a nurse is caring for a client who is receiving continuous enteral feedings via an ng tube This is a topic that many people are looking for. bluevelvetrestaurant.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, bluevelvetrestaurant.com would like to introduce to you Enteral Feeding. Following along are instructions in the video below:
Guys thank you so much for your support and kindness these last few months. I i know i havent made a video in several months. But i wanted to some explainin today as many of you that watch my sunday night podcast beauty in the beta.
Which is always linked below already. Know i am pregnant finally. Im about four months pregnant now and i have been really really tired.
I know im prone to hyperbole. But seriously its like that kind of teenage hormonal exhaustion. You had freshman year of high school.
Where youd sleep for 10 hours come home from school and sleep another three hours. I cannot get anything done i am constantly dragging ass. But it is getting better now that im out of my first trimester additionally.
Pregnancy has made me extremely dumb. I am. Forgetting basic words dropping things leaving important papers everywhere.
I dont think im going to be speaking intelligently about much for for a little while those are a few reasons that i have been making content. Another reason is that i feel hyper focused on the baby and i have a lot of anxiety surrounding my pregnancy. It has totally eclipsed political developments.
My channel my vanity. I am just thinking all the time how am i going to get through getting this baby out of me and raising her properly not to mention that pregnancy is fraught with uncertainty especially in this stage. When i cant feel the baby.
Im not showing that much if i didnt feel like garbage and i wasnt gaining weight it would be hard to tell that i was pregnant. Its just a really strange period of time and im really scared. Im really anxious and i just wanted to disappear from the online sphere for a little bit to kind of deal with this without the outside pressure people can be ruthless and i felt especially vulnerable.
The last few month and even though not making content causes a lot of stress. It seemed like stepping away for a little bit was the best course of action. Maybe not the best.
But it was it was the easiest becoming a wife moving and starting my life over trying to conceive and just losing passion for politics. Because my focus has shifted so much it all sort of happened at once and there was just a huge content slowdown. I didnt want to put out crappy content.
But i really felt like i was disappointing everyone i still do and i am so sorry for that but i have known since i started the channel that once i got pregnant especially. But really once i moved that things were going to have to change. Ive always struggled with this part of me that wants to give everyone the finger and say whatever i want which i do often.
But then sometimes i seriously regret it i retreat into myself. And im totally unable to handle the backlash in that way i have picked the least sustainable and suitable job for myself and my personality type. My ego is just too fragile i sort of feel like youre either ann coulter.
And you have what it takes to deal with all of this or you dont and i clearly dont im too neurotic. I have too much anxiety and even though im very proud of the work. Ive done and feel like like im really good at this.
It has just been so stressful now that im feeling the responsibility of another life the life of a little girl that needs to be protected and raised so that she surpasses me and lacks my bad qualities like being a loudmouth. I am really beginning to understand just how important all of this is this really is what its all about my whole life the mistakes. The red pill.
The channel everything has led me up to this mammoth task. I just have to do a good job and wrapping my mind around it around the enormity of this task is consuming me right now i feel so blessed to have the opportunity to raise a new generation. But im scared of the condition of the world around us of our country and even though our ancestors had babies in wars and famine through death and destruction.
I am still acutely aware of how difficult. Its going to be to protect her from the society that weve created while allowing her to develop her own personality. The last decade has frankly been horrible not necessarily personally.
Although im convinced that the red pill and being immersed in the online political sphere has deleterious effects on mental health of people with sensitive personality types. But as a society. Were really coming apart at the seams.
And there isnt the simplicity or the comfort of having a place in the world that previous generations. Experienced. Its going to be very important for me to focus on what is good on the future on what is positive because i have a tendency to be nihilistic and now have a very serious moral obligation to avoid infecting.
A new generation with this nihilism. I asked a michael jones about this element of our culture and the conversation that we had over the summer. And he said.
We just have to look ahead and get excited about what we can build after this society fails. And thats really what im doing by bringing new life into the world. Its what i have to do i guess.
The question that im grappling with is is it possible to do all of these things to raise a daughter to be a good wife to stay positive and to continue doing this channel. As i have been the channel exposes me to risk to extremely high levels of stress. I want to do the right thing for my family.
But i still desire to make content. There is also this question of womens role in the movement. Im not seeing a lot of women that have young kids and are still able to do this job.
Unless. They have a really specific personality type as far as current events and politics are concerned. I am.
Pretty. Much maxed out in that arena. Just with my weekly podcast with matt christensen.
And our colin show. So amidst all of the bannings and getting burned out with current events with demographic issues that weve discussed at nauseam with fiscal issues. Im seeing a lot of people change direction which i totally understand and that is something that i want to do as well.
