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Medical Surgical > Chapter 44 Enteral Nutrition > Flashcards

Chapter 44 Enteral Nutrition Flashcards

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USMLE® Step 1 flashcards
1
Q

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.

A

short-term nutritional support
mouth into the stomach
gastric contents

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2
Q

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

A

for short-term nutritional support
nose into the stomach
fluid and gas

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3
Q

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.

A

For long-term nutritional support.
Requires moderate sedation.
mouth toward the stomach,
the stomach is inflated with air.

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4
Q

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.

A

For long-term nutritional support.

aspiration

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5
Q 
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
A

D. 4 weeks

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6
Q

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.

A

basilar skull fractures

facial trauma

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7
Q 
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

A. warm water irrigation
C. Milking the tube
D. infusive digestive enzymes
E. Mechanical declogging devices

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8
Q

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

A

water

4-6 hours

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9
Q

sterile ___, ___ or ___ can be used as irrigants, depending on the patient’s electrolyte levels and ability to fight infection.

A

sterile saline, water or tap water

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10
Q 
The nurse records the
A. amount
B. color
C. Suction type
D. type of drainage
A

A. amount
B. color
D. type of drainage

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11
Q 
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
A

B. 3

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12
Q

If the nasal and pharyngeal mucosae are excessively dry __ or __ vapor inhalations may be beneficial

A

steam or cool

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13
Q 
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
A 
B. Dry skin
C. Decreased urinary output
D. Lethargy
E. Lightheadedness
F. Tachycardia
G. Hypotension
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14
Q

Pulmonary complications from gastric intubation can occur because __ and clearing of the pharynx are impaired

A

coughing

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15
Q

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

A

semi- fowler position

30-45 degrees

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16
Q 
How long should the patient sit up for after completion of feedings`
A. 30 mins
B. 45 mins.
C. 1 hour
D. 2 hours
A

C. at least 1 hour

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17
Q 
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
A

B. reverse trendelenburg

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18
Q

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

A

70 years of age. mental status, mechanical ventilation enteral tubes, supine position

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19
Q

signs and symptoms of pulmonary complications include

A

coughing during the administration of foods or medications
difficulty clearing the airway
tachypnea
fever

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20
Q

How should the nurse assess for pulmonary complications

A

regular auscultation of lung sounds and monitoring of vital signs and lab values

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21
Q

If tube position is ever in question ___ confirmation is essential

A

radiographic

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22
Q

Nasoduodenal or nasojejunal feeding is indicated when the esophagus and __ need to be bypassed or when the patient is at risk for __

A

stomach, aspiration

23
Q

for tube feedings longer than __ weeks, gastrostomy or jejunostomy tubes are preferred

A

4 weeks

24
Q

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

A

300

25
Q

what is dumping syndrome

A

dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly.

26
Q

Side effects of dumping syndrome

A

feelings of fullness, nausea, cramping, dizziness, diaphoresis, and osmotic diarrhea.

27
Q

side effects of dumping syndrome can lead to

A

dehydration, hypotension and tachycardia

28
Q

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

A

4 to 8

29
Q

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

A

24-48 hours

30
Q

Patients receiving gastric or enteric feedings can experience diarrhea. possible causes of diarrhea include

A 
malnutrition
medications
C-DIFF
Zinc deficiency
concomitant lactose
concomitant hyperthyroidism
dumping syndrome
contamination of the formula and feeding equipment
31
Q

Possible causes of constipation from gastric of enteric feedings include

A

inadequate water intake
administration of fiber-free tube feeding formula
concomitant use of opioids

32
Q

water flushes are given every __ hours and after feedings to prevent hypertonic dehydration

A

4 hours

33
Q

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.

A

60%-70%

34
Q

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

A

30 mL

2-24 hours

35
Q

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 __

A

macerated and painful

36
Q

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

A

soap and water

37
Q

if soap and water is used the area is rinsed well with __ and patted _

A

water, dry

38
Q

if 2% chlorhexidine is used the area is allowed to __ dry

A

air

39
Q

it is normal to see scant __ drainage at the site a few days post-op.

A

serous

40
Q

The nurse rotates the tube once daily to prevent skin breakdown and __ __ syndrome

A

buried bumper

41
Q

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

A

mucosa
pain
obstruction

42
Q

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

A

wound

43
Q

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

A

4 to 6

44
Q

parenteral nutrition is a method of providing nutrients to the body by an __ route

A

IV

45
Q

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

A

nutritional status
nitrogen
muscle mass

46
Q

The indications for PN include an inability to digest adequate oral food or fluids within a __ to __ day timeframe.

A

7 to 10

47
Q

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.

A

parenteral

48
Q

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

A

peripheral or central

49
Q

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.

A

6 weeks

50
Q

The subclavian site should be avoided in patients with __ kidney disease and those on __ to prevent subclavian vein stenosis.

A

advanced

hemodialysis

51
Q

Peripherally inserted central catheters (PICCs) are used for __-term (several days to months) IV therapy in the hospital, long-term care, or home setting.

A

intermediate

52
Q

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.

A

isotonic dextrose

1 to 2 hours

53
Q

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

A

infection

Medical Surgical (10 decks)

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