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HLTENN005 Contribute to nursing care of a person with complex needs > Assessment 5 Knowledge Based Test > Flashcards

Assessment 5 Knowledge Based Test Flashcards

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1
Q

Oxygen Administration

What flow rates would normally be used with nasal cannula (nasal prongs)?

Identify flow in Fi02 and l/min

A

24 - 38%, 1 - 2 litres per minute
30 - 35%, 3 - 4 litres per minute
38 - 44%, 5 - 6 litres per minute

This device is well tolerated by most individuals.

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2
Q

Oxygen Administration

What flow rate would normally be used with a simple face mask?

Identify flow in Fi02 and l/min

A

35 - 65%, 8 - 12 litres per minute

High flow of oxygen prevents the rebreathing of CO2.

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3
Q

Oxygen Administration

What flow rate would normally be used with an oxygen mask with reservoir bag (non-rebreather)?

Identify flow in Fi02 and l/min

A

60 - 100%, 6 - 15 litres per minute

This device allows for a higher Fi02 to be administered. A valve closes during expiration so that exhaled air does not enter the reservoir bag and be rebreathed.

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4
Q

Oxygen Administration

What flow rate would normally be used with a venturi mask?

Identify flow in Fi02 and l/min

A

60 - 100%, 4 - 15 litres per minute

This device is one of the most accurate ways to deliver oxygen. Different-sized adapters are used to deliver a fixed or predicted Fi02. It is ideal for CO2 retainers or hypoxic individuals.

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5
Q

Oxygen Administration

What flow rate would normally be used with a head box?

Identify flow in Fi02 and l/min

A

21 - 100%, 0.25 - 3 litres per minute

A transparent plastic box that fits over the head or shoulders of an infant. The infant can be observed easily, and a high concerntration of oxygen can be administered.

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6
Q

The Respiratory System

Describe “airway resistance”

A

Refers to the impairment of flow as air moves though the airways.

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7
Q

The Respiratory System

Describe “lung compliance”

A

A reflection of the elasticity of the lung, and surface tension on the alveoli, which determines the relative east of lung inflation.

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8
Q

The Respiratory System

Describe “inspiration”

A

Air being drawn into the lungs as the diaphragm contracts and flattens

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9
Q

The Respiratory System

Describe “expiration”

A

Air leaving the lungs as the diaphragm relaxes and decreases thoracic capacity

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10
Q

The Respiratory System

Describe “ventilation”

A

Refers to the entire process of inspiration and expiration

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11
Q

The Respiratory System

Describe the process of respiration, using the three processes

A

Ventilation: Being the movement of air between the atmosphere and the respiratory portion of the lungs

Perfusion: Being the flow of blood through the lungs

Diffusion: The transfer of gases between the alveoli and the blood

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12
Q

The Respiratory System

Define URTI

A

Upper Respiratory Tract Infection

Infection involving the nose, sinuses, pharynx, larynx or trachea.

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13
Q

The Respiratory System

Define LRTI

A

Lower Respiratory Tract Infection

Infection involving the bronchi, bronchioles, alveoli and lungs

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14
Q

The Respiratory System

Define APO

A

Acute Pulmonary Oedema

Fluid accumulation in lungs, impairing gas exchange and lung compliance

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15
Q

The Respiratory System

Define COPD

A

Chronic Obstructive Pulmonary Disease

Progressive lung disease, most commonly emphysema and chronic bronchitis

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16
Q

The Respiratory System

Define TB

A

Tuberculosis

Bacterial infection in the lung, Mycobacterium tuberculosis

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17
Q

The Respiratory System

Define PE

A

Pulmonary Embolism

Blood clot preventing blood flow to or in the pulmonary artery

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18
Q

The Respiratory System

Define the chronic inflammatory disorder of the lung

A

Asthma

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19
Q

The Respiratory System

Define the progressive disease characterised by over-distension and destruction of alveolar walls