Im not saying there will be no more content on this channel. I just dont have the same zeal for it that i once did who knows though i dont want to shut it down. Because i might have this baby and that anger that rage that drove me might return might even be stronger.
I wont know until i meet her and see what im capable of ill always do beauty on the beta of course. But im also really feeling this urge to completely change direction. Ive decided to start a channel with my dear friend critical conditon.
Robin riley. And she is also pregnant and newly married my audience here is so predominantly male that i dont think i can start rolling out the kind of content that i want to with my current branding and the demographic of this audience. Were calling the channel motherland and its linked below.
Weve already recorded our first episode it will air tomorrow at 1 00 pm. Eastern. I know there are oodles of motherhood cooking birth childhood development marriage channels.
I watch them. But what i see from almost all of them is a complete avoidance of the appearance of political bias. There will be none of that and we have to let the channel develop organically like i have here.
But there are so many cultural issues that affect child rearing that affect gender relations and marriages that affect families and communities. We want to talk about all the mom stuff of course. But we want to be more than that weve talked about the direction of that channel and the future content our premiere episode which as i mentioned is going live at 1 00 pm.
Eastern tomorrow and is linked below i really hope that you subscribe to our channel and that man or woman you enjoy our content. I hope that you understand why i want to do this. And you dont feel like im being disloyal or unappreciative of the four years of support that youve given me i cannot thank you enough for that i truly cant i just feel like i have to make a different kind of content right now.
And i really hope that you come along with me. Thank you so much for watching. And ill see you soon bye.
mls. An hour until the person is tolerating and they usually will have a goal sort of set rate that they eventually want to get to with that patient. So we typically will start slow and then incrementally increase based on how they tolerate it if this was the first initiation of tube feeds.
So well say our patient is the inter for these first four hours at 20 miles an hour. We verified by measuring the length of our external tube. Weve checked the gastric ph and the ph is a three its grassy green aspirin and weve weve monitored the site.
And it looks clean and healthy and dry and and weve weve done care on it this morning. We cleaned it when he had his his daily bed bath. So were going to we shook our entry before pouring it and you want to pre measure that for that four hours worth.
So if were gonna do four hours worth we would pre measure that ad mls and thats what were gonna were going to put in the bay. Because again we dont want to hang in this site policy. We dont want to hang more than four hours worth at a time.
Were gonna put in our ad. Mls and what we want to do first is prime our two feet bag. So again you want to make sure we have the pump set bag.
I just like to hang. It a little bit higher and you can see its already starting to run through so priming means replacing the air in the tube with fluid so in this case. Our fluid is the tube feed formula and were just going to replace that air with tube feed formula and the patient can tolerate a little bit of air into the stomach.
Its not like an iv line. Where you cant have any air. Im going to it into the patient.
But again it would be a little bit uncomfortable to give them a bolus of air. So we dont want to do that we and we want to maximize the the time that were monitoring for tolerance with actual tube feed and not with air so were gonna prime our tubing there is on the tubing a roller clamp here so if you push it all the way down. Its closed and nothing will run if you open it up all the way the the tube feed formula will one run quite quickly through the tubing so you can see it kind of running through and you can tell once its all been primed you can prime it either into a sink or garbage can generally.
I actually like to do it right back into the container. Were into the graduate. If i pre measured it into a graduate and then once its done were gonna were gonna lock that off this part is your drip chamber and generally you want your drip chamber.
To be about 1 2. Or 1 3. Full.
And you can see i kind of overfilled. It here. Im just going to try to run it back so then once youve primed the tube for full of tube feeding formula and theres no longer air in it you just one your drip chamber to be about 1 3.
To 1 2. Full ours is a little under full. But maybe just because the solution.
Were using isnt as thick and youll close your roller club just so its not dripping all over the place when you hook. It up at this point. Im just gonna rest the tube here on a towel.
Its a good idea to have a towel or a clean blue pad nearby and well just go over sort of the pump here were gonna turn it on mmm and it should just sort of beep at you and it turns on and it should it kind of defaults to zero. So were gonna do it. And then it will flash telling you that its ready for you to put your rate in so you can use this dial on the side to get to your rate.
That you want your desired rate or you can use the up down the plus minus keys here so we want to run it at 20 mls per hour and we also said that we only want to run it for 4 hours. So atm ellsworth. So you can also hit this v.
Tbd. Volume to be delivered button and do the same thing. So were gonna deliver 80.
Mls and then it should default back to our 20. Saying that it has that it took that atm hills its gonna beep at us once ad mls as infused. But its going to show us this 20 mls per hour cuz thats what its going to run at so.
Then you want to take your drip chamber and your drip chamber. Gets slipped through this sort of holder. Here.
And the pump set tubing has an elastic sort of tubing area here. So you feed that through and this wheel here and then you can lock it into this top part. So that it doesnt kink off and now youre more or less ready to go.
