Exam #4 GI Flashcards
What are the purposes of gastrointestinal intubation?
Decompress the stomach, lavage (pump) the stomach, dx GI disorders, admin meds and feeding, to tx an obstruction, to compress a bleeding site, to aspirate gastric contents for analysis
What are the goals of parenteral nutrition?
To improve nutritional status and to attain a positive nitrogen status
What does a complex mixture of parenteral nutrition contain?
Proteins, carbs, fats, electrolytes, vitamins, trace minerals, and sterile water
What is the BEST way to confirm nasogastric tube placement? Other ways?
X-Ray. Air bolus (auscultate) and pH of gastric contents
How do you measure the placement of a nasogastric tube?
Take the distal end of the tube up to the nostril and stretch it to the earlobe, then from the earlobe to the xiphoid process
Where is the nasogastric tube secured?
Taped to the nose and pinned to the patient’s gown
What are some indications for parenteral nutrition?
Intake is insufficient to maintain anabolic state, ability to ingest food is impaired, pt unwilling or not interested in eating, medical conditions, pre-op and post-op nutritional needs are prolonged
What nursing care is needed for a pt with any type of feeding tube?
Pt. teaching, tube insertion, confirming placement and securing it, monitoring the pt, maintain tube function, oral and nasal care, and tube removal
What are some collaborative problems and potential complications of enteral feedings?
Diarrhea, N/V, gas/bloating/cramping, dumping syndrome, aspiration pneumonia, tube displacement or obstruction, nasopharyngeal irritation, hyperglycemia, dehydration and azotemia
What is azotemia?
A condition where the patient’s blood contains uncommon levels of urea, creatinine, and other compounds rich in nitrogen
What is the difference between enteral and parenteral feeding tube placement?
Enteral is placed directly into the GI tract and parenteral goes into a vein
What are the advantages of enteral feedings vs. parenteral?
If the gut works, use it; Less envasive, less risk of infection (not breaking the skin); its cheaper than TPN
What happens to the stomach/bowel if its not used?
If you don’t use it, you lose it; the stomach/bowel will die
What are the 2 methods of enteral feedings?
Intermittent and continuous
How does intermittent enteral feedings work?
Cans of feeding poured slowly into a feed bag and placed on a gravity drip
How does continuous enteral feedings work?
They are hooked up to a pump
What is done with the residual volume after you have checked it?
Put the residual back in
Why would a patient on enteral or parenteral feedings get hyperglycemia?
Any time your body is under stress (such as having a feeding tube) it causes the flight or fight response which releases extra sugar into the blood to try and heal the body (even if its not needed)
What is sometimes added to TPN feedings to prevent hyperglycemia?
Insulin
Name a big risk of having a feeding tube?
Skin breakdown (especially in the nares)
What must you do if a patient aspirates while on a continuous enteral feeding?
Stop the feeding and turn the patient on their side
What is Dumping syndrome?
Quickly evacuating stool (within an hr of eating) due to not absorbing the nutritional values of the product
Which patients are more likely to get dumping syndrome?
Ones that had bariatric or gallbladder surgery
How would a patient get aspiration pneumonia during a tube feeding?
If tube is not in the correct place or HOB is lowered during feeding, the feeding may aspirate into the lungs
When do you flush an enteral or parenteral feeding tube?
Before and after feedings and before and after medications
What are the complications of administering tube feedings too fast?
Dumping syndrome, aspiration, abdominal cramping
What type of water is used with medication during a tube feeding?
Tap water
What is the #1 complication of enteral feedings?
Diarrhea
What is another big problem with enteral feedings and what are the 2 major causes of it?
Dumping syndrome due to gallbladder and bariatric surgery
With an intermittent enteral feeding, what is considered too much residual volume?
More than 1/2 of the last feeding
With a continuous enteral feeding, what is considered too much residual volume?
Per facility protocol. Usually between 150-200 mL
Which nares do you put the tube down?
Most patent and if the patient has a deviated septum, place it down the larger side
What needs to be checked frequently on a patient with enteral feedings?
The nares for skin breakdown.
Which tube feeding is more expensive, enteral or parenteral?
Parenteral
What is a slurry?
Crushed medication mixed with water
When is a gastronomy or jejunostomy tube used instead of nasogastric?
For long term feedings
When do you check the residual volume in an intermittent and continuous feedings?
Intermittent - before next feeding; Continuous - q8hrs (usually q4-6hrs)
How much of an intermittent feeding is given at one time?
