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NUR350 > GI and Nutrition > Flashcards

GI and Nutrition Flashcards

1
Q

3 Phases of Swallowing

A
  1. Oral
  2. Pharyngeal (throat, epiglottis)
  3. Esophageal (through bolus to stomach)
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2
Q

Dysphagia

A

impairment in any stage of the swallowing process

often caused by neurological disease such as stroke

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3
Q

Altered nutritional intake affects

A
  • poorer healing
  • higher risk of dehydration and constipation
  • higher risk of pressure ulcer
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4
Q

Possible symptoms of dysphagia and aspiration

A
  • coughing during meals
  • hoarse voice following meals
  • drooling
  • upper respiratory infection
  • pneumonia
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5
Q

Symptoms of aspiration pneumonia

A
  • fever
  • crackles (fine or hoarse)
  • lower lobe sounds in the lower back
  • consolidation in the lungs (dullness during percussion)
  • chest asymmetry
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6
Q

Safety during feeding

A
  • positioning, 90 degrees
  • flex neck for ‘chin-down’
  • avoid rushing
  • alternate solid & liquid boluses
  • place food in stronger side of mouth
  • alter food viscosity
  • minimize use of sedatives and hypnotics
  • minimize distraction
  • adaptive equipment
  • oral hygiene
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7
Q

Does NPO patient need oral care?

A

Yes, saliva can aspirate into lungs and cause pneumonia

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8
Q

Safety AFTER eating

A
  • remain upright, 90 degrees
  • check for pocketing of food
  • note and document intake
  • note food preference
  • note foods that client has difficulty with
  • oral hygiene
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9
Q

Therapeutic or Mechanically altered diets

A
  • regular
  • soft diet
  • pureed/minced diet
  • full liquid, clear liquid
  • low sodium
  • no sodium
  • high protein
  • heart health diet (no salt, fruits and veggies)
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10
Q

What are diet habits affected by?

A

SES
food security
personal practice

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11
Q

Thickened fluids

A

Nectar-like (peach juice)
- slightly thicker than water
Honey-like
Pudding-like

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12
Q

Enteral Nutrition

A

Nutrients provided through the GI tract distal to the oral cavity via a tube, catheter or stoma
- also called gavage or enteral tube feeding

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13
Q

Indications for enteral nutrition

A

Unable to ingest food but can still digest and absorb nutrients

  • severe swallowing deficit
  • altered LOC
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14
Q

Enteral Access Tubes - Nasal or oral insertion

A

a. Nasogastric tube
- Levin or Salem sump
b. Nasogastric or nasointestinal tube
- small bore feeding tube
- Keofeed or Dobbhoff
c. Orogastric or orintestinal
- small bore feeding tube
- Keofeed or Dobbhoff

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15
Q

Enteral Access Tubes - Surgical insertion

A

a. gastrostomy (g-tube)
b. jejunostomy (j-tube)

surgically implanted in the OR

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16
Q

Enteral Access Tubes - Endoscopic insertion

A

a. PEG (percutaneous endoscopic gastrostomy)
b. PEJ (percutaneous endoscopic jejunostomy)

put in endoscopically, interventional radiology

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17
Q

Insertion of NG tube

A

From tip of the nose to ear lobe to top of xiphoid process

  • if not inserted enough, risk of aspiration
  • not sterile
  • drinking water can assist the process
  • flushing to prevent blockage
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18
Q

Verifying Tube Placement

A

should be assess when first inserted and before initiating any food, water or meds

Radiographic assessment (gold standard)

pH testing of gastric aspirate
(pH lower than 5 = gastric, pH higher than 5 ~ intestinal or respiratory)

Capnography - detect expired CO2 (attach device to end of tube to detect CO2)

Note respiratory distress (not reliable)

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19
Q

NG tube care

A
  • avoid laying flat, at least 30 degrees
  • hold feed when bathing or dressing change
  • tape to anchor tube
  • skin integrity
  • flush (before and after med admin)
  • use liquid form if available
  • capsule meds are usually long acting and could clog up the tube
20
Q

Administering Enteral Feeding

A

a. Continuous

b. Intermittent
- syringe, careful not to use a small syringe to give too much force

c. Bolus
- needs to be worked up
- community or home setting

21
Q

Complications of Enteral Feeding

A

a. aspiration
b. delayed gastric emptying
c. diarrhea
d. constipation
e. occlusion of tube

22
Q

Feeding (gavage)

A

Installation of liquid nutritional supplements or feedings into the stomach for clients unable to ingest food orally

23
Q

Decompression

A

Removal of secretions and gaseous substances from the GI tract to prevent or relieve abdominal distension

  • Salem sump, Levin
  • tube drains by gravity or suction
24
Q

Lavage

A

Irrigation of the stomach in cases of active bleeding, poisoning or gastric dilation

