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From Flashcardlet first semester > Exam 7 Enteral and PEG tube > Flashcards

Exam 7 Enteral and PEG tube Flashcards

0
Q

Capsule

A

Open and dissolve in 15-30 mL warm water

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1
Q

When should residuals be checked?

A

Prior to beginning a new feeding and before each feeding, or follow policy

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2
Q

Nasoenteric (NE)

A

Small and more comfortable for client
Less likely to become dislodged and cause aspiration
More likely to become occluded
Only liquid meds- no crushed or powdered meds
Better for longer term therapy
Must be x-ray verified on initial insertion

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3
Q

What lab values should be monitored?

A

BUN
Electrolytes
Glucose

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4
Q

Enteral feelings

A

Bolus (one)
Continuous
Intermittent

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5
Q

Reflux

A

A backward flow of food or fluid from the stomach into the esophagus.

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6
Q

Gastric

A

Stomach

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7
Q

Care of PEG tube site (percutaneous endoscopic gastrostomy)

A
  1. Cleanse with soap and water
  2. Assess skin around tube site (infection or excoriation)
  3. Rotate tube 360 degrees each day and ck for in-and-out play of 1/4 inch
  4. May use small precut gauze at exit site if drainage is present
  5. Usually clean, dry, and no gauze left around site
  6. As always, follow policy
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8
Q

Should non sterile or sterile gloves be worn during procedure?

A

Non-sterile gloves

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9
Q

A 70 year old female has been in a long term facility for 11 years. She has a dx of senile dementia, hypothyroidism, and type 2 diabetes. She is currently getting Jevity per PEG tube feedings to equal 1400 calories per 24 hrs. The chart shows her height as 66 inches and weight of 140. She has had no history of decubitus ulcers and she can move without assistance but with difficulty. Rate the following nursing consideration in order of importance and give a rationale.

A. Observe for s/s of aspiration
B. Turn and position every 2hr
C. Observe for s/s of fluid overload
D. Observe and record LOC every shift

A

C. Rationale - age and amt of fluid intact. Fluid overload can be critical
B. rationale - age and general condition. Even though client can move, doesn’t mean they will turn q 2 hr
D. Rationale - change in LOC with dementia could mean worsening of condition. LOC could be a cue to observe for other problems
A. Rationale - observe for s/s of aspiration (with PEG chance for aspirations is low)

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10
Q

How often should an irrigation set be changed?

A

Every 24 hrs

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11
Q

Nasogastric Tube

A

“Levine” tube

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12
Q

What things should be documented?

A

Procedure
Tolerance
Use of equipment

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13
Q

What is the Residual?

A

Feeding left over from the previous feeding that remains in the stomach

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14
Q

Intermittent feeding

A
  1. Pinch tube
  2. Attach prepared administration set
  3. Adjust flow via clamp to ordered rate
  4. Allow to empty over 30-60 min
  5. Don’t exceed 150-250mL at a time
  6. Usually 6-8 feedings/ day
  7. Flush with 30mL water
  8. Clamp or plug tube
  9. Rinse equipment
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15
Q

How often should continuous system bags be changed?

A

Every 24 hrs

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16
Q

Purpose of enteral feedings

A
  1. PCM- protein caloric malnutrition
    - –if pt has a bed sore, protein plays an important role in the healing process
  2. Anorexia - psychological and physiological
  3. Neurological conditions
  4. Burns (calories and protein)
  5. Chemotherapy
  6. Coma

**in elderly, the need for protein is often increased and enteral feeding can supply this in those with increased need for tissue repair (wounds, pressure sore, etc.)

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17
Q

Nasoenteric (NE)

A

Weighted or small feeding tube

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18
Q

Types of Formulas

A

Basic- Jevity and Ensure. For clients who have no specific needs or nutritional problems such as diabetes. The standard basic formula provides a calorie per ML
High protein formulas for clients with burns and malnutrition
Diabetic formulas such as Glucerna
High fiber formulas for clients who have chronic constipation and long term enteral feedings.

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19
Q

Checking for tube placement

A

X-ray is best and must be used for (NE) tubes when first inserted
Aspirate gastric contents and ck pH
Gastric pH 1-4
Lungs- pH >6
Gastric contents are brownish, tan, or greenish in color
Lung contents- clear, mucous, might be slightly blood tinged

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20
Q

Who orders when to check residuals and the amount required to hold a feeding?

