F8 · Needs tube feeding
Actual Food and fluids
Definition
Food and fluids must be given through a tube, which needs careful care and monitoring.- Cannot swallow safely
- unconscious
- severe illness
- gut surgery
- Feeding tube in nose or stomach
- relies on prescribed feeds
- risk of tube blockage
📋 Scenario
A stroke patient receives nutrition through a nasogastric tube.
Subjective (S): (Unable to swallow.) Wife: "He can't eat anymore since the stroke."
Objective (O): Nasogastric tube in place at the marked length; feeds running at the ordered rate; head of bed 35 degrees; weight steady.
Assessment tools for this scenario: CP-FLUID Fluid Balance & Nutrition Score
Validated scales to consider: MUST, fluid chart, glucose
**CarePath diagnosis:** Needs tube feeding related to cannot swallow safely, as evidenced by feeding tube in nose or stomach and relies on prescribed feeds.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check tube position before each feed. | A tube in the wrong place, such as the lungs, can cause serious harm if feed is given, so checking confirms the stomach before feeding. |
| Keep head raised at least 30 degrees. | A raised head prevents feed flowing back up and entering the lungs. |
| Flush as ordered. | Flushing keeps the tube clear of blocking feed and medicine. |
| Give mouth care. | Without eating, the mouth dries and germs grow, so mouth care keeps it clean and comfortable. |
| Watch for vomiting or diarrhea. | Vomiting or diarrhea may mean a problem with feed rate, position or tolerance that needs a change. |
**Expected outcomes**
- Receives full prescribed nutrition by tube.
- No aspiration, vomiting, or diarrhea.
- Tube stays in place and open.
- Mouth stays clean and moist.
**Linking the data to the diagnosis**
The stroke patient cannot swallow and receives all nutrition through a nasogastric tube. His wife says he cannot eat anymore since the stroke. The nurse finds the tube in place at the marked length, feeds running at the ordered rate, the head of the bed at 35 degrees and weight steady. This is an actual problem because he depends on the tube now. A statement about trouble swallowing would describe the cause, but this one fits the nursing care of the tube and feeds. The plan aims for full prescribed nutrition, no aspiration, vomiting or diarrhea, a tube that stays in place and open, and a clean moist mouth.
CarePath diagnosis
Needs tube feeding related to cannot swallow safely, as evidenced by feeding tube in nose or stomach and relies on prescribed feeds.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Check tube position before each feed. | A tube in the wrong place, such as the lungs, can cause serious harm if feed is given, so checking confirms the stomach before feeding. |
| 2. Keep head raised at least 30 degrees. | A raised head prevents feed flowing back up and entering the lungs. |
| 3. Flush as ordered. | Flushing keeps the tube clear of blocking feed and medicine. |
| 4. Give mouth care. | Without eating, the mouth dries and germs grow, so mouth care keeps it clean and comfortable. |
| 5. Watch for vomiting or diarrhea. | Vomiting or diarrhea may mean a problem with feed rate, position or tolerance that needs a change. |
Expected outcomes
- Receives full prescribed nutrition by tube.
- No aspiration, vomiting, or diarrhea.
- Tube stays in place and open.
- Mouth stays clean and moist.
Linking the data to the diagnosis
The stroke patient cannot swallow and receives all nutrition through a nasogastric tube. His wife says he cannot eat anymore since the stroke. The nurse finds the tube in place at the marked length, feeds running at the ordered rate, the head of the bed at 35 degrees and weight steady. This is an actual problem because he depends on the tube now. A statement about trouble swallowing would describe the cause, but this one fits the nursing care of the tube and feeds. The plan aims for full prescribed nutrition, no aspiration, vomiting or diarrhea, a tube that stays in place and open, and a clean moist mouth.