But a comment. An error actually is that people leave the roller clamp closed. You want it to be open right because you want it to be able to run through and then we can hook.
It up to our patient once we have this all sort of set up again want to be wearing gloves through this and just a reminder. We had checked that this tube was in scituate flushed with the required amount of tap water. And the dietician had ordered 20 ml of tap water pre and post tube feed so we gave 20 mls so were gonna kink offer our tube and attach it here to our porch now were going to hit start and youll see the wheel turn and itll take the tube feed formula through the system and then run it into the patient so again were gonna want to monitor our patient for signs of discomfort distension vomiting signs of aspiration etc while this is running and in four hours when all a dml has gone through the pump is actually going to beep at us.
Because its going to tell us our volume to be infused or delivered. Was has been met so then were either gonna need to restock or a refill. Sorry or maybe at that point were gonna flush our tube check our gastric residuals etc.
Depending on on the situation. So thats a pump set the other type of tube feed delivery system. That you may see or use in the clinical area is it gravity set and actually im just gonna put this one on hold.
So it doesnt run too much into jake and if you did want to hold it so you were doing care with the patient you had to put their head down for a little bit youd hit this start hold button. And itll flash at you that its on hold after a couple minutes. Itll beep at you to remind you that its on hold.
And if you do want to shut. It off you just hit the off button and it it all shuts off so were gonna move on to a gravity feeding system. Some often this is an intermittent way of feeding and or sometimes referred to as bolus feeding.
This is the pump way of feeding if you are doing continuous feeding. So if the persons being fed for extended periods time and not just intermittently throughout the day. You would do the the pump set and youd again have that order great.
If the person is receiving intermittent feeds throughout the day through bolus or gravity. Its referring to this system. Where we have its still kangaroo the brand.
But its a gravity feeding set. So its very similar setup to our pump set we have a bag and we have tubing and we have a roller clamp on it and then we have a port that fits into our gt tube. There so in this case.
The physician would order an amount say 500. Ml zuv enter to be delivered three times a day via gravity in which case sometimes theyll tell you over an hour over half an hour and it also just depends on the patients tolerance. So usually we dont start with gravity.
If were just starting a new tube feed and thats something thats sort of initiated or move to overtime. If the persons tolerating it very well so well just move our pump. So the same idea if we were doing gravity.
Wed want to fill with fill our bag with our required amount before you fill. Its not a bad idea to close off your roller clamp. Well open up our bag at the top here well.
Its quite tight else take it down sometimes and well fill it with our desired amount and again were gonna prime so well close it up im this tubing its the same idea as with the pump set youre just going to going to fill your tubing with formula instead of air or replace the air with formula and you can open up your roller clamp and let that run so this is your drip chamber. In this case. The gravity set.
So were just about full in there so were full and were going to switch this game. Well just put the pump set one aside for now cap it off and so if we are gonna do gravity set youre going to use your roller clamp to regulate the the drips and there isnt a precise formula to calculate the drip rate as there is with ivs that youll learn later. But we will attach it to our patient again wed want to check placement ph maybe residuals if they recently had a feed this is intermittent were going to open up our roller clamp and were gonna watch it drip into the patient so youre sort of just gonna eyeball the the clock and make sure that this isnt going too fast that you dont come back in 10 minutes and over half of it has gone in and were gonna watch the patient for tolerance and we might need to slow it down or speed it up if we notice.
Its going too fast or not fast enough so again you can probably imagine that gravity is is more common in situations. Where the person has a really well established regimen with their feeding and pump set because its a little bit a lot more precise is you sort of off the off the hopper for people who have issues with tolerance. If theyre fed too fast.
Etc. The other type of feeding you may see. And this is also considered a bolus or intermittent feed is syringe method and so thats where you actually take the you can either take the plunger out of the syringe and pour the tube feed formula that way or you could actually draw up to feed formula and sort of slowly and still it using the syringe and that method isnt as common in adults.
It is a little bit more common in pediatrics. When youre feeding babies for instance with nasogastric tubes that youre holding the the baby in youre monitoring the rate by either holding the syringe higher or lower and while youre feeding them. But again that method isnt as common in adults.
Because if you can imagine if you were to do the syringe method and say pour the solution into the the ensure into the syringe and hook. It up to our patient. If the patient were to laugh or move or change position their stomach muscles would actually cause some regurgitation and the the solution might come back out.
And then you can also probably imagine the small amounts that youd be delivering at a time via syringe maybe you dont fit as well for the the amounts that wed be providing for an adult patient. So its a little less common for sure. But just something to to be aware of that does exist.
But more often youre doing either gravity intermittent feeds or youre doing continuous via pump or intermittent feeds. But via a pump as well so those are the generally the different types of methods for feeding a patient. .
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