Chapters 35-Nutrition and 37-Bowel Elimination

Question 1

What types of medications can be given through a feeding tube?

Answer 1

Liquid medications, certain solid dosage meds that can be crushed and mixed with liquid. **Certain capsules may be opened and emptied into liquid.

Question 2

When do you flush the feeding tube?

Answer 2

Flush before giving feeds or medications and immediately after.

Question 3

How much water do you use to flush a feeding tube: adults/children?

Answer 3

You use 15-30mL of water for adults and use 5-10mL for children.

Question 4

What are the steps for administering medications to a patient who is on suction?

Answer 4

1. Bring liquid meds to room temp.
2. Elevate HOB
3. Remove clamp from tube, CHECK placement of tube.
4. Flush tube before/after medication.
5. Give each med separately.
6. Keep tube d/c from suction and clamped 20-30min after med administration (allows for absorption)
7. d/c continuous feed and leave tube clamped before/after meds.
8. Document water intake and liquid med, document medication administration.

Question 5

What is absorption?

Answer 5

The nutritional process in which digested nutrients are transferred into the person’s circulation.

Question 6

What is anorexia?

Answer 6

A lack of appetite that results from numerous causes.

Question 7

What is anthropometric

Answer 7

A specific type of data used to determine body dimensions

Question 8

What is aspiration?

Answer 8

Misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract.

Question 9

What is dysphagia?

Answer 9

Difficulty in swallowing or inability to swallow.

Question 10

What is enteral nutrition?

Answer 10

An alternate form of feeding that involves passing a tube into the GI tract to allow installation of the appropriate formula.

Question 11

What is parenteral nutrition?

Answer 11

Nourishment provided via IV therapy

Question 12

What is a PEG tube?

Answer 12

Percutaneous Endoscopic Gastrostomy tube: this is a surgically or laparoscopically placed gastrostomy tube.

Question 13

What is PPN?

Answer 13

Peripheral parenteral nutrition: prescribed for patients who require nutrient supplementation through a peripheral vein because they have an inadequate oral intake of feedings.

Question 14

What are factors that affect nutritional status?

Answer 14

Gender, state of health, alcohol use/abuse, medication, and developmental stage: adolescent, aged adult, infant, toddler, preschoolers, adults,

Question 15

What factors affect bowel elimination?

Answer 15

Person’s developmental stage, daily patterns, amt./quality of food intake, activity level, lifestyle, emotional state, pathological processes, medications, and surgery/procedures.

Question 16

what things do you look for in a swallowing/ dyspahagia assessment?

Answer 16

Cyanosis, coughing, choking, gagging, gurgling, lots of throat clearing, drooling, cranial nerve deficits.

Question 17

What are some good interventions to prevent choking/swallowing difficulties?

Answer 17

Before meals: have pt, clear throat, perform oral care, put in high fowlers, elim. distractions, rest 30min before eating, suction, and keep comfortable.

Question 18

What are the differences between PEG, PEJ, NG, and NI tubes?

Answer 18

PEG: (G-tube) placed in the stomach, feeding only, long term use, increased risk of aspiration. PEJ: J-tube, begins in stomach, ends in jejunum, long term, less risk of aspiration, feeding only. NG: Nose-stomach, short term use, feeding and suction. NI: Nose-duodenum, short term, feeding only,

Question 19

How often do you change the PEG tube?

Answer 19

q24h

Question 20

What things do you evaluate when using a PEG tube?

Answer 20

N/V, distention, diarrhea, pain

Question 21

What are NORMAL findings when using a PEG tube?

Answer 21

normal stool, free from pain or distention, or N/V, and limited gastric residual volume.

Question 22

What are acceptable Gastric Residual Volume levels?

Answer 22

200-250mL X 2 OR 400-500mL once

Question 23

What constitutes a focused GI assessment?

Answer 23

Pertinent patient history, physical assessment, and Dx studies.

Question 24

What does pertinent patient hx. include?

Answer 24

Bowel elimination patterns, last BM, frequency, time of day, description of BM (color, consistency, shape, amount, and odor), use of laxatives/enemas, recent changes, problems with stool, and presence of artificial orifices.

Question 25

When asking patients about bowel elimination problems what should be included?

Answer 25

Nature of the problem, onset, frequency, causes, severity, symptoms, interventions/results.

