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NURS 2532 > Lab 4 > Flashcards

Lab 4 Flashcards

1
Q

what is enteral nutrition

A
  • nutrients given via the GI tract
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2
Q

why is enteral nutrition used?

A
  • when the patient cannot ingest food thru their mouth

- but they are still able to digest & absorb nutrients

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3
Q

what is a nasogastric or nasointestinal tube

A
  • feeding tube inserted thru the nose into the stomach or intestine
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4
Q

what is an orogastric or orointestinal tube

A

= feeding tube inserted thru the mouth into the stomach or intestine

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5
Q

what is a gastrostomy

A
  • feeding tube surgically placed thru a stoma into the stomach
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6
Q

what is a jejunostomy

A
  • feed tube placed thru a stoma into the jejunum
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7
Q

what is a stoma

A
  • surgically created opening
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8
Q

list some indications for enteral nutrition

A
  • cancer
  • critical illness or trauma
  • neuro or muscular disorders
  • GI disorders
  • other
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9
Q

what types of cancer indicate enteral feeding

A
  • head & neck

- upper GI tract

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10
Q

list some examples of critical illnesses or trauma that indicates enteral feeding

A
  • resp failure with prolonged intubation or inadequate oral intake
  • pts in critical care with suspected/evidence of catabolism
  • trauma patients, espeically with hypermetabolic state (ex. burns)
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11
Q

what are some examples of neuro or muscular disorders that indicate enteral feeding(5)

A
  • stroke
  • brain neoplasm
  • cerebrovascular accidents
  • neuromuscular disorders (ex. parkinsons, MS)
  • dementia
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12
Q

what are some examples of GI disorders that indicate enteral feeding (3)

A
  • enterocutaneous fistula
  • inflammatory bowel disease
  • mild pancreatitis
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13
Q

what are some examples of other situations that indicate enteral feeding (5)

A
  • inadequate oral intake
  • continuous feedings
  • anorexia nervosa
  • difficulty chewing or swallowing
  • severe depression
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14
Q

what is a large-bore (diameter) sump tubing nasogastric tube used for>

A

-both decompression and short-term enteral feeding

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15
Q

what is small bore, silastic tubing with an insertion stylet used for

A
  • longer-term feeding
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16
Q

why are small bore nasogastric or nasojejunal tubes preferred over large-bore tubes?

A
  • reduce patient discomfort & gastric erosion

- can be used over long periods

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17
Q

why might a large tube be used first and then switched to a small?

A
  • might be used to start the tube feed, and if the patient tolerates it for the first 24-48 hrs, a small-bore tube is then inserted
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18
Q

why might the physician choose to leave both the small bore tube & the large bore sump in at the same time?

A
  • for gastric decompression

- to prevent vomitting & aspiration

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19
Q

what period of time are nasoenteral tubes used for?

A
  • less than 6 weeks
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20
Q

what kind of tubes are preferred for long term feeding (>4 weeks)? why?

A
  • surgical or endoscopically placed tubes

- to reduce the discomfort of a nasal tube and provide more secure, reliable access

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21
Q

what is gastroparesis

A
  • decreased or absent innervation to the stomach, causing decreased gastric emptying
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22
Q

pts with gastroparesis, esophageal refluc, risk of aspiration, and history of aspiration pneumonia, require…

A
  • placement of tubes beyond the stomach into the intestine
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23
Q

who inserts the nasoenteral tube and can administer enteral feedings?

A
  • the nurse can insert

- nurse & others (including family in a home setting) can administer

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24
Q

how can tube placement be verified? when should it be verified?

A
  • via Xray examination

- BEFORE the pt received their first enteral feeding

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25
Q

what is paralytic ileus

A
  • obstruction of the intestine due to cessation of peristalsis
  • no peristalsis = prevents passage of food = blockage of the intestine
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26
Q

gastric ileus may prevent _____? how do we work around this?

A
  • may prevent nasogastric feedings
  • nasointestinal or jejunostomy tubes allow successful pyloric feeding of formula directly into the small intestine, jejunum, or beyond the pyloric sphincter of the stomach
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27
Q

what are the 3 parts of the small intestine

A
  • duodenom (first part
  • jejunum
  • ileum
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28
Q

what is the pyloric sphincter

A
  • band of smooth muscle around the junction where the pylorus (end of) of the stomach and the duodenom meet
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29
Q

enteral feedings can be administered thru a … (3)

A
  • nasoenteric tube
  • gastrostomy
  • jejunostomy
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30
Q

tube feedings are typically started…

A
  • at full strength at slow rates
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31
Q

when does the hourly rate increase?

