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Module 1 (Intro To Basics) > Enteral Tubing and Nutrition > Flashcards

Enteral Tubing and Nutrition Flashcards

1
Q

Tubing based on destinations
Nares to Stomach

A

Nasogastric (NG) tube
Dobhoff (NG) tube = difficult too small liquid

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2
Q

Tubing based on destinations
Nares to Small Intestine

A

Nasoduodenal tube
Nasojejunal tube

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3
Q

Surgical operation
with Tubes and Destinations

A

Gastrostomy (PEG) - stomach
Jejunostomy (J)tube - small intestines

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4
Q

PEG full name

A

Percutaneous Endoscopic Gastrostomy

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5
Q

PEG

A

-Long lasting
dysphagia
cancer/radiation affecting GI Tract
neurological deficit
bowel disease/dysfunction
cranio-facial abnormalities, trauma
malnutrition concerns

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6
Q

Tube vs. Button

A

Tube= abdomen and PEG showing catheter fixation
Button= abdomen and balloon fixation of low profile gastrostomy device

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7
Q

Once a tube has been placed, what is critical

A

confirmation

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8
Q

How do you confirm tube placement?

A

Xray is gold standard for initial confirmation

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9
Q

Always access placement by

A

measurement of tube

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10
Q

How long does it take to insert a NG tube

A

20-30 mins

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11
Q

Deviations of Tubing Length
(increases / decreases)

A

increase in length possibilities
-from intestines into stomach
-stomach into esophagus
-into lung
decrease in length possible
-stomach into intestines

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12
Q

What do you do before administering ANY meds or feedings

A

Qualified Nursing Actions
S/S of intolerance
Document findings
Follow agency policy

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13
Q

PEG value is aka

A

Lopez valve

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14
Q

Enteral Meds must be in

A

liquid or powder form via pill crusher

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15
Q

DO NOT CRUSH PO

A

EC
SR/SA/TR/CR/XL/XR
SL
Bucc

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16
Q

Preparation Rules

A

Know meds
-correct part of delivery to GI tract
Ask allergies
FINE Powder if need to crush (15-15-30)

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17
Q

How to give Enteral Meds

A

1)In med room, prepare each crushed/liquid medications in their individual label
2)Take med sleeves and pill packaging with you for verifying and scanning
3)At the bedside, mix each med individually with 15 mL sterile water
4)Confirm tube patency by gently flushing the gastric tube with 15 mL of sterile water
5)Pinch/Clamp proximal end of gastric tube each time to prevent air from entering the stomach
6)Attach syringe to the feeding tube
7)Pour dissolved meds and allow for gravity to flow through tube
8)Flush with 10 mL between each medication to prevent drug interactions
9)After administering final meds, flush with 30 mL of sterile water
10)Leave HOB elevated for 30 minutes

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18
Q

Before Proceeding Assess the pt’s GI system

A

bowel sounds
location of enteral tube
feeding in progress and hold

19
Q

Prevent Infection

A

initially thin gauze btw Gtube or Jtube external disk
clean site regularly
monitor skin for breakdown, drainage, yeast infection, replace bumper

20
Q

Closed system

A

Ready Made
nutrition solution added during manufacturing
-can’t be opened
-safely hang for 24-36 hours
more common

21
Q

Open system

A

Rehab long term
nutrition solution prepared by urse at bedside

22
Q

Both open and closed systems are administered via

A

enternal pump

23
Q

Continuous infusions

A

administered over 24 hours periods using enteral pump
-initial dose full strength at slow rate and increase 8-12 hours until goal reached
HOB elevated at all time 30 degrees

24
Q

Cyclic Nutrition

A

continous in less than 24 hours
often at night
may eat during the day
flush with 30 mL of sterile water when finished
HOB at 30 degrees

25
Q

Intermittent

A

feedings usually begin full strength at specified vol
5-8 times per day
Administered over at least 30 mins via pump or syringe
provides needed cal and vol in 4-6 times a day
Elevate HOB at least 1 hour after feeding

26
Q

Bolus

A

syringe used to deliver formula into stomach by gravity
raising and lowering syringe regulated flow
delivered more rapidly than intermittent
HOB up at least 1 hour
flush 30 mL of sterile water

27
Q

High Risk

A

diarrhea
nausea/vomiting
gas/bloating/cramping
constipation
dehydration
hyperglycemia
aspiration

28
Q

Biggest Risk of Enteral Nutrition

A

Aspiration

29
Q

Signs and Symptoms of Aspirations

A

cough
SOB
Gurgling
rapsy voice

30
Q

What to do if suspect aspiration

A

stop feeding
elevate bed
turn on the right side
notify physician
check placement based on order

31
Q

what to do for Adult tube feeding intolerance

A

stop feeding
check constipation
notify physician

32
Q

Adult tube feeding intolerance

A

Abdomenal signs ( distension, firm, tense, guarding, discomfort)
nausea (common)
-atiemetics, minimal narcotics, check for constipation

33
Q

Emesis

A

hold feedings
check for constipation
notify

34
Q

Gastric Residual Checks (20 mins on right side)

A

critical ill surgery/trauma pt, head injury, post-op abdomenal surgery, obtunded/vegetative state

35
Q

When do you discontinue order for GRV checks

A

48-72 hours or if less than 500 mL and no abdominal signs present

36
Q

Before proceeding with a feeding

A

access pt’s GI system (bowel sounds, location of tube)
HOB at 30 degrees
room temp feedings
primed tubing

37
Q

Check placement

A

verify by Xray
aspirate to assess patency and gastric contents ig symptomatic
-Exception not jejunostomy tibe or Levine/dobhoff tube
measure contents and return
flush with 30mL sterile water
document findings

38
Q

When do you STOP and don’t proceed, if giving enteral medications or feedings?

A

If greater than 500 mL residual
-return and flush with 30 mL
recheck in 4 hours
-if the same stop feeding and notify

39
Q

Gravity feedings

A

HOB 30
connect device and administer via gravity flow slowly
flush with 30 mL
HOB up for 1 hr

40
Q

Pump feedings

A

HOB 30
connect primed pump tubing
ensure pump rate as ordered
open clamp and start infusion
monitor gastric residual every 4 hours
flush per protocol

41
Q

Metaclopramide/Reglan

A

gastroparesis, GERD, nausea, vomit

42
Q

Ondansetron/Zofran

A

nausea and vomit

43
Q

Nursing Interventions/Care

A

monitor constantly for intolerance signs
I&O
daily weight
oral care
monitor accu-checks carefully
always access tubes for correct placement and proper labeling
change prepared to feed every 8 hours and closed enteral feedings every 24 or when empty
Never let tubing go dry
aware of tubing when transferring or changing pt position

44
Q

Skin irritation and infection prevention

A

thin gauze or external disk (bumper)
clean site regularly
monitor skin for breakdown, drainage, yeast infection, replacemtn

Module 1 (Intro To Basics) (32 decks)

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