A

Emphysema

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20
Q

The Respiratory System

Define the disease which commonly affects the bronchus and rapidly invades lung tissue

A

Lung cancer

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21
Q

The Respiratory System

Define the slow progressive obstruction of the airways

A

COPD

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22
Q

Define the chronic inflammatory process which causes vasodilation, congestion and oedema of the bronchial mucosa

A

Chronic bronchitis

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23
Q

The Respiratory System

Identify and describe four traumatic respiratory disorders

A

Pneumothorax: Which is an accumulation of air in the pleural space causing lung collapse

“Flail chest”: Multiple rib fractures leading to a “floating chest”

Heamothorax: Accumulation of blood in th pleural space

Laryngotracheal trauma: Crushing wound to the larynx or trachea resulting in airway obstruction

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24
Q

The Musculoskeletal and Integumentary Systems

What are the five functions of the skeleton?

A

Support and stabilisation of soft tissues

Protection of vital organs

Assists in body movement providing leverage and attachment points for muscles

Manufacture of red blood cells in bone marrow (Haematopoeisis)

Storage of fats and mineral salts, such as phosphorus and calcium

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25
Q

The Musculoskeletal and Integumentary Systems

Why is the protection of the musculoskeletal system so important?

A

The musculoskeletal system is the supporting structure of the body, providing protection for soft tissues, and enabling movement and function

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26
Q

The Musculoskeletal and Integumentary Systems

Define and describe five diseases that impact the bones and skeletal system

A

Fracture: A broken or cracked bone, involving a simple fracture to multiple fractures, and extension to other body systems

Sprain: Damage to ligament, usually as a result of hyperextension

Strain: Damage to muscle and/or tendon, usually as a result of overexertion

Osteoporosis: A disease defined by decrease in bone mass, increase in bone porousness, and an increased susceptability to fractures

Osteomyelitis: An acute or chronic infection in the bone, bone marrow, and surrounding soft tissues. Usually bacterial in origin, but can be fungal, parasitic, or viral

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27
Q

The Musculoskeletal and Integumentary Systems

Define and describe three disorders that affect the joints and tendons

A

Rheumatoid Arthritis: Chronic, systemic autoimmune disease that causes inflammation of connective tissue, primarily in the joints

Osteoarthritis: Degenerative joint disease that causes degradation of the cartilage at the joints, leading to bone ends rubbing together and synovitis

Gout: Metabolic disease caused by inflammatory response to the production or excretion of uric acid in the blood, causing accumulation of urates in the joints

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28
Q

The Musculoskeletal and Integumentary Systems

Define ten types of fractures

ACCGILOOST

A

Avulsion
Comminuted
Compression
Greenstick
Impacted
Linear
Oblique (Displaced)
Oblique (Non-displaced)
Spiral
Transverse

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29
Q

The Musculoskeletal and Integumentary Systems

Define the six aims of care for an individual with a musculoskeletal disorder

A

Promote rest or gentle movement
Relieve pain
Prevent complications
Maintain skin integrity
Maintain adequate nutritional status
Promote rehabilitation

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30
Q

The Musculoskeletal and Integumentary Systems

Identify the five stages of bone healing

BOICR

A
  1. Bleeding at fractured ends of the bone with haemotoma formation
  2. Organisation of haematoma into a fibrous network
  3. Invasion of osteoblasts, lengthening of collagen strands and deposition of calcium
  4. Callus formation as new bone builds up as osteoclasts break down dead bone
  5. Remodelling is accomplished as excess is reabsorbed and trabecular bone is laid down
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31
Q

The Musculoskeletal and Integumentary Systems

Define the seven influences that delay bone healing

AIIFMNR

A

Age
Infection
Ischaemia
Fat emboli
Mobility
Nutritional status
Remnant bone

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32
Q

The Musculoskeletal and Integumentary Systems

Describe a VTE and how to prevent them

A

Venous thromboembolism is the blockage of a vein caused by a thrombus, or blood clot, which commonly occur in the legs. Prevention includes regular leg exercise, antiembolic stocking application, sequential compression device therapy, and prophylactic anti-thrombotic medication