A
  • every 12-24 if there are no signs of intolerance
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32
Q

what are some signs of intolerance (4) to tube feeding

A
  • nausea
  • cramping
  • vomitting
  • diarrhea
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33
Q

what is a serious complication of enteral feeding

A
  • aspiration of enteral feeding into the tracheobronchial tree
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34
Q

what does aspiration of enteral feeding into the lungs cause?

A
  • irritates the bronchial mucosa = decreased blood supply to affected pulmonary tissue
  • this leads to necrotizing infection, pneumonia, and potential abcess formation
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35
Q

what does the high glucose content of formulas promote?

A
  • serves as a bacterial growth medium = promote infection
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36
Q

what else is frequently associated w pulmonary aspiration?

A
  • adult respiratory distress syndrome
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37
Q

list common conditions that increase the risk of aspiration (5)

A
  • coughing
  • nasotracheal suctioning
  • an artificial airway
  • decreased LOC
  • lying flat during & after feeding
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38
Q

how long is small-bore feeding tube for adults

A
  • 8-12 Fr

- 91-109 cm long

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39
Q

what is a stylet? what is it’s purpose?

A
  • used during insertion of a small bore tube

- is removed once the tube is in the right place

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40
Q

what are 2 different ways to verify that a feeding tube is in the right place

A
  • xray = most reliable

- measure the pH of secretions aspirated from the tube

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41
Q

list GI complications of enteral feeding

see table 42-9 for details on cause, intervention, etc. for all complications

A
  • diarrhea
  • constipation
  • abdominal cramping
  • NV
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42
Q

list complications r/t the tube

A
  • tube occlusion (blockage)

- tube displacement

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43
Q

list complications r/t imbalances

A
  • fluid overload
  • hyperosmolar dehydration
  • serum electrolyte imbalance
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44
Q

list a gastric complication associated with eneteral feeding

A
  • delayed gastric emptying
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45
Q

what are severely malnourished patients at a risk for?

A
  • developing refeeding syndrome
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46
Q

what is refeeding syndrome

A
  • metabolic disturbances that occur as a result of reinstituting nutrition
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47
Q

what should you assess/complete before administering enteral feedings via gastrostomy or jejunostomy

A
  • need for enteral feeding
  • baseline weight
  • baseline lab values
  • verify physicians order
  • hand hygeine & gloves
  • explain procedure to pt
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48
Q

list some things that may indicate need for enteral feeding (3)

A
  • difficulty swallowing
  • decreased LOC
  • surgical procedures involving the upper GI tract
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49
Q

what should you specifically verify in the physicians order before administering enteral feeding (4)

A
  • formula
  • rate
  • route
  • frequency
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50
Q

what needs to be auscultated before feeding? what would indicate need to consult the physician

A
  • bowel sounds

- if they are absent

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51
Q

what should you assess before feeing

A
  • gastrostomy or jejunostomy site for breakdown, irritation, drainage
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52
Q

describe how to prepare the feeding container to administer formula (4)

A
  • have tube feeding at room temp
  • connect tubing to container as needed or prepare ready-to-hang bag
  • shake formula well
  • fill contain and tubing with formula
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53
Q

what should you do to prep for intermittent feeding?

A
  • have syringe ready

- ensure formula is at room temp

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54
Q

what angle should the HOB be at for enteral feeding

A

30-45*

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55
Q

what need to be done before initiating food tubing

A
  • verify tube placement
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56
Q

describe how to verify the tube placement for a gastrostomy tube

A
  • attach syringe & aspirate gastric secretion

- measure?

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57
Q

what should you assess after aspirating GI content?

A
  • observe the appearance (color)
  • measure pH
  • GRV
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58
Q

what should the pH of GI contents be? what about for intestinal? for someone who has continious tube feeding?

A
  • gastric = 0-5
  • intestinal = higher than 6
  • continuous = 5 or higher
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59
Q

why is gastric residual volume important?

A
  • indicates if gastric emptying is delayed
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60
Q

what GRV volume indicated delayed gastric emptying?

A
  • > 200 mL ( may vary based on age)
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61
Q

what do you do if the GRV is less than 200 mL

A
  • return the aspirated contents to the stomach
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62
Q

describe how to verify tube placement for a jejunostomy

A
  • aspirate intestinal secretions
  • observe appearance
  • check pH
63
Q

what do you flush the tube with and how much?

