400 EXAM 2 Flashcards
1
Q
ϖ Insertion of a flexible tube into the stomach, beyond the pylorus into the duodenum (first part of small intestine) or the jejunum (second part)
A
GI intubation
2
Q
ϖ Reasons for GI Intubation
A
decompress the stomach
lavage
diagnose disorders
administer meds and feedings
compress a bleeding site
aspirate gastric contents
3
Q
o mouth to stomach
A
orogastric tube
4
Q
o Large-bore tube inserted through the mouth with a wide outlet for removal of gastric contents
A
orogastric tube
5
Q
do nurses put in the orogastric tubes?
A
NO
6
Q
nose to stomach
A
nasogastric tube
7
Q
NG tubes are used for?
A
decompression
admin meds
give feedings
fluids
8
Q
how long have NG tubes be in before you change it?
A
4 weeks
9
Q
NG tubes are not for long-term but more for ______.
A
suction
10
Q
2 types of gastric tubes?
A
Levin & Salem (gastric) pump
11
Q
the levin tube is connected to ____ _____ _____ (30-40mm Hg) to avoid erosion or tearing of the stomach lining.
A
low intermittent suction
12
Q
the gastric (salem) sump is a ____-lumen
A
double
13
Q
inner lumen of salem pump
A
vents the larger suction-drainage tube to the atomosphere
to prevent compression & injury to stomach
14
Q
where must the salem pump stay?
A
above patient’s waste
(to prevent reflux of gastric contents through it
15
Q
used for providing nutrients, fluids, medication
soft and playable.
A
• Nasoenteric tubes
16
Q
• Nasoenteric tubes are inserted by who?
A
surgeon
17
Q
goes into stomach and then in 24 hours will be in small intestine via peristalsis
A
• Nasoenteric tubes
18
Q
add how many inches for intestinal or stomach placement of tube?
A
stomach: 4-6 inches
intestinal: 8-10 inches
19
Q
should be used to confirm tube placement in stomach (Feedings)
A
• X-ray
20
Q
• Each time liquids or medications are administered and each shift for continuous feedings, tube must be checked for?
A
correct placement:
21
Q
other ways to check placement?
A
measure tube length
aspiration color
pH measurement of aspirate
air auscultation
22
Q
gastric aspirate pH
A
1-5
23
Q
intestinal aspirate pH
A
6 or higher
24
Q
respiratory aspirate pH
A
7 or higher
25
what is usually clogging the tubes?
medications, or feedings
26
how to clear aspirate?
use 30-60ml syringe to aspirate contents and
if that doesn't work leave warm water in the tube for 5-15 minutes
if that doesn't work air insufflation (20 ml)
27
− Enzymes to clear tube may also be used to unclog NG tubes
digestive enzymes
28
how often to change the tape with NG tubes?
every 2-3 days
29
• Displacement of tube can occur by
positioning, moving, pulling, coughing, suctioning
30
• Do not replace tube if patient is post ____ or _____ surgery.
esophageal or gastric surgery
31
replacing the tube is a risk for interrupting ______.
anastomosis
32
when to irrigate the tube?
o 4-6 hours with continuous feedings
| o 2 times daily without continuous feedings (20ml)
33
possible complications with tubes
fluid volume deficit
dehydration
respiratory complications
34
sx of dehydration
♣ Dry mouth, dry skin, decreased urine output, poor skin turgor, orthostatic hypotension, decreased blood pressure, lethargy, light-headedness, increased heart rate
35
♣ Coughing/clearing throat is impaired, increase risk of ______.
aspiration
| also tachypnea and fever
36
directly after tube feedings?
sit the patient up for 1 hour
37
medicines to prevent aspiration?
prokinetic agents (erythromycin and reglan)
38
how to pro kinetic agents work?
soften LES. help stomach empty fluids to prevent aspiration
39
what to do prior to removing the tube?
flush with 10 ml NS
40
o Given to meet nutritional requirements when oral intake is inadequate of not possible
enteral feedings
41
the GI tract is still functional with ____ feedings
enteral
42
advantages of enteral feedings
cheaper, safer, well tolerated by patients, easier to use
43
conditions that may require enteral therapy
```
Hypermetabolism
Neurological disease
Cancer
Psychiatric disease
Organ system failure
Learning disability
Failure to thrive
Facial/oral problems
Gastrointestinal disease
```
44
• Normal osmolality of body fluids is approximately ____ mOsm/kg
300
45
high osmolality feedings can cause ________ _____.
dumping syndrom
46
sx of dumping syndrome
fullness
nausea
diarrhea
47
dumping syndrome leads to ?
dehydration
hypotension
tachycardia
48
preventing dumping syndrome
slow down feedings formula rate
give feedings at room temp
admin feedings by drip and not bolus
stay in semi fowlers for 1 hr after feedings
instill minimum Amt of water when flushing.
49
− Administering feedings over 30 minutes at designated intervals by a reservoir enteral bag and tubing
• Intermittent gravity drip
50
− Lower risk for aspiration and complications
| − Delivery of feedings incrementally by slow drip over long periods
• Continuous feeding
51
• Continuous feedings by a slow drip may reduce ?
