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NRSG 102: Med Surg 1 > Exam 2: Chapter 44 - GI Intubation and Feeding > Flashcards

Exam 2: Chapter 44 - GI Intubation and Feeding Flashcards

1
Q

What is GI Intubation?

A

The insertion of a flexible tube into the stomach, or beyond the pylorus into the duodenum or the jejunum

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2
Q

Why might a GI Intubation be performed?

A

Decompress the stomach and remove gas and fluid Lavage Diagnose GI Disorders Administer Tube Feedings Compress Bleeding Site

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3
Q

What are NG Tubes, and used for?

A

Introduced through the nose into the stomach, often before or during surgery, to remove fluid and gas from the upper GI tract by the process known as decompression

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4
Q

Commonly used gastric tubes?

A

Levin and the Salen Sump tube

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5
Q

What is a Levin tube?

A

Single lumen (channel within a tube or catheter) and is made of plastic or rubber

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6
Q

Why is a Levin tube used?

A

Connected to low intermittent suction (30-40 mmHg) to avoid erosion or tearing of the stomach lining

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7
Q

Why is a Salem Sump used

A

Tube is radiopaque, is clear plastic, double-lumen gastric tube

Inner, smaller lumen (blue port) vents the larger suction-drainage tube to the atmosphere by means of an opening at distal end.

seen on Xray. Kept at 25 mmHg to protect fragile mucosa

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8
Q

Salen Sump:Where should the blue lumen be placed?

A

It should be kept above the patients waist to prevent reflux of gastric contents.

One-way antireflux valve seated in blue pigtail can prevent reflux of gastric conents out of the vent lumen

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9
Q

Where are gastric tubes that are used for decompression and drainage mounted? And what care should the nurse make?

A

Connected to a wall mounted suction regulator and canister or to a suction machine.

Suction should be set at right pressure and drainage assessed. Ensure that oral and nasal hygiene maintained.

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10
Q

A short term orally or nasally placed feeding tube should stay in place for no longer than

A

Four weeks before being replaced with a new tube

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11
Q

Why are gastric or enteric feeding tubes used?

A

Used for patients who have the ability to receive and process nutrition, fluids, and medications adequately by the gastric route

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12
Q

A pt with gastroparesis (reduced stomach motility), severe Gastroesophageal reflux disease, impaired glottic closure, or undergone partial or total gastrectomy or otherwise at risk for aspiration use what type of tube?

A

Nasoenteric Tube (In nose into small intestine) or oroenteric tube (from mouth to small intestine) for feeding can be used

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13
Q

What are nasoduodenal tubes?

A

Enteric tubes placed in the duodenum via the nares

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14
Q

What are nasojejunal tubes?

A

Enteric tubes placed in the jeunum via the nareas

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15
Q

Why may nasally inserted feeding tubes kink?

A

Because they are soft and pliable. They may kink when a stylet ( a stiff wire placed in a catheter or other tube that allows it to maintain its ahep) is not used during insertion

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16
Q

Enteric tubes are never inserted in those with?

A

Basilar skull fracatures, or those with maxillofacial surgery or facial trauma

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17
Q

What can be done if tube becomes obstructed?

A

warm water irrigation, milking the tube, infusing digestive enzymes, and employing mechanical declogging devices

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18
Q

Tubes used for enteral nutrition are attached to

A

Enteral delivery tubing or a syringe that contains the feeding formula. Can be connected continuously for pump feedings or intermittnetly so that end of tube may be capped between feedings

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19
Q

To maintain patency, tube is irrigated with water after every

A

feeding and medication delivery, and every 4-6 hours during continuous feedings or if the tube is set to gravity drainage or suction

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20
Q

How often should nasal tape be changed?

A

Every 3 days and as needed

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21
Q

What should you do if the nasal and pharyngeal mucosae are excesively dry?

A

Steam or cool vapor inhalations

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22
Q

Symptoms of fluid volume deficit in patients receiving enteral nutrition?

