exam 2 chapter 22 Flashcards
The ability of the esophagus to transport food and fluids is facilitated by which two sphincters?
- upper esopharyngeal (hypopharyngeal)
- lower esopharyngeal (gastroesophageal or cardiac)
prevents reflux (backward flow) of gastric contents
difficult swallowing
dysphagia
odynophagia
acute pain on swallowing
Achalasia
absent or ineffective peristalsis of the distal esophagus, accompanied by failure of the sphincter to relax in response to swallowing.
what is the common symptom of achalasia
difficult swallowing fluids and solids.
Pyrosis
chest pain and heartburn.
How is achalasia treated
by pneumatic dilation
RN should instruct patient to eat slowly and drink fluids with meals.
what is a potential complication when pneumatic dilation is performed to treat achalasia?
perforation
what are some reasons GI intubation
decompress stomach fluid or air lavage the stomach and remove toxins administer medicaitons and nutrition treat an obstruction bypass sections of the GI tract to allow them to rest.
what should the suction be when a levine tube is used?
intermittent low wall suction (30 to 40 mm Hg)
To prevent gastric erosion or tearing of the stomach lining.
what are NG tubes such as the Levin used for?
decompression of distended stomach due to air or fluid.
tube feeding is also known as
enteral nutrition
administration of nutritionally balanced liquefied food or formule through tube inserted into stomach, deodenum or jejunum
tube feeding or enteral nutrition
contraindications for gastric feedings
patients at risk of aspiration
patients undergoing gastric surgery
A patient having a pancreatic surgery may have what type of tube?
jejunal tube to rest the pancreas by bypassing the hepatopancreatic ampulla, thereby avoiding the release of digestive enzymes into the duodenum.
when should feeding be started after inserting tube feeding
bowel sounds
x-ray
tube lenght from insertion site to distal end should be measured and recorded.
Tube should be marked at skin insertion site.
insertion lenght should be checked regularly.
tube feeding administration
HOB >30
HOB remains elevated for 30 to 60 minutes for intermittent delivery.
HOB remains semi Fowlers (45) with continuous feeding.
after feeding the HOB remains high fowlers (90) for 30-60 min.
Bolus feeding
resembles normal feedings pattern
300-400 formula over 30 -60 min
given every 3-6 hrs.
continous feeding
for 24 hours period pt remains in semi fowlers position
type of feeing, given over a 8-16 hr period, usually given at night to allow freedom during the day.
cyclic feeding
reasons for cyclic feeding
pt weaned from tube feeding to oral diet
supplements for pt who cannot eat enough.
position of the tube
placement checked before each feeds and medication.
every 8 hours with continuous feeds.
must be checked before administration of any contents.
Tube patency
continuous feedings adminstered on feeding pump with occlusion alarm.
some machines have a water bag that infuses Qhour.
bolus/cyclic irrigated with water before/after each feeding and meication administration.
what do you do with residual and why?
put back
to prevent F&E imbalance
Before feeings
aspirate gastric contents and measure amount of residual
general nursing consideration for tube feeding
daily weights assess for bowel sounds before feedings accurate I&O initial glucose checks Q6 label with date and time started feedings have life of 8-24 hours pump tubing changed Q24 formula room/body temperature.
Tube feeding complications
vomiting diarrhea constipation dehydration aspiration clogged tube
if there is asiration compications
check tube placement
check residual
elevate HOB
