Critical Thinking Questions Flashcards
a) You are caring for a patient who is NPO, and has NG or a G-Tube How would you administer PO medications (tablets/pills) to a patient who has had an NG inserted?
Crush and dissolve in water.
Water (10-30 ccs), med, Water (10-30 ccs)
FLUSH WITH SAME AMOUNT EACH TIME
**liquid preferred because crushed medications may adhere to side of tubing and not all the dose is administered.
b) How does a Toomey syringe differ from an Asepto or bulb syringe and piston type 30cc or 60cc syringe?
Toomey syringes have a special nozzle that helps prevent the backflow of fluids. They are also designed to be less painful on injection. Reusable. Large bore to instill a greater volume into the tube.
Asepto has poorer control and less pressure.
c) Why should a nurse wear gloves when manipulating a feeding tube? Should you consider a drip cloth?
To make sure none of the medication gets on the hands. Keep it a clean procedure.
Yes.
d) How does the technique for feeding or medication administration vary when the tube is a Jejunostomy or Gastrostomy tube versus a Nasopharyngeal tube?
J/G tube: clean around insertion site, flush using less fluid due to shorter tube
NG: nasal care, check respiration status, flush tubing.
e) How does the technique for feeding or medication administration vary when using a Salem Sump as a feeding tube versus a small-bore feeding tube?
Salem sump is a type of large-bore NG tube. It has a pigtail vent (blue) that NOTHING should be administered through. NG feedings are usually given through small bore tubes. You can aspirate a residual volume through a Salem Sump tube but cannot aspirate through a small-bore tube.
f) What are the ethical, legal, and financial implications if the method used to verify feeding tube placement is unreliable and enteral feeding solution is administered intra-pulmonary? What signs and symptoms would suggest intra-pulmonary administration of medications or feedings?
The hospital and you get sued. Dun dun dun. These complications will require the patient to extend their hospital stay, d/t mistake and the hospital has to pay.
**administration of solution into respiratory tract can lead to serious complications (impaired gas exchange, pneumonia).
Sx/sx: changes in respiratory status, decreased o2 saturation, increased respiration rate, dyspnea, coughing and coarse breath sounds
g) What types of enteral formulas are available? Are there formulas for specific disease conditions?
milk-based, lactose free, disease specific (diabetes, COPD, renal failure), and high nutritional values.
h) Discuss various recommendations for evaluating residual volume when administering enteral feedings.
Recommendations for stopping tube feeding for elevated GRVs range from 250 to 500 mL, but automatic cessation of feeding should not occur for GRVs less than 500 ml in the absence of other signs of intolerance.
**if the residual is over 500 ml, hold the feeding and notify physician. If it is between 250 to 500 ml, put it back and recheck in 30-60 minutes. If still same, hold and call. If less than 250 put it back and administer the new feeding as prescribed.
**Check residual every 4 to 6 hours during continuous feedings or before every intermittent feeding.
**flush with 30 mls every 4 hours
i) What are the potential complications of enteral feeding?
Digestive complications: nausea, vomiting, diarrhea, constipation, dehydration, malabsorption, aspiration.
j) Consider the signs and symptoms of feeding intolerance. Compare these to complications associated with TPN.
feeding intolerance: weight loss, vomiting, abdominal distention, abnormal bowel sounds
TPN: weight loss, electrolyte imbalance, edema, hyper/hypoglycemia
k) Identify specific nursing interventions for managing total parenteral nutrition (TPN). What routines of care are associated with initiating TPN versus maintaining a patient on TPN? What specific parameters need to be included when assessing a patient receiving TPN? What interventions need to be implemented if a bag of TPN runs dry before the next bag is delivered from the pharmacy?
Ensure placement of central line or PICC line via x-ray before initiating the first bag of TPN, initial vitals, assessment, initial weight, ensure consent was obtained, start slow and watch for reactions.
Daily weight, monitor lab values, vitals at least q4h, finger stick glucose monitoring along with insulin administration if needed.
l) What conditions might require the administration of parenteral nutrition rather than enteral feedings. Compare factors such as risks, complications, and cost of these two forms/routes of nutrition.
Patients who do not have bowel function. Enteral nutrition requires bowel function.
