Chapter 44 Enteral Nutrition Flashcards
what is an orogastric tube? for __ term nutritional support. A tube is inserted through the __ into the __. Contains a wide outlet for removal of __ contents.
short-term nutritional support
mouth into the stomach
gastric contents
What is a nasogastric tube? for __ term nutritional support. a tube is inserted through the __ into the __
it is used to remove __ and __ from the upper GI tract
for short-term nutritional support
nose into the stomach
fluid and gas
enterostomal tube Stomach (PEG)
For __ term nutritional support. Requires moderate __. insertion is done with a lighted endoscope it is inserted via the patient’s __ toward the __, the stomach is inflated with __. The PEG tube is guided down the esophagus, into the stomach, and through the abdominal incision.
For long-term nutritional support.
Requires moderate sedation.
mouth toward the stomach,
the stomach is inflated with air.
What is a J tube? For __ term nutritional support. It is indicated when the gastric route is not accessible, or to decrease __ risk when the stomach is not functioning adequately to process and empty food and fluids.
For long-term nutritional support.
aspiration
An orally or nasally placed feeding tube should stay in place for no more than \_\_\_ before being replaced with a new tube. A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks
D. 4 weeks
Enteric tubes are never inserted in patients with basilar skull __ or in those who have had maxillofacial surgery or facial __ or in those with uncontrolled coagulation abnormalities.
basilar skull fractures
facial trauma
What steps can be taken to declog a feeding tube Select All that Apply A. warm water irrigation B. cold water C. milking the tube D. infusive digestive enzymes E. Mechanical declogging devices
A. warm water irrigation
C. Milking the tube
D. infusive digestive enzymes
E. Mechanical declogging devices
To maintain patency the tube is irrigated with ___ after every feeding and medication delivery and every __ to __ hours during continuous feedings or if the tube is set to gravity drainage or suction
water
4-6 hours
sterile ___, ___ or ___ can be used as irrigants, depending on the patient’s electrolyte levels and ability to fight infection.
sterile saline, water or tap water
The nurse records the A. amount B. color C. Suction type D. type of drainage
A. amount
B. color
D. type of drainage
The nose is inspected daily for skin irritation and the nasal tape is changed every \_\_ days and as needed. A. 1 B. 3 C. 4 D. 2
B. 3
If the nasal and pharyngeal mucosae are excessively dry __ or __ vapor inhalations may be beneficial
steam or cool
The nurse should be vigilant for symptoms o fluid volume deficit in patients receiving enteral nutrition. These can include A. diaphoresis B. dry skin C. decreased urinary output D. Lethargy E. lightheadedness F. Tachycardia G. Hypotension H. Bradycardia
B. Dry skin C. Decreased urinary output D. Lethargy E. Lightheadedness F. Tachycardia G. Hypotension
Pulmonary complications from gastric intubation can occur because __ and clearing of the pharynx are impaired
coughing
Feedings and medication should always be given with the patient in the ___ position, and the patients head should be elevated at least __ to __ degrees to reduce the risk of reflux and pulmonary aspiration
semi- fowler position
30-45 degrees
How long should the patient sit up for after completion of feedings` A. 30 mins B. 45 mins. C. 1 hour D. 2 hours
C. at least 1 hour
what position can be considered when it is not possible or advisable to elevate the head of the patient's bed? A. transverse B. reverse trendelenburg C. Lateral D. Sims
B. reverse trendelenburg
Patients at risk for aspiration include those older than __ years of age, unable to protect their airways, with altered __ status, receiving mechanical __ with gastric or __ tubes an in the __ position
70 years of age. mental status, mechanical ventilation enteral tubes, supine position
signs and symptoms of pulmonary complications include
coughing during the administration of foods or medications
difficulty clearing the airway
tachypnea
fever
How should the nurse assess for pulmonary complications
regular auscultation of lung sounds and monitoring of vital signs and lab values
If tube position is ever in question ___ confirmation is essential
radiographic
Nasoduodenal or nasojejunal feeding is indicated when the esophagus and __ need to be bypassed or when the patient is at risk for __
stomach, aspiration
for tube feedings longer than __ weeks, gastrostomy or jejunostomy tubes are preferred
4 weeks
The osmolality of normal fluids is approximately __ mOsm/kg. Osmolality is an important consideration for patients receiving tube feedings through the duodenum or jejunum b/c feeding formulas with a high osmolality may lead to undesirable effects
300
what is dumping syndrome
dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly.
