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General Nursing > Gastric Tubes > Flashcards

Gastric Tubes Flashcards

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1
Q

What are the six purposes of gastric intubation?

A
  1. decompress the stomach
  2. meet nutritional requirements when oral intake is not possible
  3. administer medications
  4. diagnose GI disorders
  5. compress bleeding site (ER only)
  6. lavage stomach (ER only)
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2
Q

What are the different types of gastric tubes?

A

nasogastric, nasoenteric, gastrostomy/jejunostomy

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3
Q

What is the purpose of a nasogastric tube?

A

decompression of stomach until normal peristalsis returns.
feeding
short-term

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4
Q

What is the purpose of nasoenteric tubes?

A

feeding only.
lasts several weeks

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5
Q

What is the purpose of a gastostomy/jejunostomy

A

feeding only.
long-term.

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6
Q

What are the types of gastrostomy tubes?

A

G-tube
PEG (percutaneous endoscopic gastrostomy) tube

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7
Q

What are the types of jejunostomy tubes?

A

PEJ (percutaneous endoscopoic jejunostomy) tube

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8
Q

What is the point of a nasogastric pigtail?

A

The pigtail is an air vent that prevents suctioning of the gastric mucosa. Gastric fluid should not be present in the pigtail.

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9
Q

What interventions should you take if the pigtail clogs?

A

push air (10-20mL) or fluid (20mL) through the tube. The anti-reflux valve should prevent clogging. Always place the pigtail above the stomach.

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10
Q

What is the common suction pressure for a Salem Sump?

A

80mmHg

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11
Q

How do you check the placement of a salem sump?

A

X-ray or pH

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12
Q

How do you use a salem sump for stomach decompression?

A

Intermittent suction at 80mmHg

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13
Q

What should you never do with the pigtail of a salem sump?

A

Never clamp it, connect it to suction, or use for irrigation

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14
Q

What are some reasons for decreases in suction output? What interventions do you take?

A

Displaced tube - check placement
tube obstruction - flush or irrigate
other etiology - assess patient for N/V, abd distention

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15
Q

What is an Enfit connector and what is it for?

A

Enfit connectors promote patient safety by reducing medication administration errors.

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16
Q

What does a nurse need to consider prior to insertion of a gastric tube?

A
  1. it needs a provider’s order
  2. reason for insertion
  3. patient related factors: feeding duration
  4. risk factors of complications
17
Q

What are some risk factors of complications prior to gastric tube insertion?

A
  1. level of consciousness
  2. coagulation status
  3. nasal polyps/surgery
  4. gagging
  5. esophageal disorders
18
Q

What are common regular interventions for gastric tube maintenence?

A

maintain patency by flushing regularly

19
Q

How do you insert a nasogastric tube?

A
  1. place patient in high fowler’s position.
  2. measure from nose to ear lobe to xiphoid process, then add up to 15cm
  3. lubricate tube
  4. extend head back and insert the tube downward
  5. apply gentle pressure to advance until the nasopharynx
  6. tilt head forward and advance as patient swallows
  7. if continued gagging, check if tube has coiled in the throat
  8. mark length at nose
  9. check placement with aspiration & pH, then CXR
  10. secure tube with tape, and to the gown with a safety pin.
20
Q

What are the ways to verify NG tube placement?

A
  1. CXR
  2. pH
  3. auscultatory air bolus, water bubbling
  4. tube length
  5. placement in pulmonary system = observe for S/Sx respiratory distress, keep HOB 30 degrees, capnography monitoring
21
Q

If the aspirated contents are green, yellow, or red, and the pH is less than 5, where is the most likely source?

A

gastric fluid

22
Q

If the aspirated contents are yellow, and the pH is greater than 6, where is the most likely source?

A

pulmonary lung fluid

23
Q

If the aspirated contents are yellow, orange, or red, and the pH is greater than 7, where is the most likely source?

A

intestinal fluids

24
Q

What type of tubes can be used to administer enteral nutrition?

A

NG tube, G-tube, NJ tube, PEG tube, OG tube
via intermittent/bolus feedings or continuous feeding

25
Q

What are some indications for enteral nutrition?

A
  1. patients at high risk for aspiration: altered LOC, dysphagia, impaired gag reflex, ventilation, esophageal disorders, delayed gastric emptying
  2. abnormal or obstructed ingestion and absorption of nutrients: surgical resection, obstruction, pancreatitis, liver failure, fistula
  3. decreased oral intake: anorexia, nausea, depression
26
Q

How do you prevent aspiration risks in tube feedings?

A
  1. Administer at prescribed rate and method
  2. observe patient tolerance
  3. measure GRVs prior to feeding or every 4-6 hrs
  4. hold feeding if GRV >200mL two times in a row
  5. keep patient upright during and for an hour after feeding
27
Q

How is tube patency maintained?

A

routine irrigation
- continuous: flush every 4 hrs
- intermittent: flush before and after each feed
- flush before and after each med, feeding, checking of GRV, disconnecting or clamping tube
- pediatrics: 1-3mL for neonates, 3-5mL for pediatrics.

28
Q

How long can a feeding hang for and how often do the bags need to be changed?

A

feedings should not hang for more than 4-8 hours, and bags need to be changed every 24 hours.

29
Q

What considerations need to be taken when administering medications?

A
  1. do not mix with feedings
  2. use liquid medications
  3. do not crush SL, ER/DR, or enteric coated pills
  4. crush pills and mix with water
  5. poke a hole in the capsule and squeeze it out
30
Q

What are common problems and potential complications of NG tubes and feedings?

A

tube displacement, tube obstruction, irritation and ulcers or mucosa
aspiration and pneumonia
N/V, diarrhea, gas, bloating cramping

31
Q

How can feeding cause diarrhea? N/V? Gas, bloating, cramping?

A

diarrhea: too fast, too rich, too much fiber
N/V: too much or delayed gastric emptying
Gas: too fast, too rich, too cold, too much fiber

32
Q

If flushing with water does not declog a tube, what other solutions can be used?

A

cranberry juice
soda
meat tenderizers (papain)
pancreatic enzymes

33
Q

What are common problems associated with gastrostomies or jejunostomies?

A
  1. wound infection
  2. GI bleeding
  3. premature removal of tube
  4. constipation
  5. diarrhea
34
Q

Determine which procedures can NAP assist with in relation to gastric tubes.

A
  1. Insert a feeding tube
  2. patient positioning and comfort
  3. Verify placement of a tube
  4. reporting changes in patient condition
  5. nasal and oral hygiene
  6. measurement of drainage
  7. anchoring tube to patient gown
35
Q

What differences do nurses need to consider when inserting a NG tube in a pediatric patient?

A
  1. measurement of the tube ends between the xiphoid process and belly button.
  2. gastric tube sizings are smaller
  3. confirm placement with x-ray
  4. vagal stimulation may occur with tube placement.
36
Q

What differences do nurses need to consider when inserting a NG tube in a geriatric patient?

A
  1. GRV checks are needed
  2. remove ill-fitting dentures for comfort and safety
  3. lubricate tube for insertion d/t dry mucosa.

General Nursing (6 decks)

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