```
aspiration
nausea
distention
vomiting
diarrhea
```
52
− Infused feeding is given over 8-18 hours
| − Feedings can infuse at night to avoid interrupting the patient’s lifestyle
• Cyclic feeding
53
− May be appropriate for those being weaned from tube feedings to an oral diet, or those who cannot eat enough and need supplements, or those at home who need daytime hours free from the pump
• Cyclic feeding
54
when to check gastric residual?
o for intermittent before each feeding/med
o continuous feedings Q4H (return residual)
55
you can crush a ____ not a _____.
capsule; tablet
56
• At least 30-50mL of water or NS flush is administered when:
− Before and after each dose of medication and tube feeding
− After checking for gastric residuals and gastric pH
− Every 4-6 hours with continuous feedings
57
liquid meds via NG tube
no preg
58
simple compressed tablets via NG tube
crush and dissolve in water
59
buccal or sublingual tablets via NG tube
administer as prescribed
60
soft gelatin capsules filled with liquids via NG tube
puncture and squeeze out
61
what types of meds you can not crush for NG tube?
enteric coated
time released tablets
time released capsules
62
how often to change feeding tubing and bag?
q24 hours.
63
• NG or nasoenteric tube feeding can cause ?
diarrhea or constipation
64
o Causes of diarrhea
malnutrition
medications
C.dif from ATB use
Zinc deficiency
concomitant lactose intolerance
dumping syndrome
65
• Water flushes given Q4H and after feedings to prevent ?
hypertonic dehydration
66
o Feeding tube directly into the stomach
gastrostomy
67
ex of gastrostomy
PEG TUBE
68
o gastrostomy tubes can Also be used for gastric decompression when what occurs?
intestinal obstruction
69
o Preferred route if enteral nutrition is needed for longer than 4 weeks
gastrostomy
70
gastrostomy tubes are first choice for patients in a ____.
coma
71
• Initial tube can be removed and replaced once the tract is well established, typically 6 weeks to 3 months
PEG tube
72
o LPGD
• Low profile gastric device
73
have one way valve (so can't check residual)
inserted flush with the skin
LPGD
74
− Formula feeding can begin ___-____ hours post tube insertion
− Infusion rate gradually increased
2-24
75
− If tube placed for gastric drainage?
connect to low intermittent suction of gravity drainage bag (measure and record drainage)
76
o Normal to see ___ ___ drainage for a couple days
scant serous
77
the nurse needs to remember to ___ the tube daily
turn
78
– no turning of the tube can cause pain
o Buried bumper syndrome
79
Skin may become irritated from _______ action of leaking gastric juices
enzymatic
80
if skin is wet around stoma?
pat dry
81
− Skin at exit site is evaluated daily for signs of
breakdown, irritation, excoriation, presence of drainage or gastric leakage, bleeding
82
− Dislodgement requires immediate attention because tract can close within ___-___ hours if the tube is not replaced promptly
4 to 6
83
what to do if dislodgment occurs?
insert foley
84
tube feeding complications?
tube obstruction
vomiting/aspiration
diarrhea
constipation
dehydration
85
how to prevent tube obstruction?
crush all meds and flush with warm tap water
86
how to prevent diarrhea?
slow feedings
87
how to prevent constipation?
change formula or increase flushes
88
TPN is used when?
GI is not functional
89
Method of providing nutrients to the body by an IV route
TPN
90
ϖ If digestive system isn’t working or needs to rest you would use what type of nutrition?
TPN
91
goals for TPN
ϖ to improve nutritional status, establish a positive nitrogen balance, maintain muscle mass, promote weight maintenance or gain, and enhance the healing process
92
how long can you use TPN
7-10 days
| b/c high glucose, protein, and fat
93
clinical indications for parenteral nutrition
insufficient intake
impaired ability to ingest food
unwilling or unable to digest nutritients
prolonged preop and postop nutritional needs
major body burns
inability to ingest adequate oral or fluids within 7 days
malnourished
94
o need about _____-_____ calories a day
1200-1500
95
amt of formula administered over a 24 hour period
1-3 L
96
o Simply looks like milk hanging in a bag
o Has to be ordered by physician - individualized
formula
97
o Inspect bag---> do not use if:
* Separation and oily appearance – cracked solution
| * Precipitate – white crystal
98
what to do if formula is cold?
let it sit out for 30-45 minutes
99
single or double lumen
bacillic or cephalic vein
PIC
100
jugular vein or subclavian
inserted by surgeon or ACNP
central line
101
needs a fllter
TPN
102
does not need a filter
INTRAVENOUS FAT EMULSIONS (IVFEs)
103
• Usually length of therapy is 5-7 days
o Peripheral Method PPN
104
TPN is delivered through?
central line
105
PPN is delivered through?
PIC line
106
the middle lumen is used for?
food
107
parenteral Solution discontinued _____ to allow patient to adjust to glucose levels
gradually
108
if parenteral solution is stopped abruptly, what do you need to do?
o isotonic dextrose can be administered at same rate for 1-2 hrs
109
♣ The most common complication of central line
pneumothroax
110
site care for central line
monitor for infection
change dressing every 7 days
high risk for bacterial growth
111
the more you change the dressing-----
the higher risk for infection
112
sx of infection with central line
Redness, drainage, erythema
113
sx of sepsis with central line
− fever, chills, N/V, septic shock, even death
114
how to prevent air embolism
make sure cap is tight
115
what if you walk into room and cap is off ?
valsalva maneuver
116
• Sometimes given with TPN
Patients who need large amount of calories quickly and you’re worried about fluid overload
fat emulsions
117
• patients can have allergic reactions to fat emulsions. what is sx?
for dyspnea, fever, cyanosis, flushing, phlebitis
118
• If solution runs out ?
10% dextrose and water infused at same rate
