Nutritional Needs of A Client: Presented By:-Lawang Dolma Tamang B.Sc. Nursing 3rd Year 13th Batch

Fundamental of Nursing
Unit 5:-Basic Needs of Client
Nutritional Needs of a client
Presented by:-
Supervised by:-
Lawang Dolma Tamang Ms. Neha Shrestha
B.Sc. Nursing 3rd Year Lecturer, SMAHMI
13th Batch College of Nursing
5/26/20 05:23 PM Nutritional needs of a client 1

Learning Objectives:-
At the end of the teaching/ learning session, B.Sc. Nursing 1st year
students will be abe to:-
• explain the procedure of nasogastric tube feeding.

Administering a nasogastric tube feeding:-
Assessment: Assess for:-
• Any clinical signs of malnutrition or dehydration
• Allergies to any food in the feeding
• Presence of bowel sounds
• Any problems that suggest lack of tolerance of previous feeding.

Administering a nasogastric tube feeding…
 Planning:-
Before commencing a nsogastric feeding, determine the type, amount

and ferquency of feeding and tolerance of previous feeding.

 Implementation:-
Preparation:-
Assist the patient to a fowler’s position in bed or a sitting position in a chair,

the normal position for eating.
If a sitting position is contraindicated, slightly elevated rightside lying

position is acceptable.
These position enhances gravitational flow of the solution and prevent

aspiration of fluid into lungs.
 Implementation:-
Performance:-
1) Explain the procedure to the patient and inform that the feeding may
not cause any discomfort but may cause a feeling of fullness.
2) Wash hands and observe appropriate infection control procedure.
3) Provide privacy for the procedure.

4) Assess tube placement:-
Attach the syringe to open the end of the tube and aspirate alimentary
secretions.Check the pH.
Allow 1 hour to elapse before testing the pH.
Use a pH meter rather pH paper if the patient is receiving a continuous

feeding or if food coloring has been added to formula.

5) Assess residual feeding contents:
Aspirate all stomach contents and measure the amount before

administering the feeding. This is done to evaluate absorption of the last
feeding.
If 100 ml is withdrawn, check with the nurse in charge or refer to

policy before proceeding.This precise amount is usually determined by
the physician order or policy.
5) Assess residual feeding contents:
Reinstill the gastric contents into the stomach if this is the policy.
Remove the syringe bulb or plunger and pour the gastric content via
the syringe into the nasogasrtic tube.
Removal of the content could disturb the patient’s electrolyte balance.
If the patient is on a continuous feeding, check the gastric residual

every 4 to 6 hours or according to the agency protocol.
6) Administer the feeding:-
• Before administering feeding:
Check the expiration date of the feeding.Warm the feeding to room

temperature. An excessively cold feeding may cause cramps.
When an open system is used, clean the top of the feeding container
with alcohol before opening it.This minimizes the risk of contaminates
entering the feeding syringe or feeding bags.
7) Feeding bag (Open system):
Hang the bag from an infusion pole about 30cm (12 inches) above the
tube’s point of insertion into the patient.
Clamp the tubing and add formula to the bag.
Open the clamp, run the formula through the tubing, and reclamp.The
formula will displace the air in the tubing, thus preventing the
instillation of excess air into the patient’s stomach or intestine.
7) Feeding bag (Open system)…
Attach the bag to the nasogastric tube and regulate the drip by
adjusting the clamp to the drop factor on the bag (20drpos/min) .

8) Syringe (Open system):-
Remove the plunger from the syringe and connect the syringe to a
pinched or clamped nasogastric tube.
Pinching or clamping the tube prevents excess air form entering the
stomach and causing distention.
Add the feeding to the syringe barrel.

8) Syringe (Open system)…
Permit the feeding to flow in slowly at the prescribed rate. Raise or

lower the syringe to adjust the flow as needed.
 Pinch or clamp the tubing to stop the flow for a minute if the patient
experience discomfort.
Quickly administered feedings can cause flatus, cramp and reflux

vomiting.
9) Prefilled bottle with drip chamber (Closed system):
Remove the screw on cap form the container and attach the
administration set with the drip chamber and tubing.
Close the clamp on the tubing.
Hang the container in an intravenous pole about 30 cm( 12 inches)

above the tube’s insertion point into the patient. At this height the
formula should rub at safe rate into the stomach or intestines.
9) Prefilled bottle with drip chamber (Closed system)…
Squeeze the drip chamber to fill it one third to one half of its capacity.
Open the tubing clamp, run the formula through the tubing and
reclamp the tube.The formula will displace the air in the tubing thus
preventing the instillation of excess air.
Attach the feeding set tubing to the feeding tube and regulate the drip
rate to deliver the feeding over the desired length of time.
10) Rinse the feeding tube immediately before all of the formula has run
through the tube:
Instill 50 to 100 ml of water through the feeding tube. Water flushes the
lumen of the tube, preventing future blockage by sticky formula.
Be sure to add the water before the feeding solution has drained form the
neck of a syringe or from the tubing of an administration set to prevent the
instillation of air into the stomach or intestine thereby preventing
unnecessary distention.
11) Clamp and cover the feeding tube:
Clamp the feeding tube before all of the water is instilled. Clamping
prevents leakage and air from entering the tube if done before water is
instilled.
Cover the end of the feeding tube with gauze held by elastic band in
order to prevent leakage.

