication.

KANGAROO PUMP STUDY GUIDE QUESTIONS:

SET-UP
37. How is the pump set (feed/flush tubing) loaded?

38. Complete the chart:

Function Screen Display
A set is not loaded
The set is loaded correctly
The set is loaded incorrectly

PRIMING THE PUMP

39. When priming the pump set, should the tubing be connected to the patient?

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40. Complete the chart:

Function/button When is this function used.
Auto Prime

Hold to Prime Feed

Done

41. How does the nurse set the pump for continuous or intermittent mode?

PROGRAMMING THE ePUMP:

42. Identify the two parameters that are programmed while using the Continuous Mode.

43. Identify the four parameters that are programmed while using the Intermittent (Bolus)
Mode.

44. After programming the ePump, what button must be pressed to start the feeding?

45. What function(s) does the HOLD button allow other than temporarily holding the feeding?

46. What error message will be seen on the screen:

46.1 When the pump set is inappropriately loaded?
46.2 When there is a clogged line above the pump?
46.3 When there is a clogged line between the pump and the patient?
46.4 When the pump should be removed from service?

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Student Name: __________________________

SKILL CHECKLIST

NEEDS MORE
PROFICIENT PRACTICE
Washes hands and applies gloves.
Places HOB at 30 degrees.
Verifies tube placement. pH and aspirate.
Checks for gastric residual.
Prepares intermittent feeding. (syringe or bag)
Prepares continuous feeding.
Initiates intermittent feeding at no more than 18
inch above insertion site.
Loads continuous feeding tubing into Kangaroo
ePump.
Sets Kangaroo pump rate as instructed by faculty.
Demonstrates enteral medication administration.

Revised 12/13. C. Lambrecht/A. Moore

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