A

The physician

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21
Q

Probiotic

A

beneficial bacteria that can be found in various foods

When you consume probiotics, you add these healthy bacteria to your intestinal tract.

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22
Q

Gelatin capsule

A

Aspirate with syringe or dissolve in warm water

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23
Q

Bolus feeding/open system and syringe

A
  1. Pinch tube- to keep air from getting into stomach
  2. Connect syringe
  3. Fill syringe with feeding
  4. Elevate 18 inches above stomach or insertion site
  5. Allow feeding to flow slowly (gravity)
  6. Can refill syringe until ordered feeding is complete
  7. Flush with 30mL water
  8. Clamp or plug tubing
  9. Keep HOB elevated for one hour
  10. Rinse syringe
    • always ck electrolytes, BUN, glucose
    • notify physician if pt starts having diarrhea after being on tube for 5-7 days
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24
Q

Potential complications

A
  1. Pulmonary aspirations- leads to pneumonia caused by not checking tube placement
  2. Constipation/ diarrhea
  3. Tube occlusion- flushing tube
  4. Tube displacement
  5. Abd. Cramping, N/V
  6. Delayed gastric emptying
  7. Electrolyte imbalance
  8. Fluid overload- ck for fluid overloading the first 24 hrs
    - -ankle edema, aspiration, discomfort, increased respirations
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25
Q

What are symptoms of overfeeding or intolerance?

A

Fullness
Cramping
N/V
Diarrhea

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26
Q

Tablets

A

Crush pill- dissolve powder in 15-30mL warm water

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27
Q

Administering enteral feeding through gastric and enteric tubes

A
  1. Gather equipment
  2. Procedure
    A. assess bowel sounds
    *hypoactive bowel sounds may cause problems with tube
    *contact physician with any abnormal abnormal bowel sounds
    B. verify physicians order for formula, rate, and frequency
    C. Wash hands
    D. Prepare feeding
    *room temp- do to take out of fridge and hang immediately bc it will cause cramping
    E. Shake formula if required
    F. Always ck expiration date
  3. Elevate head of bed to 30-40 degrees
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28
Q

How often should weight and I&O be measured?

A

Daily

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29
Q

Administering meds through feeding tube

A
  1. Elevate HOB high Fowlers 70-80
  2. Ck placement / residual
  3. Insert syringe (50-60 mL)
  4. Flush with 20-30mL water
  5. Pour med into syringe
  6. Flush with 10mL of water between meds
  7. Follow the last med with 20-30mL water
  8. Have client maintain sitting position for 30min
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30
Q

Lumen

A

The central space within a tube shaped body part or organ, such as a blood vessel or the intestines

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31
Q

Prebiotic

A

non-digestible foods that make their way through our digestive system and help good bacteria grow and flourish.
help feed and keep beneficial bacteria healthy.

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32
Q

PEG complications

A
  1. Infection (most common- most infections are not life threatening and involve insertion site area. Keeping the area clean is the best preventive measure. If occurs, local and/or oral antibiotics)
    * **serious complications occur in <1% patients
  2. Perforation
  3. Hemorrhage (range from minor to serious)
  4. Leakage into the peritoneal cavity (very serious)
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33
Q

Enteric

A

Intestines

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34
Q

Administering medications through tubes

A
  1. Prepare med:
    A. Assure med can be crushed!!!
    B. Cannot administered sublingual, enteric-coated, or sustained release meds via feeding tubes
    (obtain liquid for small feed (NE) tube)
    C. Do not mix meds and feedings!!!
35
Q

Nasogastric (NG)

A

Large and easily flushed
Becomes occluded less easily
Better for administering non liquid meds
Easier to insert by less skilled personnel
Easier to ck residuals
More comfortable for client
More likely to become misplaced after insertion
Best for very short term
Versatile- can be used for more than feedings

36
Q

Percutaneous

A

medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an “open” approach where inner organs or tissue are exposed

37
Q

Gravity and Pump

A

Gravity is less accurate
Pump reduces the chance of aspiration, diarrhea, and reflux
Provides a steady flow rate, and decreases chance of blockage
Gravity must be monitored more closely and flushed more frequently
Gravity method should not be used for specialized formulas such as high protein formula for burn victims, etc.
Gravity should not be used for continuous feedings. Intermittent only

38
Q

What is the purpose of checking residuals?