12) Ensure patient’s comfort and safety:
Pin the tubing to the patient’s gown.
Ask the patient to reamain sitting up right in fowler’s position or

slightly elevated right lateral position for at least 30 minutes. These
position facilitates digestion and movement of the feeding from the
stomach along the alimentary tarct and prevents potential respiration of
the feeding into the lungs.
12) Ensure patient’s comfort and safety:
Check the agency’s policy on the frequency of changing the

nasogastric tube and use of smaller lumen if a large bore tube is in
place. These measures prevents irritation and erosion of the pharyngeal
and esophageal mucous membrane.

13) Dispose of eqipment appropriately:
If the equipment is to be reused, wash it thoroughlywith soap and water

so that it is ready for resues.
Change the equipment every 24 hours.

14) Document all relevant information:
Document the feeding including amount and kind of solution taken,

duration of the feeding and assessments of the patients.
Record the volume of the feeding and water administered on the

patient’s intake and output record.

15) Monitor the client for possible problems:
Carefully assess patients receiving tube feedings for problems.
To prevent dehydration, give the patient supplemental water in

additional to prescribed tube feedings as ordered.

Summarization:-
A nasogastric tube feeding should be initiated only after determining the
type, amount and ferquency of feeding and tolerance of previous feeding.
Different system such as open system and closed system has its own
procedure of feeding.The patient should be assessed receiving tube
feedings for any problems.

Multiple Choice Questions (1*1=1marks):-
1) Before administering feeding, the stomach content is aspirated and
measured in order to evaluate:-
a) Absorption of last feeding
b) Instillation of excess air
c) Instillation of medications
d) Patient’s electrolyte balance
Key answer:- a)
Short Answer Questions:-
1) Explain the procedure of nasogastric tube feeding. (4 marks)

References:-
1) Berman A., Synder S., Frandsen G., Kozier and Erb’s Fundamentals
of Nursing: Concepts, process and Practice, 10th ed. Pearson,
P: 1104-1123
2) Jacob A., R R., Tarachand J., Clinical Nursing Procedures: The Art of
Nursing Practice, 2nd Edition, Jaypee, P: 879-896

References…
3)Pathak S., Devkota, R., A Textbook of Fundamentals of Nursing,
Revised Ed 2018. Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar,
P: 235-265
4) https://en.m.wikipedia.org/wiki/nasogastric intubation


Nutritional Needs of A Client: Presented By:-Lawang Dolma Tamang B.Sc. Nursing 3rd Year 13th Batch

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Fundamental of Nursing

Unit 5:-Basic Needs of Client

Nutritional Needs of a client

5/26/20 05:23 PM Nutritional needs of a client 1

• explain the procedure of nasogastric tube feeding.

5/26/20 05:23 PM Nutritional needs of a client 2

• Any clinical signs of malnutrition or dehydration

• Allergies to any food in the feeding

• Presence of bowel sounds

• Any problems that suggest lack of tolerance of previous feeding.

5/26/20 05:23 PM Nutritional needs of a client 3

Before commencing a nsogastric feeding, determine the type, amount

5/26/20 05:23 PM Nutritional needs of a client 4

Assist the patient to a fowler’s position in bed or a sitting position in a chair,

If a sitting position is contraindicated, slightly elevated rightside lying

These position enhances gravitational flow of the solution and prevent

2) Wash hands and observe appropriate infection control procedure.

3) Provide privacy for the procedure.

5/26/20 05:23 PM Nutritional needs of a client 6

Allow 1 hour to elapse before testing the pH.

Use a pH meter rather pH paper if the patient is receiving a continuous

5/26/20 05:23 PM Nutritional needs of a client 7

Aspirate all stomach contents and measure the amount before

If 100 ml is withdrawn, check with the nurse in charge or refer to

Removal of the content could disturb the patient’s electrolyte balance.

If the patient is on a continuous feeding, check the gastric residual

• Before administering feeding:

Check the expiration date of the feeding.Warm the feeding to room

Clamp the tubing and add formula to the bag.

5/26/20 05:23 PM Nutritional needs of a client 12

Add the feeding to the syringe barrel.

5/26/20 05:23 PM Nutritional needs of a client 13

Permit the feeding to flow in slowly at the prescribed rate. Raise or

Quickly administered feedings can cause flatus, cramp and reflux

Close the clamp on the tubing.

Hang the container in an intravenous pole about 30 cm( 12 inches)

5/26/20 05:23 PM Nutritional needs of a client 18

Pin the tubing to the patient’s gown.

Ask the patient to reamain sitting up right in fowler’s position or

Check the agency’s policy on the frequency of changing the

5/26/20 05:23 PM Nutritional needs of a client 20

If the equipment is to be reused, wash it thoroughlywith soap and water

Change the equipment every 24 hours.

5/26/20 05:23 PM Nutritional needs of a client 21

Document the feeding including amount and kind of solution taken,

Record the volume of the feeding and water administered on the

5/26/20 05:23 PM Nutritional needs of a client 22

Carefully assess patients receiving tube feedings for problems.

To prevent dehydration, give the patient supplemental water in

5/26/20 05:23 PM Nutritional needs of a client 23

5/26/20 05:23 PM Nutritional needs of a client 24

a) Absorption of last feeding

b) Instillation of excess air

d) Patient’s electrolyte balance

5/26/20 05:23 PM Nutritional needs of a client 26

5/26/20 05:23 PM Nutritional needs of a client 27

5/26/20 05:23 PM Nutritional needs of a client 28

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