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Nursing Fundamentals II > GI - NG Tubes > Flashcards

GI - NG Tubes Flashcards

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1
Q

Aspirate

A

to remove fluids or gases by suction

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2
Q

Bolus

A
  • a one time large dose

- meds, food

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3
Q

Carina

A

point at which trachea divides into right and left bronchi

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4
Q

What do you do if someone starts to cough and turn blue while you are inserting NG tube?

A

pull out and start over

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5
Q

What precaution do you take for someone that is in coma?

A
  • check placement of tube

- make sure it is not in lungs

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6
Q

Cachexia

A
  • a state of ill health, malnutrition and protein wasting

- eating own muscle

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7
Q

Decompression

A
  • to decrease pressure

- remove contents in stomach

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8
Q

Dumping syndrome

A
  • symptoms due to rapid entry of undigested food into jejunum
  • diabetes or ng tube too long
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9
Q

How long can you leave a NG tube in?

A

7 to 10 days

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10
Q

Dysphagia

A

difficulty swallowing

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11
Q

Emesis

A

vomiting

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12
Q

Enterostomy

A

opening into stomach or jejunum through which a feeding tube is inserted

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13
Q

Why do stroke patients have an NG tube?

A

dysphagia, aspiration issues

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14
Q

Enteral

A
  • within the intestines-gastro intestinal tract

- something into GI tract

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15
Q

Eructation

A

producing gas from the stomach, belching

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16
Q

Flatus

A

gas from the intestine

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17
Q

Gastrostomy

A

surgical creation of a gastric fistula

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18
Q

Gavage

A

introduction of nourishment into the GI tract by mechanical means

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19
Q

Intermittent

A

coming and going, suspending activity at intervals

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20
Q

Ileus

A

obstruction of intestine caused by paralysis of intestinal muscles

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21
Q

Nasogastric

A

tube that is passed through the nose into the stomach

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22
Q

Lumen

A

inner open space of a tube

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23
Q

Jejunostomy

A

surgical creating of an opening into the jejunum

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24
Q

Kwashiorkor

A

extreme malnutrition from severe protein insufficiency

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25
Q

Lavage

A
  • washing out of a cavity, irrigate

- stomach - taken overdose of medicine and need to get it out

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26
Q

Parenteral

A

outside of the intestines

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27
Q

Patent

A

wide open, accessible

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28
Q

PEG

A

percutaneous endoscopic gastrostomy, type of NG tube

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29
Q

Regurgitation

A

return to the mouth from the stomach

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30
Q

Residual

A

what is left over

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31
Q

Salem Sump

A
  • double lumen radiopaque gastric tube with blue pigtail
  • one lumen for meds
  • second lumen - safety valve
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32
Q

Reasons for NG intubation

A
  • decompress
  • instill medicine
  • irrigate
  • feed
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33
Q

Why would you use gravity drainage?

A
  • sometimes for people who have fragile suture line
  • suction would create bleeding
  • below the bed on a hanger
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34
Q

Why would you use a NG tube to decompress?

A
  • major GI surgery, no collection of acids, secretions in stomach
  • vomit blood - need to get blood out of stomach
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35
Q

intermittent suction

A

on and off

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36
Q

continuous suction

A

on all the time

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37
Q

Why would you use a NG tube to instill medicine?

A
  • run out of veins, rectal

- must always flush with water both before and after giving a medication

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38
Q

Why would you use a NG tube to irrigate?

A
  • to maintain patency
  • to wash out (lavage)
  • GI bleed, suction out, put in ice saline to try to create vasoconstriction, last ditch approach
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39
Q

Why would you use a NG tube to feed?

A
  • Only 7 to 10 days
  • Stroke, neuromuscular disorder
  • Gavage
  • Bolus
  • Continuous/intermittent feeding
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40
Q

What size does an NG tube come in?

A
  • 12 to 18 French

- average is 14 french

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41
Q

How do you decide where to place NG tube?