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33
Q

The Musculoskeletal and Integumentary Systems

Define four conditions that might contraindicate application of antiembolic stockings

A

Dermatitis
Skin grafts
Size of legs
Peripheral vascular disease

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34
Q

The Musculoskeletal and Integumentary Systems

Define the signs and symptoms of compartment syndrome

A

Swelling
Restriction of movement
Vascular compromise
Pain or lack of sensation
Severe pain during muscle stretch

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35
Q

The Musculoskeletal and Integumentary Systems

Define the six observations required during a neurovascular assessment

A

Presence of pulses
Temperature of the limb
Movement ability of the limb
Skin colour of the limb
Sensations at the limb
Capillary refill at the limb

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36
Q

The Musculoskeletal and Integumentary Systems

Define the three basic layers of the skin, and their function

A

Epidermis: Outermost layer, Avascular, protects tissue, stores melanin, contains phagocytes
Dermis: Second layer, vascular, nutrient supply to epidermis, regulation of body temperature, contains sensory receptors, contains hair follicles, subcutaneous glands and sweat glands
Subcutaneous: Innermost layer, vascular, protective and supportive layer, provides insulation and temperature regulation, contains storage for fat

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37
Q

The Musculoskeletal and Integumentary Systems

Define the four functions of the skin

A

Protection
Thermoregulation
Metabolism
Sensory perception

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38
Q

The Musculoskeletal and Integumentary Systems

Define five factors that impact skin integrity

A

Age
Poor nutrition
Trauma
Excess moisture
Infection

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39
Q

The Musculoskeletal and Integumentary Systems

Define the signs and symptoms of Psoriasis

A

Red patches of thick, silvery scales on the skin, which may be accompanied by itching, burning, or painful lesions

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40
Q

The Musculoskeletal and Integumentary Systems

Define the signs and symptoms of Pityriasis

A

Scaly and pink macular rash usually occuring on back, torso, or abdomen, and may be mildly itchy.

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41
Q

The Musculoskeletal and Integumentary Systems

Define the signs and symptoms of contact dermatitis

A

Caused when an irritant substance comes into contact with the skin, causing inflammation and rash, which may be red, scaly and cracked in appearance

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42
Q

The Musculoskeletal and Integumentary Systems

Define the signs and symptoms of melanoma

A

A malignant tumour, seemingly related to excess sun exposure. Appears as a flat, irregular macule in the early stages, progressing to a dark brown or black spot. The moles may itch or bleed.

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43
Q

The Musculoskeletal and Integumentary Systems

Define and describe a superficial thickness burn

A

A burn which has affected only the epidermal layer of the skin, leaving the skin dry, erythematous, oedematous and hypersensitive, causing irritation and pain.

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44
Q

The Musculoskeletal and Integumentary Systems

Define and describe a partial thickness burn

A

A burn which has affected the epidermal and dermal layers of the skin, leading to erythematous flesh, poor vascularity, blistering, and significant pain.

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45
Q

The Musculoskeletal and Integumentary Systems

Define and describe a full thickness burn

A

A burn which has affected the epidermal, dermal and subcutaneous layers of the skin, leaving charred flesh, no blisters, little pain as the nerve endings have been destroyed, no vascularity, and appears white or charred black.

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46
Q

The Musculoskeletal and Integumentary Systems

Define the nursing care required for a patient with a full thickness burn

A

Manage shock
Manage hydration
Wound care
Manage nutrition
Pain management
Promote mobility
Manage scarring
Psychological support

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47
Q

Special Senses

Define the action and an example of a miotic medication

A

Any medication which causes constriction of the pupil of the eye, to allow visualisation of other eye structures; Acetylcholine chloride

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48
Q

Special Senses

Define the action and an example of an eye-related beta blocker

A

Reduce blood pressure, which can be used to reduce intraocular pressure, as a treatment for glaucoma; Betaxolol