Question 26

What four components should be included in the abd assessment?

Answer 26

Inspection, auscultation, percussion, and palpation.

Question 27

How are normal bowel sounds described?

Answer 27

high-pitched, gurgling, and soft.

Question 28

What is gastric residual volume?

Answer 28

Amount of gastric feed remaining in stomach after feed has been discontinued.

Question 29

What types of biochemical data might affect a person’s nutritional status?

Answer 29

Hemoglobin: (12-18 g/dL) increased=anemia
Hematocrit: (40-50%) Decreased: anemia, increased: dehydration.
Serum Albumin: (3.5-5.5 g/dL) decreased: malnutrition
Prealbumin: (23-43mg/dL) decreased: malnutrition
Transferrin: (240-480mg/dL) decreased: anemia
BUN: (17-18mg/dL) increased: starvation, dehydration, decreased: malnutrition, overhydration.
Creatinine: (0.4-1.5mg/dL): increased: dehydration, decreased: reduction in muscle mass, severe malnutrition.

Question 30

What are some age-related changes that may affect a patient’s nutritional status?

Answer 30

Altered abil. to chew, loss of smell/taste, decreased peristalsis in esophagus, GERD, decreased gastric secretions, slowed intestinal peristalsis, lowered glucose tolerance, reduction in appetite/thirst sensation, alcohol intake, depression/loneliness, physical handicaps, low income, malnutrition, drug interactions.

Question 31

What are some signs/symptoms of malnutrition?

Answer 31

listless, low energy, cachectic, depressed mood, overweight or underweight, dull, dry, brittle hair, loss of hair color, dark skin under eyes, flaky skin, facial edema, pale skin, pale eye pallor, dry eyes, tongue has smooth, beefy appearance, spongy gums, enlarged thyroid, brittle; ridged nails, poor posture, poor muscle tone, bowed legs, swollen abd, absent reflexes, mental confusion, tachycardia, enlarged liver/spleen.

Question 32

What are some ways to monitor nutritional status?

Answer 32

Absence or presence of: N/V, diarrhea, distention, feeling of fullness, amount of food eaten, hunger, and pain.

Question 33

Name the 9 types of diet that a patient may have.

Answer 33

Consistent carb. diet, fat-restricted, high-fiber, low-fiber, sodium restricted, Renal diet, clear liquid, pureed, and Mechanically altered.

Question 34

What are two SHORT term feeding tubes? When are these used?

Answer 34

Nasointestinal (NI) and Nasogastric (NG).
NI: short term, feeding only, nose-duodenum
NG: short term, both suction and feed, nose-stomach

Question 35

What are LONG term feeding tubes?

Answer 35

PEG-(gtube):directly into the stomach, long term, high risk for aspiration.
PEJ- (jtube): stomach-duodenum-jejunum: long term, less risk of aspiration NEVER suction.

Question 36

What are methods for verifying placement of gastric tubes?

Answer 36

x-ray, measuring pH level, visual assessment of aspirate, measure tube length and measure tube marking, CO2 monitoring.

Question 37

What are steps that a nurse takes to promote patient safety?

Answer 37

check tube placement, check gastric residual before each feed OR q4h, assess: N/V, bowel sounds, bloating, distention, pain, and girth. Elevate 30 degrees or higher for one hour after feeding.

Question 38

What are some actions to prevent contamination?

Answer 38

check date on formula, use gloves, disinfect opening and rim of container, label equipment with pt, name date, time feeding was hung. Clean reusable equip q24h w/soap and water. Replace disposable equip q24h, closed systems discard after 48hrs., NEVER give meds when infusing feed, flush tube, before/after, and between med administration.

Question 39

how do you describe bowel sounds? What might they indicate?

Answer 39

hypoactive: decreased bowel motility (abd surgery, late bowel obstruction
hyperactive: increased motility (diarrhea, gastroenteritis, early bowel obstruction
absent bowel sounds: peritonitis, paralytic ileus, prolonged immobility
audible, inaudible: absence or presence of sound

Question 40

what are the characteristics of normal bowel sounds?

Answer 40

high-pitched, gurgling, soft, 5-30 sounds/min.

Question 41

what are some special considerations for patients who have diarrhea?

Answer 41

answer bell promptly, ensure commode/bedpan nearby, find and remove cause, spec. consideration to anal care, monitor for electrolyte imbalance/dehydration