A

Dry skin and mucous membranes, decreased urinary output, lethargy, lightheadedness, hypotension, and increased heart rate

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23
Q

Assessment for patient recieving enternal nutiriton?

A

Accurate record of intake and output

This includes measuring fluid from intake from tube feeding and flushes , oral liquids, and IV fluids.

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24
Q

Aspiration pneumonia occurs when

A

regurgitated stomach contents or enteral feedings from an imporperly positioned feeding tube are instilled into the pharynx or the trachea

Those at risk are those older than 70, unable to protect airways, AMS, or other neurologic deficits

Head should always be elevaed 30-45 degrees. Position maintained for one hour afterwards

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25
Q

Signs and symptoms of pulmonary complications include

A

Coughing during administration of foods or medications

Difficulty clearing the airway

Tachypnea and Fever

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26
Q

Advantage of tube feedings over PN?

A

They are lower in cost, safer, usually well tolerated by patient and easier to use in extended-care facilities

27
Q

Nasoduodenal or nasojejunal feeding is indicated when

A

When the esophagus and stomach need to be bypassed or when the patient is at risk for aspiration

28
Q

What tubes are preferred for administration of medications or nutrition longer than 4 weeks?

A

Gastrostomy or jejunostomy tubes

29
Q

What happens when a concentrated solution of high osmolality enters the intestine?

A

Water moves rapidly into the intestinal lumen from fluid surrounding the organs and vascular component.

Pt hasnt feelings of fullness, nausea, cramping, dizziness, diaphoresis, and osmotic diarrhea (dumping syndrome).

30
Q

What is the dumping syndrome?

A

Physiologic response to rapid emptying of gastric contents into the small intestine, manifested by nausea, weakness, sweating, palpitations, syncope, and possibly diarrhea

31
Q

What can dumping syndrome lead to

A

dehydration, hypotension, and tachycardia

32
Q

Purpose of Enteral Feeding

A

Meets nutritional requirements when oral intake is inadequate or not possible, and the GI tract is functioning

33
Q

Enteral Formulas contain how much water and more information about it

A

Contain 70-85% free water and are not designed to meet total fluid needs

34
Q

What are Polymeric Formulas?

A

Tube feeding formula. Most common.

Composed of protien, carbohydrates, and fats in a high-molecular weight form and require that the patient has normal digestive function.

35
Q

What are chemically defined or “predigested” formulas?

A

Contain easier-to-absorb nutrients

36
Q

What are modular products?

A

A tube feeding formula. Contain only one major nutrient such as protein adn are suually to enhance commerically prepared products

37
Q

Tube Feeding Administration Methods

A

Intermittent Bolus Feedings ; Divided into 3-4 feedings daily and can be given as quikcly as patient can tolerate, but are initiated slowly

Intermittent Gravity Drip ; Raising or lowering the syringe above the abdominal wall regulates the rate of flow. Administer feedings over 30 minutes or longer at desingated intervals by a reservoir enteral bag and tubing.

Continuous Infusion Cyclic Feeding; Delivery of feedings by a slow infusion over long periods. Portable lightweight pumps are available

38
Q

What is cyclic feeding?

A

Alternative to the continuous infusion method!

Infused feeding is given by an enteral feeding pump over 8-18 hours. May be infused at night . Appropriate for those being weaned form tube feedings to an oral diet.

39
Q

Whenever water is used to irrigate these tubes, it must be recorded as?

A

fluid intake.

40
Q

Gastric Residual Volume exceeding what has thought to indicate feeding intolerance?

A

250-500 mL

41
Q

To ensure patency and to decrease the chance of bacterial growth, sludge build-up, or occlusion of the tube, what is done?

A

At least 30 mL of water is given before and inter intermittent tube feeding and when checking the tubes

42
Q

Tube Feeding: What is an open system?

A

Packaged as a liquid or a powder to be mixeed with water that is either poured into a feeding container or given by a large syringe. Feeding container hung on pole and tubing replaced every 24 hours.