A
  • check nostrils for patency
  • do they breathe better in one over the other
  • polyps, trauma, etc…
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42
Q

When not to insert a NG tube…

A
  • The patient is recovering from gastric, nasal, craniofacial or hypophysectomy (removal of the pituitary gland) surgery or brain/facial injuries
  • If it gets pulled out do not put back in until you speak with the surgeon
  • The patient may return from the OR with a NG tube in place but always check with the MD before inserting a new tube on a new GI surgical.
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43
Q

What should you elevate head of bed to when inserting NG tube?

A

at least 45 degrees

44
Q

What type of lubrication do you use for NG tube insertions?

A

water based

45
Q

How do you measure the length of NG tube?

A
  • Measure from the tip of the nose to the earlobe, to the xyphoid process.
  • Mark the tube before insertion.
46
Q

Why do you set up a signal for the patient?

A

so they can let you know if they are having a bad time

47
Q

How much of the NG tube do you lubricate?

A

first 4 inches

48
Q

What position is the patient’s head in when you first start the NG tube insertion?

A

the patient’s head is slightly up

49
Q

What position is the patient’s head in when you pass the gag reflex?

A

chin toward chest

50
Q

What can a patient do to help you advance the NG tube?

A

take sips of water

51
Q

How do you check for placement of NG tube?

A
  • use pen light to look at back of throat
  • aspirate stomach contents
  • hear air at end of tube
  • x-ray
52
Q

What is the pH of stomach?

A
  • 1 to 4 but as high as 5.5

- question under 1 and over 5.5

53
Q

What do you expect if patient is coughing after insertion of NG tube?

A

tube could be in trachea

54
Q

How often should the NG tube be repositioned?

A
  • at least once a shift
  • inspected for skin or mucous membrane irritation
  • loosen tape, rotate tube, look for skin irritation
55
Q

What should you do with end of tube after insertion?

A

attach tube for suction or plug it

56
Q

What do you do with tube when not feeding?

A

plug it

57
Q

How do you test position of NG tube with air?

A

insert 10-15 mL of air and listen for it come through the tube in the stomach

58
Q

NG tube - single lumen

A

must be attached to low (30-40 mm Hg) intermittent suction

59
Q

NG tube - double lumen

A
  • May be attached to intermittent high (120 mm Hg) suction or continuous low suction
  • Stabilize blue tube above level of stomach and insert blue to blue anti-reflux valve
60
Q

NG tube - triple lumen

A
  • Usually used for irrigation and suction simultaneously, such as a GI bleed
61
Q

Why provide oral care for patient with NG tube?

A
  • Patient only has to mouth breathe

- NG tube will decrease peristalsis, oral care will stimulate this

62
Q

How often should you offer oral care?

A

every two hours

63
Q

What do you document about NG tube insertion?

A
  • How it went
  • Return - color and amount
  • Toleration - patient is resting, no complaints, watching tv - state of patient when you left the room
  • How did procedure go
  • Chart - clean and concise, if chart went to trial what would they look for
64
Q

What solution do you use for irrigation?

A
  • what the dr orders

- can be water or NS

65
Q

Why would you use NS to irrigate?

A

prevent electrolyte imbalance

66
Q

How much solution do you use to irrigate?

A

30-40 mL

67
Q

When would you irrigate?

A
  • Lot of return from suction but no longer getting suction

- Patient is nauseous and want to vomit - tube is clogged

68
Q

How do you put in solution when irrigating?

A
  • Gently
  • If fluid doesn’t go in, draw back out, and try again
  • If fluid still doesn’t go in may need to replace the NG tube because it is more than likely clogged
69
Q

What type of patient do you never irrigate a NG tube on?

A

surgical

70
Q

What is a gastrostomy tube?

A
  • Usually placed for long term feeding
  • Stomach
  • Measured in French
71
Q

When is a jejunostomy tube used?

A
  • May be placed if the stomach needs to be bypassed or if the stomach has been removed, etc.
  • Have had gastric bypass
  • Tends to be smaller, hard to get meds down
  • Measured in French
72
Q

How is a “G” or “J” tube held in place?

