Module 5 Flashcards
What are some of the reasons for nasogastric intubation in your patients?
Access route for administration of fluids, drugs & nutrients.
Allow drainage of stomach contents when indicated.
Allow removal of air from stomach when indicated.
What type of patients would you expect to see having nasogastric intubation and why?
Long-term care - nutritional support
Surgical - removal of gastric contents & gas
Pancreatitis - removal of gastric acid & stomach contents
Pre-term infants - nutritional support due to lack of suckling and swallow reflexes
What are the potential complications of enteral feeding and what can you do as a nurse to prevent these occurring?
Insertion:
Aspiration, trauma, vomiting, cough/gagging/choking, laryngeal spasm, pain, epistaxis on insertion.
Interventions:
Height of bed (HOB) 30 degrees
No more than 3 attempts of insertion
X-ray following insertion
GI/Metabolic:
Not meeting caloric requirements (starvation)
Hyperglycaemia/hypoglycaemia, over hydration, diarrhoea, constipation
Altered electrolytes - specifically K+, Mg+, PO2
Interventions:
Regular blood and urinalysis
Mechanical:
Tube migration
Tube blockage/obstruction
Interventions:
Secure tube with tape and change daily
Measure external length every shift
Flush with 50ml water before and after feeds/med administration
Avoid crushing tablets to put down tube - use alternate route where possible or obtain elixirs from pharmacy
Infection:
Aspiration pneumonia
Tube contamination
Contamination of feed
Interventions:
Clean no-touch technique when handling feeds
Check batch and use-by date prior to administration
Wash hands before and after manipulation of tube
Change feed set every 24 hours
Do not allow feed to hang >8/24
Keep pt sitting upright at 30 degrees when feeding, or lie in left lateral position with bed head tilted up to reduce risk of aspiration.
Describe the nursing responsibilities and patient teaching in medication administration for Gastroesophageal reflux (GERD/GORD), Gastritis & Peptic Ulcer Disease.
Up to 30% of people taking heartburn or reflux meds may be able to cease after initial course which is typically 4-8 weeks.
Take OTCs periodically. If need to take regularly then medical review is required.
Heartburn or reflux meds may be prescribed if symptoms are severe or occur twice a week or more.
Heartburn and reflux meds include antacids, proton pump inhibitors (PPIs) and histamine-2 receptor antagonists. Discuss differences between and mechanism of action.
Some antacids are not recommended for people with impaired kidney function, heart failure, high levels of calcium in the blood, hyperparathyroidism, phenylketonuria.
Avoid food or drink that trigger symptoms.
Avoid large or late meals, and lying down immediately after eating.
Raise head of bed if symptoms are worse at night and disrupt sleep.
Lose weight (if overweight)
Reduce alcohol intake
Stop smoking
Medical review is required if:
Experiencing mild and/or infrequent (once a wk or less) symptoms that are not relieved by lifestyle changes;
Heartburn or reflux meds don’t provide relief, or need to take more than once a week;
Experience symptoms after 4-8 weeks of treatment with a PPI or histamine-2 receptor antagonist.
Seek urgent medical advice if experience alarm symptoms such as difficulty and/or painful swallowing, unexplained weight loss, persistent vomiting, blood in vomit or stools.
You are asked to provide pre and postoperative information to a patient having a hiatus hernia repair and the family.
What information would you give, what anatomical models would you use and what drawings would you do for the patient to better illustrate the information you are providing?
Models: Thoracic - from lungs extending to bowel.
Images: Pt brochures and information flyers.
Describe function of diaphragm and lower oesophageal sphincter.
Explain how profusion of stomach through the hiatus in the diaphragm will result in pain and Sx of GORD.
Describe lifestyle changes that may improve symptoms:
Reduce alcohol
Weight loss.
Avoid large meals.
Smoking cessation.
Elevate head of bed.
Avoid foods that exacerbate symptoms.
What are the essential steps in carrying out a swallowing assessment?
- Ensure pt is able to swallow saliva and cough on demand.
- Sit pt up >30 degrees.
- Perform mouth care and decontaminate mouth.
- Assess for gag reflex and control of mouth/tongue. If impaired refer to speech pathologist.
- Assess for LOC, speech disturbance and facial droop. If impaired refer to speech pathologist.
- Have pt swallow a few spoonfuls of water. If cough/gurgle refer to speech pathologist.
- Observe pt drink small cup of water. If cough/gurgle refer to speech pathologist.
- See screening tools.
http: //health.vic.gov.au/clinicalnetworks/stroke/dysphagia.htm
