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Fundamentals of Nursing > Gastrointestinal Intubation > Flashcards

Gastrointestinal Intubation Flashcards

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1
Q

What is intubation?

A

Placement of tube into body structure

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2
Q

What is an ostomy?

A

A surgically created opening

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3
Q

What are the 4 categories of gastrointestinal tubes?

A
  1. Orogastric
  2. Nasogastric
  3. Nasointestinal
  4. Transabdomenal
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4
Q

Example of and use of an orgastic tube. Physical characteristics

A

Ewald- lavage or removal of debris, toxic material in stomach -large diameter/single lumen

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5
Q

Two examples of Nasogastric tubes

A

Levin tube and Salem sump

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6
Q

Characteristics and use of Levin tube

A

Single lumen, small diameter, used for decompression, lavage, lavage and diagnostics

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7
Q

Characteristics and use of Salem sump

A

Double lumen, small radius, used for decompression

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8
Q

What is the purpose of a double lumen?

A

To prevent stomach adhesion and blockage of drainage ports during suction

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9
Q

What are risks of prolonged use of nasogastric tubes?

A

Tissue breakdown, dilation of cardiac valve which leads to gastric reflux which leads to aspiration

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10
Q

What are the 6 reasons for intubation?

A
  1. Gavage 2. Lavage 3. Gastric residual for diagnostics 4. Decompression 5. Compression/Tamponade 6. med administration
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11
Q

What is Tamponade?

A

Controlling of gastric bleeding via compression

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12
Q

Two functions for nasointestinal tubes

A
  1. gavage 2. decompression
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13
Q

Two types of nasointestinal tubes

A
  1. Keofeed 2. Maxter
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14
Q

Use and characteristics of Keofeed

A

Gavage, small diameter with weighted tip

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15
Q

Use and characteristics of Maxter

A

Decompression, double lumen with tungsten weighted tip

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16
Q

Typical duration of Keofeed?

A

4 weeks or longer

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17
Q

Advantages to keofeed?

A

Reduce gastric reflux, able to stay in place for long durations

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18
Q

disadvantages of keofeed

A

Long and thing so they curl easily

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19
Q

How is a Maxter tube placement monitored and what aids its placement?

A

radiopaque tip via x-ray and via peristalisis

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20
Q

Two types of transabdominal tubes

A
  1. Gastrostomy tube

2. Jejunostomy tube

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21
Q

What does PEG tube stand for?

A

Percutaneous endoscopic gastrostomy tube

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22
Q

How is a PEJ tube inserted?

A

Through a PEG tube

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23
Q

When are transabdominal tubes preferred?

A

When alternative to oral feeding is required for more than 1 month

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24
Q

3 major functions of the nurse in tube management

A
  1. insertion of tube
  2. Maintain patentcy
  3. removal of tube
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25
Q

How can the nurse calm an anxious client prior to tube insertion?

A

Have client establish hand signal to indicate a pause to facilitate some form of control

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26
Q

What are the 7 aspects of the Preintubation assessment?

A
  1. level of consciousness
  2. weight
  3. bowel sounds
  4. abdominal distention
  5. integrity of nasal and oral mucosa
  6. ability to swallow, cough and gag
  7. nausea and vomiting
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27
Q

What do assessment serve as?

A

A baseline for future comparisons

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28
Q

Related to the nose, a major goal of the preintubation assessment is?

A

To establish which nostril is better suited for insertion

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29
Q

What excludes a nostril from being used?

A

Deviated septum, nasal polyps or narrow nasal passage

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30
Q

How does a nurse perform tube measurement?

A

NEX

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31
Q

NEX stands for

A

Nose. Earlobe. Xiphoid

32
Q

What are 3 methods for assessing stomach placement?

A
  1. Fluid aspiration
  2. Auscultating the abdomen
  3. PH Testing of aspirated liquid
33
Q

Which colors should aspirated gastric fluid be?

A

Yellow, green, brown

34
Q

What is auscultation of the abdomen?

A

Instilling 10ml of air into tube, placement of bell over stomach to listen for swoosh sound

35
Q

What is an indicator that tube-end might be in the esophagus?

A

Belching

36
Q

What are the two types of performed suction?

A
  1. continuous

2. Intermittent

37
Q

Low pressure suction values are usually between?

A

40 to 60 mm Hg

38
Q

How can a nurse promote tube patentcy on a client that is NPO?

A

Providing ice chips or sips of water

39
Q

What is the potential disadvantage of ice chips/ water administration when trying to maintain tube patency?

A

Water is hypotonic so to much which will draw electrolytes into gastric secretions to be suctioned out

40
Q

Can a nurse perform a tube irrigation?

A

Not without a medical order

41
Q

Unobstructed larger diameter tubes are usually removed and changed every

A

2-4 weeks

42
Q

Unobstructed smaller diameter tubes are usually removed and changed every

A

1-3 months

43
Q

How does the NEX measurement of a nasointestinal tube differ to a nasogastric?