Never any more than 4 hrs worth at a time in an open system
How must a continuous parenteral feeding be given?
An IV pump
How big must the syringe be that is used in enteral feedings?
Greater than or equal 30 mL (Don’t forget to flush before and after)
How do you prevent dumping syndrome?
Infuse slowly and avoid cold solutions in the tube feedings
What position should the patient be in when receiving enteral feedings?
30-45 degrees during feeding and for at least 1 hr after
What do you need to assess for in a patient with an NG tube?
Patient knowledge, self care ability, skin and nutritional/fluid status
Aspiration is a risk with any type of enteral feeding, but what is an added risk with a gastronomy tube?
Wound infection
How often do you change the dressing on a gastronomy tube?
Daily
How often do you change the dressing on a PICC line?
24 hrs after insertion and then q7days
Enteral feeding can cause hyperglycemia, what about parenteral?
Hyperglycemia and rebound hypoglycemia
What is another possible complication that is distinct to parenteral feeding?
Pneumothorax from PICC line insertion
How often do you take vitals on patients on parenteral feedings?
q4hrs including temperature or by protocol
What kind of procedure is a dressing change on a PICC line?
Sterile procedure with gloves and mask. Patient needs to either turn head to cough or wear a mask themselves
What do you do if a parenteral infusion runs out and why?
Hang 10% dextrose solution and call Dr. This prevents the patient’s blood sugar from getting too high or too low
What are you going to assess for a patient on parenteral feedings?
Daily weight, I&O, electrolyte balance and blood glucose
What are the 4 different methods for administering tube feedings?
Intermittent bolus, intermittent gravity drip, continuous infusion, and cyclic feedings
What is a cyclic feeding?
Periodic feedings given over a short period of time
What is the purpose of enteral feedings?
Meet nutritional requirements when oral intake is inadequate or not possible, and the GI tract is functioning
What are the advantages of enteral feedings?
Safe and cost-effective; Preserve GI integrity; Preserve the normal sequence of intestinal and hepatic metabolism; Maintain fat metabolism and lipoprotein synthesis; Maintain normal insulin and glucagon ratios
What are some interventions for tube feedings?
Maintain hydration by supplying additional water and assess for signs of dehydration; Promote coping by support and encouragement, encourage self-care and activities; Reduced risk of aspiration; Pt teaching
What determines the type of tube used for feedings?
It is determined by where it enters the body (G-tube goes into the stomach and J-tube goes directly into the jejuneum)
List some nursing diagnoses for a patient with a gastrostomy.
Imbalanced nutrition, Risk for infection, Risk for impaired skin integrity, Ineffective coping, Disturbed body image, Risk for ineffective therapeutic regimen management
What are some collaborative problems/potential complications with a gastrostomy?
Wound infection, GI bleeding, premature removal of tube, aspiration, constipation and diarrhea
Can you cut gauze to place around a gastrostomy and why?
No because the fibers can fragment and get into wounds. It is better to leave the dressing off until you can get the right gauze
What are the indications for TPN?
Bowel obstruction, CA, can’t swallow, Crohn’s disease, anorexia, hyperemesis
List some potential complications of parenteral nutrition.
Pneumothorax (when inserting PICC or peripheral lines), clotted or displaced catheter (PICC line is close to the heart and can mess with it), sepsis, hyperglycemia, hypoglycemia (from over-correcting hyperglycemia), and fluid overload (may be too much fluid for patient to tolerate it)
Can you put TPN in peripheral veins?
No. Will most likely blow the vein
How often is the tubing for parenteral nutrition changed?
All tubing and bag needs changed q24hrs (even if there is TPN left in the bag)
What steps are taken to maintain fluid balance when on parenteral nutrition?
Use infusion pump (flow rate should not be increased or decreased rapidly), monitor indicators of fluid balance and electrolyte levels, I&O, weight and monitor blood glucose levels
What is a peptic ulcer?
Erosion of a mucous membrane forms an excavation
What type of pain does a peptic ulcer produce?
Dull gnawing pain or burning in the mid-epigastrium; Heartburn and vomiting may occur
Where are peptic ulcers located?
Stomach, pylorus, duodenum, or esophagus
What infection often causes/exacerbates peptic ulcers?
H. pylori
What are some risk factors for peptic ulcers?
Excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking (decreases gastric blood flow and can increase the harmful effects of H. pylori) and familial tendency
What is a Bilroth I treatment for?
Gastroduodenostomy for gastric ulcers
What is a Bilroth II treatment for?
Gastrojejunostomy for duodenal ulcers