Can be used for bolus feedings, intermittent feedings, or continuous drip. CAn be delivered by push, gravity, or pump.

Hang time in bag at room temperature should never exceed 4-8 hours.

43
Q

Tube Feeding: What is an closed system?

A

Used a prefilled, sterile container of about 1 L of formula that is spiked with enteral tubing that allows hang time of 24-48 hours at room temperature. Must use pump control.

44
Q

What do you do if a patient is Hypernutric?

A

You do not want to give them saline

45
Q

How to prevent dumping syndrome

A

Slow the formula instillation rate to provide time for carbohydrtes and electrolytes to be diluted Administer feedings at room temperature Administer feeding by continuous drip REmain in semi-fowler 1 hour after feeding Instill the minimal amount of water needed to be flushed

46
Q

Maintaining Adequate Hydration: How is this achieved?

A

Water flushes given every 4 hours and after feedings to prevent hypertonic dehydration.

47
Q

What is a Gastostomy?

A

A procedure in which an opening is created into the stomach either for hte purposoe of administering nutrition, fluids, and medications via a feeding tube or for gastric decompression in patietns with gastroparesis, gastroesophageal reflux disease, or intestinal obsturction

48
Q

Gastrostomy is preferred over a nasally inserted tube to deliver enteral nutrition support longer trhan / also preferred because

A

4 weeks

Also preferred in those who are comatose because the gastroesophageal sphincter remains intaact, making regurgitation and aspiration less likely

49
Q

How many Balloon and Non-Balloon Gastrostomy tubes (G Tubes) be placed?

A

Surgically, endoscopically, or fluroscopically

50
Q

How is a G Tube placed?

A

Requires an abdominal incision and either a permanent gastric stoma (an artifically created opening) is created surgically that can be accesed with a feeding tube or a gastric stome is established that remians open as long as it remains intubated

51
Q

How is a Percutaneous Endoscopic Gastrostomy (PEG) tube inserted?

A

Lighted endoscope inserted via mouth toward stomach then inflated with air. PEG tube guided down and goes out the stomach through the abdominal incision.

Internal fixaation bolster is pulled snug agianst the stomach wall. An external retention bolster is threaded down the tube and positioned snnug to the skin

52
Q

Initial G Tube can be replaced after how much time?

A

Typically 6 weeks to 3 months

53
Q

Routine replacement is needed how long for balloon G tube?

A

3-6 months

54
Q

How long do you need to wait to replace a non-balloon G tube?

A

6-12 months

55
Q

How often should the G tube be cleaned?

A

daily, with soap and water or 2% chlorhexidine gluconate and then dried throughly.

56
Q

Alternative to G tubes that are bulky?

A

Low-Profile Gastrostomy Devices (LPGDs). Specific kinds include MIC-KEY or the Bard Button.

57
Q

When are LPGDs inserted?

A

6 Weeks to 3 months after initial G tube placement or placed as the initial G tube.

58
Q

Why are LPGDs used?

A

they are flush with the skin, eliminate the possibility of inward tube migration, have antireflux valves o prevent gastric leakage, and do not require tape or other securement devices.

Those requiring enteral nutrition are able to conceal feeding tube access site under their clothing. They need a special connection tubing.

59
Q

What is a jejunostomy?

A

Surgically placed opening into the jejunum for the purpose of administering nutrition, fluids, and medications.

60
Q

J Tube is indicated when

A

the gastric route is not accessible, or to decrease aspiration risk when the stomach is not functioning adequately to process and empty food and fluids

61
Q

What is another way the small intestine can be acessed?

A

Placing a jejunal extension tube through an exisitng G tube and manipulating it through the pylorus into the small intestine endoscopically, fluroscopically, or during a surgical procedure.

62
Q

What is a Orogastric tube??

A

A large-bore tube inserted through the mouth into the stomach that contains a wide outlet for removal of gastric contents

63
Q

What tubes are used to treat bleeding esophageal varices?

A

Sengstaken-Blakemore and Minnesota tube

NRSG 102: Med Surg 1 (52 decks)

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