A

Addition of 9 inches (23 cm)

44
Q

During nasointestinal tube insertion, which syringe is used to aspirate fluid?

A

50-mL syringe

45
Q

Durring nasointestinal tube insertion, when does the nurse tape the tube to the nose?

A

When the third mark on the tube is reached

46
Q

Why is a larger syringe perfered to a smaller one for fluid aspiration?

A

Larger one produces less negative pressure during aspiration and this provides more fluid for testing

47
Q

What are 4 causes for gastrostomy leaks?

A
  1. Clamped G-tube while tube feeding is infusing
  2. Mismatch between stoma and G-tube
  3. Increased abdominal pressure from formula accumulation, sneezing, coughing
  4. Underinflation of balloon beneath the skin
48
Q

Benefit to instilling nutrients into the stomach

A

Reduction of enteritis (inflammation of intestines) since gastric juices destroys microorgansims

49
Q

Disadvantage to instilling nutrients into the stomach

A

Increased risk of gastric reflux ( increased volume within stomach)

50
Q

Advantage to intestinally placed tube

A

Reduced risk of gastric reflux

51
Q

Disadvantage to intestinally placed tube

A

Dumping syndrome

52
Q

What is Dumping syndrome?

A

When calorically dense content is placed into intestines, low blood glucose arise because of insulin surge

53
Q

Symptoms of dumping syndrome

A

Naseua, sweating, weakness, dizziness

54
Q

List 4 activities with gastrostomy management

A
  1. Daily inspection of skin around tube
  2. Making sure sutures are in tact
  3. Apply skin barrier ointment (zinc oxide)
  4. Rotate bumper 90 degrees once a day
55
Q

What are the 4 feeding schedules?

A
  1. Bolus feeding
  2. Intermittent feeding
  3. Cyclic feeding
  4. Continous feeding
56
Q

Describe bolus feeding

A

liquid infusion less than 30 minutes of 250-400 mL per administration 4-6 times a day.

57
Q

Disadvantage of bolus feeding

A

Causes abdominal distention, high risk for gastric reflux and aspiration

58
Q

Describe intermittent feeding

A

Liquid infusion 4-6 times a day of 250-400 mL per administration for 30-60 mL

59
Q

What is a key requirement of intermittent feeding?

A

Container and feeding tube needs to be flushed throughly after each feeding to reduce microorganism growth

60
Q

How often are feeding tube sets replaced

A

Every 24 hours

61
Q

Describe Cyclic feeding

A

infusion for 8-12 hours followed by 12-16 hour pause

62
Q

When is cyclic feeding usually used and what time is it given?

A

To wean clients off of tube feeding and late evening and sleeping

63
Q

Describe installation rate of continuous feeding

A

1.5 mL/minute

64
Q

Continuous feeding is fed into where?

A

The small intestine

65
Q

Benefit of continuos feeding

A

Reduces risk of gastric reflux since formula is fed directly into intestine

66
Q

What are key aspects of the daily nursing assessment following tube insertion?

A
  1. Weight
  2. Condition of nasal oral mucosa
  3. Fluid intake and output
  4. Bowel sounds
  5. Lung sounds
  6. Vomiting naseua
  7. Bowel patterns
  8. Abdominal distention
  9. Skin around ostomy
67
Q

What is a mandatory requirement of the nurse to obtain once feeding schedule has started?

A

Gastric residual

68
Q

Purpose of obtaining gastric residual

A

To determine wether fluid intake exceeds client’s physiological capacity

69
Q

What is the rule of thumb of obtaining gastric residual?

A

Should be no more than 100 ml or 20% of the last hours feeding volume

70
Q

What action is performed if gastric residual is higher than normal?

A

STOP feeding, recheck residual every 30 minutes until normal volume

71
Q

What is the best way to maintain tube patency?

A

Flush tube with 30-60 mL of water prior and after feeding (every 4 hours if on continuous feed)

72
Q

What liquid can be used to flush a tube other than water?

A

Cranberry juice

73
Q

What are two ways to clear tube obstruction and what is required from both of them?

A
  1. Meat tenderizer
  2. Pancreatic enzymes
    Both require medical order
74
Q

How much water does an adult client require?

A

30 mL of water per kg of bodyweight

75
Q

Steps to clearing obstructed tube

A
  1. Choose 50 mL syringe
  2. Wash hands
  3. Don gloves
  4. Aspirate as much as possible from tube
  5. Instill 5 mL solution
  6. Clamp tube and wait 15 minutes
  7. Aspirate and flush with water
76
Q

When, why and how long do we ambulate the patient on which side?

A

After assessing that the nasointestinal tube is in the stomach, to aid the weighted tip in traveling through the pyloric valve and for 1 hour on the right side

Fundamentals of Nursing (14 decks)

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