A

Checking residuals or holding feedings if the residual is large ( usually 150mL or above) reduces aspiration and fluid overload.

39
Q

Observe for ________ and S/S of ______

A

Edema

CHF

40
Q

Gastric tube care

A

PEG (percutaneous endoscopic gastrostomy)

41
Q

Purpose of checking?

A

If the residual is 150ml or above hold feeding. This reduces aspiration and fluid overload.

Note: the physician will order when to check residuals and the amount required to hold a feeling.

42
Q

Capsules

A

Open and dissolve in 15-30 ml warm water

43
Q

Gelatin capsules

A

Aspirated with a syringe or dissolve in warm water.

44
Q

Document

A

Chart procedure, tolerance, and equipment used.

45
Q

Care of PEG tube site (percutaneous endoscopic gastrostomy)

A

Cleanse with soap / water
Assess skin around tube site (infection or excoriation)
Rotate tube 360 degrees each day and check for in-and-out play of 1/4 inch.
May use small precut gauze at exit site if drainage is present
Usually clean, dry and NO gauze left around site.
As always, follow policy.

46
Q

Types of tubes

A

PEG (Percutaneous Endoscopic Gastrostomy)
Nasogastric (NG) and referred to often as Levine tube.
Nasoenteric (NE) weighted or small feeding tube.

47
Q

Observe for

A

Edema and s/s of CHF

48
Q

Potential Complications

A 
Pulmonary Aspiration #1
Diarrhea/constipation
Tube occlusion
Tube displacement 
Abd. Cramping, N/V
Delayed gastric emptying
Electrolyte imbalance
Fluid overload
49
Q

Pros and cons of nasogastric tube

A

Large and easily flushed. Better for administering non liquid meds. Doesn’t occlude easily.
Easier to insert by less skilled personnel.
Easier to check residual.
More comfortable for client.
Best for short term use.
Versatile - can be used for more than feedings.

Con - More likely to become misplaced after insertion.

50
Q

Administering medication through tubes

Prepare medications:

A

Assure the meds can be crushed

Do Not mix medications and feedings!

51
Q

Administering medications through feeding tube

A

Elevate the head of bed (high Fowler’s 70-80)
Check placement / residual
Insert syringe (use 50-60ml syringe)
Flush with 20-30 ml of water
Pour medication into syringe
Flush with 10ml of water between meds
Follow the last med with 20-30 ml of water
Have client maintain sitting position 1hr.

52
Q

Monitor lab values

A

BUN, glucose, electrolytes

53
Q

Purpose of Enteral feeding

A

In elderly the need for protein is often increased and enteral feeding can supply this in those with increased need for tissue repair.
( wounds, pressure sores, etc.)

54
Q

Administering Enteral Feeding through Gastric and Enteric Tubes
Gather equipment

A 
Non-sterile gloves
And other PPE as needed
Stethoscope
Disposable pad or towel
Feeding formula
60 ml syringe
Asepto
Alcohol pads
pH paper
Water for irrigation
55
Q

Reflux

A

A return or backward flow

56
Q

Points to remember! (Administering Meds)

A

Liquid meds only through a small feeding tube.
When disconnected or unplugged, tube should always be pinched off from air.
Why? To keep air out of the stomach.
When administering meds through a continuous feeding turn Pump Off, or On Hold, while administering meds.
Always check placement before administering meds through a tube.
Flush with 30 ml water before and after med. 10 ml between each med. Each med SHOULD be given separately.

57
Q

Gravity vs pump

A

Gravity is less accurate.
Must be monitored more closely and flushed more frequently.
Gravity method should not be used for specialized formulas such as high protein formulas for burn victims.
Gravity should not be used for continuous feedings. Intermittent only.

58
Q

Percutaneous

A

Effected through the skin; describes the application of a medicated ointment by friction, or the removal or infection of a fluid by needle.

59
Q

PEG Complications

A

Infection (Most common-most infections are not life threatening and involve insertion site area. Keeping the area clean is the best preventive measure. If occurs, local and/or oral antibiotics).

60
Q

When to check residuals

A

Prior to beginning a new feeding and before each feeding, or follow policy.