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49
Q

Special Senses

Define the action and an example of a mydriatic

A

Any medication which causes dilation of the pupil, allowing visualisation of other eye structures; Atropine sulfate

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50
Q

Special Senses

Define the action and an example of an eye related carbonic anhydrase inhibitors

A

A group of medications which supress the action of carbonic anhydrase, an enzyme which interacts with carbon dixoxide and water to create carbonic acid, and helps reduce intraocular pressure; Acetazolamide

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51
Q

Special Senses

Define the action and an example of a opthalmic vasoconstrictor

A

Medications which are used to constrict the blood vessels within the eye, reducing blood flow and intraocular pressure; Brimonidine tartrate

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52
Q

Special Senses

Define the action and give an example of artificial tears

A

Medications, often based on normal saline, which artificially moisturise the eyes in cases where dry eyes is a problem; Normal saline

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53
Q

Define the action and give an example of diuretic used for eyes

A

A group of medications which increase fluid output, which may be prescribed to reduce intraocular pressure; Acetazolamide

54
Q

Special Senses

Define the action and give an example of an antibiotic used for eyes

A

Medications used to treat bacterial infection, such as bacterial conjunctivitis; Chloramphenicol

55
Q

Special Senses

Define the action and give an example of an anti-vertigo

A

Medications used to prevent and relieve the symptoms of vertigo, such as dizziness or a feeling of spinning; Hyoscine hydrobromide

56
Q

Special Senses

Define the action and give an example of an antibiotic used in the ear

A

Medications used to treat bacterial infection, such as bacterial otitis media; Chloramphenicol

57
Q

Special Senses

Define the action and give an example of a sedating anti-histamine used for the skin

A

Medications which inhibit the actions of histamine in the body, to prevent or manage allergic reaction, which also have a sedative effect; Promethazine hydrochloride

58
Q

Special Senses

Define the action and give an example of a non-sedating anti-histamine used for the skin

A

Medications which inhibit the actions of histamine in the body, to prevent or manage allergic reactions, which do not have a sedative effect; Fexofenadine hydrochloride

59
Q

Special Senses

Define the action and give an example of an anti-fungal used for the skin

A

Medications which act on fungal agents, inhibiting or prohibiting fungal growth; Clotrimazole

60
Q

Special Senses

Define the action and give an example of an antibiotic used for the skin

A

Medications used to treat bacterial infection, such as MRSA; Linezolid

61
Q

Special Senses

Define the action and give an example of an anti-parasitic used for the skin

A

Medications used to treat parasitic infestation, such as scabies; Permethrin

62
Q

The Cardiovascular System

Define the structures which make up the cardiovascular system

A

Heart
Blood
Blood vessels
Lymphatic system

63
Q

The Cardiovascular System

Define nine clinical manifestations of a cardiac disorder

A

Chest pain
Dyspnoea
Palpitations
Cough
Fatigue
Cyanosis
Syncope
Oedema
Abnormal pulse

64
Q

The Cardiovascular System

Define six clinical manifestations of a vascular disorder

A

Intermittent claudication
Pain at rest
Pale, cold extremities
Altered peripheral pulses
Gangrene
Leg ulcers

65
Q

The Cardiovascular System

Describe a myocardial infarction and the signs and symptoms a patient may present with

A

Myocardial infarction is the death of part of the myocardium as a result of severe or total ischaemia. Patients may present with central chest pain radiating to the jaw, arms, neck or back which lasts longer than five minutes; cold, clammy skin; Nausea and/or vomiting; dyspnoea; and angina amini.

66
Q

The Cardiovascular System

Explain how a MI would be diagnosed

A

Collection of blood to assess for the presence of the blood mark troponin, a cardiac enzyme, whose presence in the blood is an indicator of cardiac cell death, and allows diagnostic differentiation between angina and myocardial infarction.

