lab quiz 5

Question 1

enemas

Answer 1

• Instillation of solution into the rectum and sigmoid colon
• Promotes defecation by stimulating peristalsis (occurs every 3-5 minutes)
• Used to treat constipation or fecal impaction, administer meds, or prepare patients for surgery or diagnostic procedures

Question 2

types of enemas

Answer 2

• Cleansing: Tap water (hypotonic), Normal saline, Fleet (hypertonic), Soapsuds
• Oil-rention
• Medicated (kayexalate, neomycin, steroids, lactulose)
• Barium

Question 3

proper positioning

Answer 3

Left side lying (sim’s) with right knee flexed

Question 4

stool characteristics that indicate bleeding

Answer 4

• Black - upper GI bleed in stomach
• Dark - bleeding higher up in GI tract (small intestine)
• Maroon - proximal large intestine, late small intestine
• Red - distal colon
• Bright red - sigmoid colon, rectum
• A small amount of blood - hemorrhoids

Question 5

unexpected outcomes of enemas

Answer 5

• Rigid, distended abdomen
• Severe abdominal cramping
• Bleeding
• Inability to retain solution

Question 6

NG irrigation

Answer 6

• Confirm orders
• Verify NG placement
• Connect syringe to NG
• Slowly inject saline
• Aspirate irrigant per policy

Question 7

troubleshooting NG issues

Answer 7

• Resistance - do not force irrigation, reposition, check for kinks/occulsion
• Nausea - assess tube patency and irrigate tube, verify suction is on
• Skin breakdown - skin care, monitor irritation, secure tube appropriately, switch tube to other nare
• Pulmononary conditions - frequent respiratory assessments, ensure proper tube placement

Question 8

NG Insertion and maintenance documentation

Answer 8

• Type, size, length, naris used
• Confirm placement
• pH and gastric contents
• Tube connections
• Ongoing assessment findings

Question 9

NG irrigation documentation

Answer 9

• Intake and output
• Characteristics and pH of gastric contents

Question 10

NG removal documentation

Answer 10

• Tube characteristics
• Final output

Question 11

Enteral nutrition tube types

Answer 11

• NG or NJ
• Gastrostomy or jejunostomy (surgically placed)
• Small bore vs. large bore

Question 12

enteral nutrition administration

Answer 12

• Review orders, confirm pt identification
• Baseline assessment
• Enteral feeding should not be cold (cramping)

Question 13

Continuous feeding adjustment

Answer 13

• Continuous rates are increased if the patient is stable and not experiencing symptoms or intolerance
• Generally increase 10-20mL per hour or 60-120mL per bolus feeding until the feeding goal is reached

Question 14

enteral meds

Answer 14

• Forms - liquid, dissolving tablets, crushed tablets
• Verify correct placement of enteral tube before administration
• Irrigate tube before and after administration
• Flush between meds with 13-30mL water
• After administering the last meds, flush the tube with 30-60mL water

Question 15

enteral nutrition troubleshooting

Answer 15

• Clogged - pause feedings, semi-fowler’s (30-45), attempt flushing, change meds to liquid form, do not crush meds not meant to be crushed
• Poor or misconnected tube - re-check and verify connections; could be a medical emergency if any sites are disconnected
• Diarrhea - consult dietician, monitor for underlying infection, ensure proper skin care

Question 16

Aspiration (complication)

Answer 16

• History of GERD, CVA, parkinson’s, artificial airway, decreased LOC, laying flat
• Interventions - prokinetics, HOB elevation, placement verification, assess gastric residual

Question 17

NG tube complications

Answer 17

• Diarrhea
• Constipation
• Tube occlusion
• Tube displacement
• Nausea/vomiting
• Electrolyte imbalance
• Fluid overload
• Re-feeding syndrome - N/V, diarrhea
• Localized infection