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Skills 2 Lab > Enteral tubes > Flashcards

Enteral tubes Flashcards

1
Q

What are 2 Enteral tubes we see in skills 2?

A
  1. GT (gastrostomy tubes)
  2. NG (Nasal-gastro)
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2
Q

What are the 3 types of GT tubes?

A

1.Percutaneous endoscopic gastrostomy or jejunostomy (PEG or J-PEG)
2. Balloon gastrostomy
3. Jejunostomy tube

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3
Q

Which tube is used for long term feeding needs like >4 weeks?

A

GT

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4
Q

How is GT tube inserted?

A

surgically

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5
Q

Which tube is used for shorter term feeding like <4 weeks ?

A

NG

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6
Q

How is NG tube inserted?

A

nurse at bedside

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7
Q

Why are Enteral tubes sometimes indicated?

A
  1. Abdominal decompression (temporary)
  2. Enteral feeding/nutrition
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8
Q

What are examples of Abdominal decompression?

A
  1. drug overdose
  2. GI bleed lavage (test to see if they have a GI bleed)
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9
Q

What diagnoses may require enteral feeding/nutrition?

A
  1. cancer (head and neck)
  2. critical illness
  3. stroke
  4. dementia
  5. pancreatitis
  6. anorexia
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10
Q

What are the 3 checks before starting Enteral nutrition ?

A
  1. Nutritional assessment consult with RD
  2. a medical order
  3. contraindications awareness
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11
Q

What 4 things does an RD do in the nutritional assessment consult?

A
  1. initial nutritional assessment
  2. enteral formula recommendations
  3. goal rate of feeding
  4. ongoing monitoring of nutritional status
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12
Q

What is required in the medical order for enteral nutrition?

A
  1. the type of formula requested
  2. Initial flow rate
  3. Progression rate
  4. Goal rate
  5. Route (NG, GT, etc)
  6. volume and frequency of free water flushes per 24 hrs
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13
Q

What are 4 examples of contraindications to Enteral feeding

A
  1. perforation of GI tract
  2. Gastrointestinal ischemia (hemodynamically unstable)
  3. Bowel obstruction
  4. inability to access GI tract
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14
Q

When is continuous administration indicated?

A

When the goal is to catch the person up with nutrition (starting out)

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15
Q

Which method of administration is used for small bowel feeds?

A

continuous (b/c need smaller amounts and consistent amounts)

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16
Q

Which method of administration has a low risk for abdominal distension, aspiration?

A

Continuous

17
Q

Which is the highest risk for abdominal distention, aspiration?

A

Bolus

18
Q

Which method of administration is delivered by pump?

A

continuous

19
Q

Which method of administration is pump OR gravity?

A

intermittent

20
Q

Which method of administration is delivered by syringe?

A

Bolus

21
Q

What is GRV?

A

Gastric residual volumes

22
Q

When do we stop feeding immediately?

A

overt regurgitation
suspect aspiration

23
Q

How far should we put an NG tube?

A

nare to the end of the purple port

24
Q

How far should the GT be?

A

bolster to end of feeding port

25
Q

What kind of tubes should we not be aspirating ?

A

small bowel feeding tubes

26
Q

How many hours before eating is pH of gastric contents valid?

A

4-6 hours prior

27
Q

What 2 things make gastric pH readings invalid?

A
  1. food
  2. antacids
28
Q

how does tube occulsion occur?

A

med admin with crushed medsho

29
Q

What are ways to identify tube occlusion and how do we fix it?

A
  1. you can’t get liquid in (tube occluded) -
    -viokase + bicarb solution
    - replace tube
  2. tube displacement
    - get a longer tube
  3. decreased LOC, delayed gastric emptying, HOB not elevated for feeds >30 degrees, vitals show signs of aspiration, infection
    -stop immediately
    -notify MD
    -monitor vitals, RR, sputum etc
    - reassess tube placement
  4. Diarrhea - feed intolerance
    - notify MD and dietician
    - maybe change formula or rate
    - monitor perineal skin integrity
    - fluid status/electrolytes
30
Q

Why are low profile devices (Mic-Key) helpful?

A
  1. good for kids/people who pull it out
  2. decreases likelihood of pyloric obstruction from inward migration of the tube
  3. anti-reflux valve
  4. ca be replacement device after stoma tract has healed
  5. uses “key” as an extension to help with feeds
31
Q

Steps to feeding

A
  1. prepare food
  2. measure external tube
  3. assess skin around bolster
  4. pH strips (if continuous or often then maybe pH will be thrown off)
  5. HOB 30-45 degrees - 90 degrees is best
  6. water (usually tap water) for pre/post feed (dietition tells us)
  7. patients tolerance for the feed - bowel sounds, distention, aspiration (SOB/RR/cough/ etc) - GRV site specific
  8. GRV check q4 hrs (continuous) < or = 200ml gr can be refed - monitor again in 4 hrs. if >200ml discard and stop TF
  9. gloves
32
Q

pump feed steps

A

1.prime the tube
2.drip chamber should be ½ - 1/3 full
3. towel/blue pad
4.set pump rate – like 20ml/hr – VTBD 80ml/4 hrs
5. set the tube and open the chamber
6.gloves
7. kink tube and attach to port then hit start
8. monitor discomfort, distention, vomiting, aspiration etc.

33
Q

water flush measurments pre and post meds

A

15-30 mL of warm water before administering meds

5-10 mL between meds

15-30 mL waterafter last medication

34
Q

what size syringe do we use and why?

A

60mL min.
to avoid too much pressure and tube rupture

Skills 2 Lab (5 decks)

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