A

a balloon is often used

73
Q

How often is site care done for “G” or “J” tubes done?

A

twice a day

74
Q

How do you clean a “G” or “J” tube sight?

A

clean only with water, may need something more, see facility policy

75
Q

What is proud flesh?

A

skin that grows around the tube may use nitrate to burn it off

76
Q

When would you use a dressing for a “G” or “J” tube?

A

when drainage is present

77
Q

Do you cut the dressing to fit the site?

A
  • never cut, always fold
  • fiber/strings can get into site and cause infection
  • fold 2 four by fours and can be taped together
78
Q

How long should the tube be for a small bore feeding tube?

A

NEX + 10 inches

79
Q

What are the checks for small bore feeding?

A
  • Air-30-60 ml then aspirate
  • pH>5
  • Turn patient to right side
  • OBTAIN XRAY Before Starting Feeding
80
Q

What should you do prior to starting an enteral feeding for the first time?

A
  • xray
  • air
  • aspirate
81
Q

What do you do after the first feeding?

A

aspirate

82
Q

How much residual should there be prior to enteral feeding?

A
  • no more than 50 mL

- wait and hour and recheck

83
Q

Do you want to elevate the bed prior to feeding?

A

yes

84
Q

Why do you want to check dr orders prior to feeding?

A
  • nephro, diabetics, lactose intolerant, etc…
85
Q

How long is a closed bag good for?

A

24 hours

86
Q

How long is an open bag good for?

A

4 to 6 hours

87
Q

intermittent feedings

A
  • Usually delivered via an infusion pump
  • Prime tubing so patient doesn’t get a lot of air
  • Check expiration date on formula
88
Q

How long does an intermittent feeding last?

A

usually given over 60 minutes

89
Q

How much formula do you give at an intermittent feeding?

A

not more than 200 - 400 cc’s at one feeding

90
Q

Continuous feedings

A
  • delivered around the clock

- water flushes given (approx. 50ml) q shift

91
Q

How much formula is given each hour for continuous feedings?

A

usually 50 - 100 cc’s per hour

92
Q

Bolus feeding

A
  • Large volume given at one time
  • Delivered via gravity flow
  • More for people who don’t want to be tied to a system
93
Q

How much formula do you give at a bolus feeding?

A

Usually 250 - 400 ml

94
Q

What do you do prior to starting a bolus feeding?

A
  • Aspirate - more than 50 ml wait one hour, no gastric contents listen for air
95
Q

How much water do you flush into a patient prior to/after a bolus feeding?

A

30 mL

96
Q

Do you use a luer lock syringe to administer bolus feedings?

A

no, too much pressure

97
Q

Do you push fluids with a syringe?

A
  • no because it causes too much pressure

- use gravity flow

98
Q

How often should the oral cavity be inspected?

A

once a shift with a flashlight

99
Q

How often should oral cares be done?

A

every 2 hours

100
Q

Medications via enteral tube

A
  • Use liquid form of medication whenever possible
  • Never crush medications unless approved by your institution (check policy)
  • Always flush tube with H20 before and after giving medications
  • Always include the H20 on the intake sheet
  • Never mix medications together unless facility policy supports this practice.
101
Q

Feeding Pump

A
  • Feeding should not hang more than 4-6 hours with an open system
  • Use feeding ordered by physician and amount to be administered
  • Keep HOB elevated 30-45 degrees
  • Flush using side port with 30 ml water every 4-6 hours using a new sterile syringe
  • Rinse open system before adding more formula
102
Q

What do you need to take out a NG tube?

A

dr orders

103
Q

What do you do prior to with drawing the NG tube?

A

Flush with 10-20 ml normal saline or air-to clear tube

104
Q

What should patient do as you take NG tube out?

A

hold breath

105
Q

What should you do with NG tube as you pull it out?

A

rotate it to loosen tissue that may have grown on it

106
Q

Can you give a patient something to drink after taking out a NG tube?

A

If they have orders - give them something to drink, not hot or icy cold, not acidic, encourage them to start with something soft

Nursing Fundamentals II (13 decks)

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