61
Q

Tablets

A

Crush pill

Dissolve powder in 15-30ml warm water.

62
Q

Probiotic

A

Having favorable or health-promoting effect on living cells and tissues.
(Lactobacillus acidophilus present in the gastrointestinal tract is probiotic because its presence inhibits the growth of harmful bacteria such as Salmonella and Listeria.

63
Q

Prebiotic

A

A nutrient that stimulates the growth or health of bacteria living in the large intestine.
(Prebiotics are typically neither absorbed nor digested by the mammalian gastrointestinal tract.
Their effects on human health occur indirectly, through their promotion of commensal organisms in the colon.)

64
Q

Checking for tube placement

A

X-ray is best and must be used for NE tube when first inserted.
Aspirated gastric contents and check pH.

65
Q

Intermittent feeding

A 
Pinch tube
Attach prepared administration set
Adjust flow via clamp to ordered rate
Allow to empty over 30-60 minutes
Don't exceed 150-250 ml at a time
Usually 6-8 feelings/day
Flush with 30 ml water
Clamp or plug tube
Rinse equipment
66
Q

Lumen

A

The space within an artery, vein, intestine, or tube.

67
Q

Pros and cons of nasoenteric tube.

A

Small and more comfortable for patient.
Less likely to become dislodged and cause aspiration.
Better for long term therapy.

Cons
More likely to become occluded.
Only liquid meds - no crushed or powdered meds.
Must be x-ray verified on initial insertion.

68
Q

Serious complications

A

Occur in less than 1% of patients.
Perforation
Hemorrhage can range from minor to serious)
Leakage into the peritoneal cavity (VERY SERIOUS)

Note if your patient complains of abdominal pain and starts looking bloated and may have a fever. Start to suspect leakage
Pt. will become septic very quickly if leakage is occurring. This applies mostly to patients with new peg, but can occur to existing peg patient.

69
Q

Daily

A

Weight, intake and output

70
Q

High fiber formulas

A

For clients who have chronic constipation and long term enteral feedings.

71
Q

Gastric pH and contents

A

pH = 1 - 4

Contents are brownish, tan or greenish in color.

72
Q

Gastric

A

Pertaining to the stomach

73
Q

Basic formulas

Like Jevity and Ensure

A

Are for clients who have no specific needs or nutritional problems such as diabetes.

The standard basic formula provides about a calorie per mL.

74
Q

Pump

A

Pump reduces the chance of aspiration, diarrhea and reflux.

Provides a steady flow rate and decreases chance of blockage.

75
Q

Purpose of Enteral feeding

A 
PCM - protein calorie malnutrition
Anorexia 
Neurological conditions
Burns (calories & protein)
Chemotherapy
Coma
76
Q

Check for symptoms

A

Of overfeeding
Intolerance
(Fullness, cramping, N/V, diarrhea)

77
Q

Prepare feeding

A

Needs to be at or about room temperature. Not cold, if cold can cause abdominal cramping.
Shake formula (if required)
Check expiration date.
Elevate head of bed at least 30 - 40 degrees.

78
Q

Bolus feeding / Open System and Syringe

A 
Pinch tube
Connect syringe
Fill syringe with feeding
Elevate 18 inches (above stomach or insertion site)
Allow feeding to flow slowly (gravity)
Can refill syringe until ordered feeding complete
Flush with 30 ml of water
Clamp or plug tube
Keep HOB elevated 1 hr
Rinse syringe
79
Q

Procedure

A

Verify physician’s order for formula, rate and frequency
Assess bowel sounds
Wash hands
Put on gloves.

80
Q

Lung pH and contents

A

pH > 6

Contents clear, mucous, might be slightly blood tinged.

81
Q

Enteric

A

Pertaining to the small intestines

82
Q

High protein formulas

A

For clients with burns and malnutrition.

83
Q

CANNOT ADMINISTER via FEEDING TUBE

(Obtain liquid for small feed(NE) Tube.

A

Sublingual, enteric-coated or sustained release medications

84
Q

Diabetic formulas

A

Glucerna

85
Q

Continuous system bags

A

Change every 24 hours

Irrigate set every 24 hours.

86
Q

Residuals

A

Is the feeding left over from previous feeding that remains in stomach.

From Flashcardlet first semester (43 decks)

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