A
  • 30 mL room temp tap water
64
Q

describe how to initiate a syringe feeding

A
  • pinch proximal end of gastrostomy or jejunostomy tube
  • remove plunger& attach barrel end of syringe to end of tube
  • fill syringe with formula
  • release tube & elevate syringe
  • allow syringe to emoty gradually by gravity
  • refill until prescribed amount has been deliveru
65
Q

describe how to initiate a continuous drip feeding

A
  • verify that volume in container is sufficiency for length of feeding (4-8 hrs)
  • hang container on iv pole
  • clear tubing of air
  • thread tubing into pump according to manufacturs instructions
  • connect tubing end to gastrostomy or jejunostomy tube
  • begin infusion @ prescribed rate
66
Q

when should we flush the tube with water and how much?

A

flush tube with water:

  • every 4-6 hours
  • and before & after administering meds via feeding tube
67
Q

why is water administered via feeding tube with or between feedings?

A
  • helps maintain fluid & electrolyte balance
68
Q

what doe continuous feeding reduce the risk of

A
  • diarrhea

- abdominal discomfort

69
Q

patients who receieve continuous drip feedings should have their GRV & tube placement checked how often?

A
  • every 4-6 hr
70
Q

why do we hang the container for continuous drip feeding?

A
  • allows for gravity-based flow = prevents accumulation of air in their stomach
71
Q

what should you do when tube feedings are not being administered?

A
  • cap or clamp the proximal end of the tube
72
Q

describe care for the container and tubing after all intermittent feedings; why do we do this?

A
  • must be rinsed w water

- to reduce bacterial growth in the container & tubing

73
Q

how often should the container & tubing be replaced?

A
  • every 24 hrs
74
Q

what should be done post initiation of feeding?

A
  • assess skin around tube exit site
  • dispose of supplies
  • hand hygeine
  • evaluate tolerance to tube feeding
  • measure amount of aspirate every 8-12 hr
  • monitor BG
  • monitor intake & output, weights
  • observe lab values
  • inspect stoma site
75
Q

how often/long do you monitor bg

A
  • every 6 hr until max admin rate has been reached & maintained for 24 hrs
76
Q

how long/often should you measure the pt’s I+Os and daily weight

A
  • I&O: every 24 hrs

- weight daily until max admin rate is reached & maintained for 24 hours, then 3 times/week

77
Q

describe the care of skin around the exit site

A
  • before it has healed, clean with NS –> small precut gauze may be applied to exit site & secured w tape
  • clean daily w warm water & mild soap once the site has healed
  • assess dressing for drainage, and change daily/as needed
  • fully healed tubing exit site is left open to air
78
Q

if a patient has receievd nasogastric tube feedings before tube insertion & then undergoes a procedure, how long is the tube not to be used after the procedure?

A

4-6 hr

79
Q

describe the patient’s eating status the night before the procedure

A
  • NPO
80
Q

provide a summary of how to administer enteral feedings via gastrostomy or jujenostomy tube

A
  • assess need, baseline weight, lab values
  • verify order
  • hand hygeine
  • explain procedure to pt
  • auscultate bowel sounds
  • assess site
  • hand hygeine & gloves
  • prepare feeding containe
  • elevate HOB to 30-45*
  • verify tube placement
  • flush tube with 30 mL water
  • initiate feedings
  • flush tube w water every 4-6 hr, before, after, and between feedings
  • rinse container & tubing
  • assess skin
  • evaluate response, BG, I&O, weight, lab values, skin
81
Q

describe steps for med admin via a gastrostomy tube or small-bore feeding tube prior to initiation

A
  • verify order
  • investigate and if possible, use alternative route of med admin
  • prep med & do your med checks
  • determine if med must be given on empty stomach or if it is compatible with enteral feeding
  • hand hygeine
  • identify patient
  • explain procedure & meds to pt
  • verify tube placement
  • assess gastric residual
82
Q

what type of meds do you avoid giving via gastrostomy or small bore feeding tube

A
  • avoid med regimens that frequently interrupt enteral feedings
  • avoid if have pH less than 4
  • do not give whole or undissolved meds
  • do not mix meds
83
Q

describe steps to initiate administration of meds via gastrostomy or small bore feeding tube

A
  • draw med in syringe
  • connect syrige to tube ( do not use pigtail vent)
  • administer med by push the med thru the tube by pressing the plunger or allow it to flow freely using gravity
  • administer each med seperately & flush between each
  • after giving all meds, flush again w water
84
Q

how much water do you flush with between meds

A
  • 15-30
85
Q

describe the stops post-med administration via gastrostomy or small bore feeding tube

A
  • remove gloves
  • hand hygeine
  • document
  • evaluate response to meds
86
Q

define ileus

A
  • obstruction of the ileum or other part of the intestine
87
Q

define peritoneum

A
  • the serous membrane lining the abdominal cavity
88
Q

what kind of disorders may result in the need for a stoma?