25
Q

Compression (rare)

A

put pressure on the GI tract to stop bleeding (esophageal varices)

26
Q

Stay Connected

A

a global design standard for tubing connectors to reduce incidence of medical device tubing misconnections
- ensure IV tubes can’t be connected to gastric tubes

27
Q

Parenteral Nutrition

A

Nutrient through vascular access (central venous catheter CVC or central venous access device CVAD)

  • not through peripheral lines at
  • highly sterile procedure

IV infusion of highly concentrated solutions

28
Q

Indications for Parenteral Nutrition

A
  • non-functional GI tract
  • extended bowel resting
  • preoperative TPN (total parenteral nutrition)
29
Q

Complications of Parenteral Nutrition

A
  • infection
  • air embolism
  • catheter occlusion
  • sepsis
  • electrolyte imbalance
  • hyper or hypoglycemia
  • pneumothorax (air leak causing collapsed lung)
  • refeeding syndrome (not absorbing well, in and out of cell space)
30
Q

Assessment of Elimination Patterns

A

a. nursing history
b. physical exam
c. lab tests
- stool for culture & sensitivity
- stool for ova and parasite
- stool for guaiac - if blood in stool (Fecal Occult Blood Test)
d. fecal characteristics (soft, formed, hard, brown)

31
Q

Diagnostic Exams

A

Direct visualization
- endoscopy

Indirect visualization

  • barium swallow or enema
  • xray
  • ultrasound imaging
32
Q

Constipation

A

Decrease in frequency of BM accompanied by difficult passage of dry hard stool

Symptoms: cramping, bloating, gas accumulation, pain

Causes: narcotics, dehydration, immobility

33
Q

Fecal Impaction

A

Collection of hardened feces in the rectum

Symptoms: inability to pass stool despite urge to defecate, oozing of diarrheal stool, loss of appetite, abdo distention with cramping, rectal pain

34
Q

Diarrhea

A

Increase in number of stools and the passage of liquid, unformed feces

Causes: medications, new tube feeding

35
Q

Complications of diarrhea

A

C difficile

  • distinct odour
  • certain antibiotics lead to disruption of normal flora, creating colonization by c. difficile, release of toxins that damage mucosa and cause inflammation
36
Q

Nursing care for diarrhea

A

especially if new onset and was on antibiotics

  • rehydrate and correct electrolyte imbalance
  • administer antidiarrheal meds
  • take additional precautions (isolation, PPE)
  • obtain stool sample if indicated
37
Q

Fecal incontinence

A

Inability to control the passage of feces and gas from the anus

  • implications for social isolation
  • beware of skin breakdown
38
Q

Flatulence

A

Accumulation of flatus (gas) in the lumen of the intestines causing bowel wall to stretch and distend
- can cause belching (burping)

Symptoms: abdominal fullness, pain and cramping

39
Q

Hemorrhoids

A

Dilated, engorged veins in the lining of the rectum (may be internal or external)

40
Q

Promoting Defecation

A
  • privacy
  • positioning
  • nutrition (high fiber and liquid intake)
  • regular exercise
  • bowel retraining
41
Q

Suppositories

A

glycerin

- soften stools to help it pass more easily

42
Q

Enemas

A

Instillation of a solution into the rectum and sigmoid colon which promotes peristalsis
Volume instilled breaks up the fecal mass, stretches rectal wall and initiates defecation reflex

43
Q

Types of enema

A

a. cleansing enema
Tap water (hypotonic - can cause excess fluid absorption)
NS (isotonic - safest)
Hypertonic (fleet enema, contains phosphate)
Soapsuds (castile soap)

b. oil retention
lubricates rectum and colon and soften feces

c. carminative enema
provide relief from gaseous distension

d. medicated enema

44
Q

Administering an enema

A
  1. sims position
  2. place waterproof pad under buttocks, bed pan
  3. insert rectal tube
    adult: 7.5-10 cm
    child: 5-7.5 cm
    infant: 2.5-3.75 cm
  4. instill solution slowly
    adult: 750-100 ml
    adolescent: 500-750 ml
    school aged: 300-500 ml
    toddler: 250-350 ml
    infant: 50-250 ml
45
Q

Digital removal of stool

A
  • last resort
  • removal of fecal impaction
  • vitals before and after procedure
  • observe for bradycardia (monitor for 1 hour)
  • can cause irritation to mucosa, bleeding, perforation of bowel wall and stimulation of vagus nerve
46
Q

Bowel diversions

A

creation of an artificial opening (stoma) through the abdominal wall

  • ileostomy: surgical opening in the ileum
  • colostomy: surgical opening in the colon

location determines consistency of stool

NUR350 (27 decks)

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