67
Q

The Cardiovascular System

Describe the nursing interventions for a patient experiencing a MI

A

Pain management
Keep patient calm and still
Monitor for arrhythmia
Maintain ECG until pain free
Medication administration
Monitor oxygen saturation
Monitor for hypoxia
Monitor for signs of infection
Psychological management

68
Q

The Cardiovascular System

Describe the causes of angina

A

Angina is caused by diminished blood supply carrying oxygen to the heart, considered a reversible ischaemic process, and a precursor or warning sign of an impending MI

69
Q

The Cardiovascular System

Define the four types of angina

A

Stable angina
Unstable angina
Vasospastic angina
Microvascular angina

70
Q

The Cardiovascular System

Describe the treatment options for angina

A

Cardiac stress test to confirm diagnosis
Patient education to reduce stress and manage exertion
Pharmacological interventions (GTN, beta blockers, calcium channel blockers)
Angioplasty
Bypass surgery

71
Q

The Cardiovascular System

Define the cardiovascular disease which may require insertion of a pacemaker

A

Heart block, an arrhythmia where the heart beats to slowly, caused by an error in the hearts eletrical conductive system

72
Q

The Cardiovascular System

Describe ischaemic heart disease

A

Ischaemic heart disease is where the coronary arteries become diseased and are unable to supply adequate blood flow to the heart

73
Q

The Cardiovascular System

Describe atherosclerosis

A

Atherosclerosis is a deposition of atheromatous plaque within the walls of the artery, thus causing narrowing and loss of elasticity, followed by fibrosis and calcification, resulting in an occluded, inelastic artery and severely retarded blood flow, if at all.

74
Q

The Cardiovascular System

Describe arrhythmia

A

Abnormal heart rhythm

75
Q

The Cardiovascular System

Describe ischaemia

A

Diminished blood supply

76
Q

The Cardiovascular System

Describe anaemia

A

Reduced red blood cell count

77
Q

The Cardiovascular System

Describe infarction

A

Death of tissue

78
Q

The Cardiovascular System

Describe asystole

A

Absence of ventricular contraction

79
Q

The Cardiovascular System

Describe angioplasty

A

Widening of coronary artery that have become occluded

80
Q

The Cardiovascular System

Describe a STEMI

A

ST elevated myocardial infarction, caused by a sudden and complete blockage of a coronary artery

81
Q

The Cardiovascular System

Describe a NSTEMI

A

Non ST elevated myocardial infarction, caused by a severely occluded artery, but not completely occluded

82
Q

The Cardiovascular System

Define three infectious and inflammatory conditions of the heart

A

Pericarditis
Myocarditis
Endocarditis

83
Q

The Cardiovascular System

Describe the meaning of the abbreviations AF, Af, SVT, VT, and VF

A

Atrial fibrillation
Atrial flutter
Supraventricular tachycardia
Ventricular tachycardia
Ventricular fibrillation

84
Q

The Cardiovascular System

Decribe a pulmonary embolism (PE)

A

A pulmonary embolism is when a blood clot enters the pulmonary artery, occluding blood flow to the lungs

85
Q

The Cardiovascular System

Describe the causes of a PE

A

Movement of an embolised clot, usually from the legs as a result of venous thromboembolism, which becomes lodged in the pulmonary artery, partially or completely occluding it.

86
Q

The Cardiovascular System

Define peripheral vascular disease (PVD)

A

A blood circulation disorder that causes the blood vessels outside of the heart and brain to narrow, block or spasm

87
Q

The Cardiovascular System

Describe the clinical manifestations of PVD

A

Intermittent claudication
Pain at rest
Pale, cold extremities
Altered peripheral pulses
Gangrene
Leg ulcers