A
  • certain diseases that cause conditions that prevent the normal passage of feces thru the rectum
89
Q

what is a stoma

A
  • temporary or permanent artificial opening in the abdominal wall
  • the ends of the intestine are brought thru the abdominal wall to create the stoma
90
Q

what is an ileostomy

A
  • a surgical opening into the ilieum (3rd part of the small intestine)
91
Q

what is a colonostomy

A
  • a sugrical opening into the colon
92
Q

what determines the consistency of stool?

A
  • the location of the stoma
93
Q

describe the consistency of an ileostomy; why does this happen?

A
  • bypasses the entire large intestine = liquidy & frequent stools
94
Q

list the parts of the large intestine from beginning to end

A
  • ascending
  • transverse
  • descending
  • sigmoid
95
Q

describe the consistency of stool for a colonostomy of the ascending colon

A
  • liquid & frequent
96
Q

describe the stool of a colostomy of the transvers colon

A
  • more solid & formed stool
97
Q

describe the stool for a colostomy of the descending & sigmoid colon

A
  • near normal stool
98
Q

what determines the location of a colostomy

A
  • the medical problem

- the pt’s general condition

99
Q

what are the 3 types of colostomy construction

A
  • loop
  • end
  • double-barrell
100
Q

what is a loop colostomy

A
  • temporary large stomas constructed in the transverse colon
101
Q

when is a loop colostomy performed

A
  • in a medical emergency when closure of the colostomy is anticipated
102
Q

describe how a loop colostomy is constructed

A
  • surgery pulls a loop of bowel onto the abdomen

- it has 2 openings thru one stoma: the proximal for stool & distal for mucus

103
Q

what is a end colostomy

A
  • one stoma formed from one end of the bowel with the distal portion of the GI tract removed or sewn
104
Q

when might an end colostomy be used

A
  • often a result of surgical treatment for colorectak cancer
  • pts with diverticulitis who are treated surgically
105
Q

what is a double barrel ostomy

A
  • when the bowel is surgically severed and the 2 ends are brought out onto the abdomen
106
Q

how many stomas does a double barrel colostomy have? what is the purpose of each?

A
  • 2
  • proximal functioning stoma
  • distal nonfunctioning stoma
107
Q

what is a kock continent ileostomy

A
  • created using the patient’s small intestine as a pouch
108
Q

when is a kock continent ileostomy used?

A
  • in the treatment of ulcerative colitis
109
Q

describe how a kock continent ileostomy works

A
  • has a continent stoma with a nipple-type valve that is drained with an external catheter
  • pt places the external catheter intermittently in the stoma & empties the pouch several times a day
110
Q

how is the kock continent ileostomy protected

A
  • with a protective dressing or stoma cap
111
Q

when is an ascending colostomy done?

A
  • for right-sided tumours
112
Q

when is the double barrelled colostomy used

A
  • emergencies such as intestinal obstruction or perforation bc it can be created quickly
113
Q

define peristomal

A

skin around the stoma

114
Q

define effluent

A
  • the stool discharged from the ostomy
115
Q

how is the effluent collected

A
  • pt must wear a pouch or appliance to collect it from the stoma
116
Q

why is skin care so important for pts with ostomies

A
  • to prevent liquid stool from irritating the skin around the stoma
117
Q

how often is irrigating a colostomy done? when in particular is it done?

A
  • not as common as it once was

- pts with a left-sided colostomy may be instructed to irrigate to regulate their colon emptying

118
Q

what is used to irrigate a colostomy? why?

A
  • a special cone-tipped irrigator

- prevents bowel penetration & backflow of irrigating solution

119
Q

what should never be used to irrigate a colostomy

A
  • an enema set
120
Q

describe how irrigation is usually done

A
  • pt sits on the toilet & places an irrigating sleeve over the stoma (other end goes into the toilet bowl)
  • the solution is instilled slowly thru the lubricated cone tip
  • pt then removes the cone tip
  • pt waits 30-45 min for the solution and feces to drain out of the irrigation sleeve
  • once it stops, apply stoma cap or pouch
121
Q

what determines how much and the type of solution to irrigate with

A
  • the physical
122
Q

for adults, what is the typical amt of solution used to irrigate

A

500-700 mL

123
Q

how long should irrigation take

A

5-10 min

124
Q

if a pt chooses to irrigate their colostomy, how often is it done

A
  • timing is individualized to match the pt’s lifestyle
125
Q

describe the characteristics of an effective pouching system

A
  • protects the skin
  • contains fecal material
  • remains odour free
  • comfortable
  • inconspicuous
126
Q