Side effects of dumping syndrome
feelings of fullness, nausea, cramping, dizziness, diaphoresis, and osmotic diarrhea.
side effects of dumping syndrome can lead to
dehydration, hypotension and tachycardia
Tube feedings are delivered by either an open or a closed system.
the open system can be used for bolus feedings, intermittent feedings, or continuous drip feedings and can be delivered by push, gravity, or pump.
to avoid bacterial contamination the formula hang time in the bag at room temp should never exceed what the formula manufacturer recommends which is usually no more than __ to __ hours
4 to 8
close delivery systems use a prefilled, sterile container of about 1L of formula that is spiked with enteral tubing and allows a hangtime of __ to __ hours at room temperature
24-48 hours
Patients receiving gastric or enteric feedings can experience diarrhea. possible causes of diarrhea include
malnutrition medications C-DIFF Zinc deficiency concomitant lactose concomitant hyperthyroidism dumping syndrome contamination of the formula and feeding equipment
Possible causes of constipation from gastric of enteric feedings include
inadequate water intake
administration of fiber-free tube feeding formula
concomitant use of opioids
water flushes are given every __ hours and after feedings to prevent hypertonic dehydration
4 hours
for a patient to be considered for tube feeding at home, the patient should
be medically stable and successfully tolerating at least __% to __ % of the feeding regimen
be capable of self-care or have a caregiver willing to assume the responsibility
have access to supplies and interest in learning how to administer tube feedings at home.
60%-70%
The first fluid nourishment is given soon after tube insertion and can consist of sterile water or normal saline flush of at least __ ml.
Formula feeding can begin as prescribed, typically within __ to __ hours post tube insertion
30 mL
2-24 hours
The skin surrounding a gastrostomy or jejunostomy requires special care b/c it may become irritated from the enzymatic action of gastric or intestinal juices that may leak around the tube. Left untreated the skin becomes __ and __
macerated and painful
The nurse washes the area around the tube under the bumper with __ and __ or 2% chlorhexidine gluconate daily and as needed to remove any encrustation
soap and water
if soap and water is used the area is rinsed well with __ and patted _
water, dry
if 2% chlorhexidine is used the area is allowed to __ dry
air
it is normal to see scant __ drainage at the site a few days post-op.
serous
The nurse rotates the tube once daily to prevent skin breakdown and __ __ syndrome
buried bumper
Buried bumper syndrome can occur when there is excessive traction on the G tube from the external retention bolster to the extent that the internal fixation bolster becomes imbedded in the gastric __, This causes __ during feedings and can lead to tube __ and peritonitis
mucosa
pain
obstruction
During the postoperative course, the most common complications are __ infections or cellulitis at the exit site, bleeding, leakage, excessive tightness of external retention bolster, and dislodgement
wound
dislodgement of a recently inserted tube requires immediate attention b/c the tract can close within __ to __ hours if the tube is not replaced promptly
4 to 6
parenteral nutrition is a method of providing nutrients to the body by an __ route
IV
The goals of PN are similar to the goals of enteral feedings; namely to improve __ status, establish a positive __ balance, maintain muscle __. promote weight maintenance or gain and enhance the healing process
nutritional status
nitrogen
muscle mass
The indications for PN include an inability to digest adequate oral food or fluids within a __ to __ day timeframe.
7 to 10
enteral nutrition should be considered before __ support. B/C it assists in maintaining gut mucosal integrity and improved immune function and is typically associated with fewer complications.
parenteral
PN may be given through either __ or __ IV lines, depending on the patient’s condition and the anticipated length of therapy. An infusion pump is always used for the administration of PN
peripheral or central
Percutaneous central catheters are used for short-term less than __ weeks IV therapy in acute care settings. The subclavian vein is the most common vessel accessed b/c the subclavian area provides a stable insertion site to which the catheter can be anchored, is easily compressible, allow the patient freedom of movement, and provides easy access to the dressing site.
6 weeks
The subclavian site should be avoided in patients with __ kidney disease and those on __ to prevent subclavian vein stenosis.
advanced
hemodialysis
Peripherally inserted central catheters (PICCs) are used for __-term (several days to months) IV therapy in the hospital, long-term care, or home setting.
intermediate
If the PN solution is abruptly terminated __ dextrose can be given at the same rate the PN solution was infusing for __ to __ hours to prevent rebound hypoglycemia.
isotonic dextrose
1 to 2 hours
The catheter is another major source of colonization and __. The use of chlorhexidine/silver sulfadiazine or minocycline/rifampin-impregnated catheters is recommended for a patient whose catherer expected to remain in place for longer than 5 days
infection