88
Q

The Cardiovascular System

Define lymphoedema

A

Swelling due to blocked lymphatic circulation

89
Q

The Cardiovascular System

Define aneurism

A

Burst blood vessel

90
Q

The Cardiovascular System

Define leukaemia

A

Cancer of the blood

91
Q

The Cardiovascular System

Define electrocardiogram

A

Measurement of the electrical activity of the heart

92
Q

The Cardiovascular System

Define hypertension

A

Elevated blood pressure

93
Q

The Cardiovascular System

Define pulmonary embolism

A

Blood clot in the pulmonary artery

94
Q

The Cardiovascular System

Define anaemia

A

Reduced red blood cell, haemoglobin, and iron count

95
Q

The Cardiovascular System

Define phlebitis

A

Inflammation of the blood vessels

96
Q

The Cardiovascular System

Define myocardial infarction

A

Death of the cells of the myocardium

97
Q

Enteral Feeding and Gastrointestinal Disorders

Define gastritis

A

Inflammation of the gastric mucosa

98
Q

Enteral Feeding and Gastrointestinal Disorders

Define gastroenteritis

A

Inflammation of the mucosal lining of the stomach and intestines

99
Q

Enteral Feeding and Gastrointestinal Disorders

Define haemorrhoids

A

Distended or swollen veins in the anal area, either internal or external

100
Q

Enteral Feeding and Gastrointestinal Disorders

Define bowel obstruction

A

Mechanical or functional obstruction of the intestines

101
Q

Enteral Feeding and Gastrointestinal Disorders

Define Crohn’s disease

A

A form of irritable bowel disease which can affect any part of the GI tract from the mouth to the anus, but most commonly affects the small intestine and/or colon

102
Q

Enteral Feeding and Gastrointestinal Disorders

Define ulcerative colitis

A

Irritable bowel disease which affects the mucosal and submucosal layers of the colon causing inflammation leading to ulceration, bleeding, mucous production and necrosis

103
Q

Enteral Feeding and Gastrointestinal Disorders

Define cholelithiasis

A

Acute inflammation of the gallbladder wall, caused by stones in the cystic or common bile duct

104
Q

Enteral Feeding and Gastrointestinal Disorders

Define appendicitis

A

Acute inflammation of the veriform appendix

105
Q

Enteral Feeding and Gastrointestinal Disorders

Define peptic ulcer

A

Localised area of erosion and ulceration in the stomach mucosa or duodenum

106
Q

Enteral Feeding and Gastrointestinal Disorders

Define illeostomy

A

A surgically formed fistula from the ileum to the abdominal wall

107
Q

Enteral Feeding and Gastrointestinal Disorders

Define ascities

A

Abnormal fluid buildup in the abdomen

108
Q

Enteral Feeding and Gastrointestinal Disorders

Define maleana

A

Abnormal black tarry stool containing blood

109
Q

Enteral Feeding and Gastrointestinal Disorders

Haematemesis

A

Vomiting of blood

110
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the required treatment for a bowel obstruction

A

Implement nil by mouth, clear fluids, free fluids, or liquid diet as indicated; Insertion of nasogastric tube on straight drainage, aspirating every four hours; Implement intravenous therapy for fluid and mineral intake; A bowel resection may be required to remove the obstructed section of bowel, and a stoma may be required

111
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the clinical manifestations of Crohn’s disease

A

Abdominal pain and tenderness
Feeling of a filled abdomen
Fatigue
Diarrhoea, which may contain blood, mucous or pus
Constipation
Nausea
Weight loss
Pyrexia
Rectal bleeding
Inflammation of the joints, eyes and/or mouth

112
Q

Enteral Feeding and Gastrointestinal Disorders

Describe how Crohn’s disease is diagnosed

A

A physical examination; Complete blood count, with a focus on anaemia and white blood cell count; Computerised tomography (CT) scan of the abdomen; An endoscopic examination; and a barium swallow test

113
Q

Enteral Feeding and Gastrointestinal Disorders

Define seven symptoms of ulcerative colitis

A

Blood in stool
Nausea and vomiting
Diarrhoea
Low grade pyrexia
Abdominal pain and distension
Weight loss
Malabsorption

114
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the treatment and management of a peptic ulcer