list factors that play a role in the fit of the pouch

A
  • location of the ostomy
  • type & size of stoma
  • amount & consistency of effluent
  • size & contour of the abdomen
  • condition of skin around the stoma
  • skin sensitivities or allergies
  • their physical activity
  • cognitive ability for learning
  • pt’s preference, age, and dexteruty
  • cost of equipment
127
Q

define enterostoma; therapist

A
  • a nurse trained to care for wound & ostomy management
128
Q

a pouching system consists of…

A
  • a pouch

- and skin barrier

129
Q

what different ways do pouches come in

A
  • one or two piece systems
  • disposable or reusable
  • precut or not
130
Q

list different types of skin barriers for pouching systems

A
  • wafers
  • pastes
  • powders
  • liquid film
131
Q

what are wafer skin barriers

A
  • one piece pouch systems permanently attached to the ostomy pouch
132
Q

describe how a 2-piece pouching system works

A
  • pouch can be detached from the skin barrier for emptying or changing
133
Q

what does a 2-piece pouching system allow?

A
  • the skin barrier to remain around the stoma for several days
    = minimize chance of skin damage from too frequent removal
134
Q

what is an important thing to consider when using a 2-piece pouching system

A
  • skin barrier & pouch must be the same size & from the same manufacturer
135
Q

a good skin barrier….

A
  • protects the skin
  • prevent irritation from repeated removal of the pouch
  • comfortable for the pt to wear
136
Q

see textbook for steps to pouch an ostomy (way too long for flashcards)

A

…

137
Q

describe when enteral vs parental feeding is done

A
  • enteral = if oral intake is inadequate or contraindicated but the GI tract is at least partially functioning
  • parental = if gut is nonfunctioning or inaccessible
138
Q

when is enteral nutrition indicated

A
  • if the pt is unable or unsafe to orally maintain/improve nutritional status
139
Q

what nutritional statuses indicate enteral eating

A
  • protein calorie malnutrition (PCM)
    or risk of PCM with inadequate oral intake (>2-5)
  • normal nutritional status with prolonged inadequate oral intake (>7-10)
140
Q

list some contraindications to enteral feeding

A
  • perforation of the GI tract
  • GI ischemia
  • complete mechanical bowel obstruction
  • complete non-mechanical bowel obstruction
  • high output enterocutaneous fistula involving proximal small bowel
  • inability to access GI tract
141
Q

what determines route of enteral feeding

A
  • condition of the GI tract

- anticipated duration

142
Q

for what duration can nasoenteral tubes be used for? enterostomy (gastro & jejuno)?

A

<6 weeks = naso

- enterostomy = >6 week

143
Q

what is PEG

A

percutaneous endoscopic gastrostomy

  • uses an endoscope to ensure correct positioning of the gastrostomy
  • eventually replaced w a balloon tube
144
Q

describe how to initially verify the correct placement of enteral tubes

A
  • xray
145
Q

describe how to verify that the tube is in the correct place with each ongoing verification

A
  • measure external length
  • observe aspirate
  • pH
146
Q

ph measurment of aspirated contents is only valid if… ? when is it invalid?

A
  • valid if stomach has been empty for 4-6 h

- invalid if antiacids have been used

147
Q

what do you do if displacement of the tube is suspected

A
  • hold tube feedings
  • consult physician
  • in most cases, an abdominal xray must be done
148
Q

what are the benefits of low profile devices for enteral feeding

A
  • cosmetically appealing to patients
  • may be beneficial to children or confused adults who tend to pull at the tube
  • may decrease the likelihood of pyloric obstruction from inward migration of the tube
149
Q

what is the usual volume delivery for continuous administration

A
  • 25-150 mL/hr over 12-24 hrs
150
Q

what is the usual volume of admin for intermittent

A
  • 235-500 mL over 30-90 min several times/day
151
Q

what is the usual volume & duration of admin for bolus

A
  • 200-500 ml over <15 min several times/day
152
Q

how is continuous, intermittent, and bolus delivered?

A
  • continous = pump
  • intermittent = pump or gravity
  • bolus = syringe
153
Q

what is the only method of admin used for small bowel feeds

A
  • continuous
154
Q

describe the risk of aspiration for continuous, intermittent, and bolus

A
  • continuous = low
  • intermittent = higher
  • bolus = highest

NURS 2532 (5 decks)

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