A

Administration of antibiotics (if indicated) and proton pump inhibiting medication; Management of diet, reducing spicy and acidic foods; Surgery may be required in severe cases to repair the mucosal lining

115
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the specific questions required when taking a history from a patient with a GI disorder

A

When did the patient last void; last have their bowels open; What is their appetite like; what is their diet like; what is their fluid intake like; have they experienced any nausea, vomiting, indigestion or diarrhoea; and reproductive history for females

116
Q

Enteral Feeding and Gastrointestinal Disorders

Define where an enteral tube may be inserted

A

Nasogastric tube (NGT) or Percutaneous endoscopic gastrostomy (PEG)

117
Q

Enteral Feeding and Gastrointestinal Disorders

Describe when a patient would require an enteral tube

A

Enteral tubes are used to drain fluids and matter from the stomach to reduce the risk of aspiration if the patient were to vomit, and to provide food or medications to a patient who cannot swallow

118
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the nursing management required for a patient on NGT straight drainage

A

pH testing; Tube measurement; X-ray confirmation of location; Fluid balance chart; Input and output tracking

119
Q

Enteral Feeding and Gastrointestinal Disorders

Describe four contraindications for NGT

A

Maxilofacial disorders, surgery or trauma
Skull fractures
Oesophageal tumours, fistula or surgery
Laryngectomy

120
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the equipment required for NGT insertion

A

Nasogastric tube
Lubricant
Tissues
Disposable receptacle
Enteral syringe
Personal protective equipment
pH indicator strips
Securing tape
Scissors
Torch
Drainage bag
Cup of water
Emesis receptacle
Tongue depressor
Skin preparation
Cap/spigot
Pen

121
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the key nursing responsibilities when nursing a patient with an enteral feed

A

Confirm placement of tube before use; Patient should be reclined in semi-fowlers position during feeding and for 30 to 60 minutes post feed; Monitor for signs of respiratory difficulty, vomiting/regurgitation, tolerance to feed, abdominal distension, pain, or diarrhoea

122
Q

Enteral Feeding and Gastrointestinal Disorders

Describe five possible complications associated with enteral feeds

A

Tube migration; Tube blockage; Regurgitation; Intolerance; Aspiration

123
Q

Enteral Feeding and Gastrointestinal Disorders

Describe how the placement of a NGT is checked

A

Through usage of pH testing (aspirate less than 5.5) or an x-ray

124
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the process if the aspirate from a NGT had a pH greater than 5.5

A

If pH is more than 5.5, consult with medical officer or senior nurse for advice, and do not use the tube

125
Q

Enteral Feeding and Gastrointestinal Disorders

Describe how many mL of water should be mixed with crushed medication administered by a NGT

A

10 to 15 mL

126
Q

Enteral Feeding and Gastrointestinal Disorders

Describe how many mL of water should be used when flushing the NGT tube

A

15 to 30 mL

127
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the process for checking a NGT prior to use

A

Informed consent; Contraindications; pH test; Aspirate; X-ray; Measure tube; Semi-fowlers; Flush 10 to 20 mL; Give medication or food; Flush 10 - 20 mL; Spigot tube; Document fluid balance chart, pH and measurement

128
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the action and give an example of an antacid

A

Medications given to relieve excessive gastric acid in the stomach, which may lead to GORD and peptic ulcers; Calcium carbonate

129
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the action and give an example of a proton pump inhibitor

A

Medications which reduce gastric acid secretions; Pantoprazole

130
Q

Describe the action and give an example of a H2 antagonist

A

Medications which reduce gastric acid secretions; Nizatidine

131
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the action and give an example of a laxative/aperient

A

Medications which are taken to relieve constipation, by either improving peristaltic action or softening the stool; Lactulose

132
Q

Enteral Feeding and Gastrointestinal Disorders

Describe the action and give an example of an antidiarrhoel

A

Medications which are taken to relieve diarrhoea; Loperamide

HLTENN005 Contribute to nursing care of a person with complex needs (2 decks)

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