Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR350 Final > Nutrition and GI skills care > Flashcards

Nutrition and GI skills care Flashcards

1
Q

Assessment of nutrition of GI

A

Nutritional screening

  • 25% of adults in hospitals are malnourished after being there for a couple of days
  • Higher risk for pressure ulcers, dehydration, constipation, etc.

Nutritional assessment
- Assessments are usually done by dietitians

Patient preferences

  • Important as a RN to know
  • Ask what they prefer

Lab values

  • Important nutritional assessment
  • example: Albumum

Physical assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Phases of swallowing

A

1) Oral
- Food taken into mouth and stimulated different sense
- Creates a ball called a bolus

2) Pharyngeal
- Bolus arrises in throat and triggers swallowing reflex
- Glottic closes and allows passage into esophagus instead on airway

3) Esophageal
- Passage of bolus from esophagus to stomach due to sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dysphagia

A

Impairment in any stage of the swallowing process

often neurological disease such as stroke, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Aspiration

A
  • Fluids or bolus go down wring tube into lungs instead of stomach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Silent aspiration

A
  • Don’t show signs/symptoms of aspiration while it’s occurring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Possible symptoms of dysphagia and aspiration

A
  • Coughing during meals
  • Hoarse voice following meals
  • Drooling
  • Upper respiratory infection
  • Pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of aspiration pneumonia

A
  • Fever
  • Hear crackles when listening (coarse or fine) and hear when patients have a lower lobe pneumonia
  • Dullness when percussing lungs; consolidation in lungs
  • General malaise, feeling really horrible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Safety during feedings

A
  • Positioning – upright 90 degrees
  • Flex neck for ‘chin-down’
  • Avoid rushing
  • Alternate solid & liquid boluses
  • Place food in stronger side of mouth
  • Mechanically-altered diets -determine food viscosity best tolerated
  • Minimize use of sedatives and hypnotics
  • Minimize distractions
  • Adaptive equipment if client is able to feed self
  • Oral hygiene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Safety after feedings

A
  • Positioning – patient should remain upright for 30 minutes
  • Check for pocketing of food
  • Note and document intake
  • Note any foods that are preferred
  • Note any foods the patient has difficulty with
  • Oral hygiene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Therapeutic diets and mechanically altered diets

A
  • Regular
  • Mechanically altered such as soft diet
  • Pureed diet
  • Full liquid, clear liquid
  • Low sodium
  • No added salt
  • High protein
  • Therapeutic diets aren’t really realistic once someone has left the hospital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Thickened fluids diet

A

Thin - no alteration
Nectar like - slightly thicker than water, like unset gelatin
Honey like - a liquid with the consistency of honey
Pudding like or spoon thick - a liquid with the consistency of pudding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Indications for enteral nutrition

A
  • Client unable to ingest food but can still digest and absorb nutrients
  • Can be for a variety of reasons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Types of entral access tubes

A

1) Nasal or oral insertion
- Nasogastric tube (Levin or Salem sump)
- Nasogastric or nasointestinal tube – small bore feeding tube (Keofeed/Dobbhoff)
- Orogastric or orointestinal - small bore feeding tube (Keofeed/Dobbhoff)

2) Surgical insertion
- Gastrostomy (G-tube)
- Jejunostomy (J-tube)

3) Endoscopic insertion
- PEG (percutaneous endoscopic gastrostomy)
- PEJ (percutaneous endoscopic jejunostomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Insertion of a nasogastric (NG) tube

A
  • Measure from tip of nose to earlobe and to the tip of the xyphiod process
  • Want end to reach the stomach
  • If not far enough risk of aspirating and going into trachea
  • Not a sterile procedure; but want to wear gloves and mindful that can elicit gag reflex and potential for vomiting
  • Sit them up; encourage them to drink water if possible during insertion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Small-bore enteral feeding tube

A
  • Often starts with thicker tube; if need feeding over period of time more to smaller one for more comfort
  • Don’t want them to get blocked
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Insertion of enteral tube: surgical or endoscopic insertion (PEG/PEJ)

A
  • Light swallowed to guide insertion into the abdominal wall
  • Comes in difference sizes in the French; starts small and advance in sizes going up
  • Balloon on end to prevent falling out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Verifying tube placement

A
  • Radiographic assessment - gold standard - before initiating feeding or medication administration
  • pH testing of gastric aspirate
  • Capnography- detecting expired CO2 by attaching device to end of tube
  • Note respiratory distress – may not be reliable
  • Aspiration of stomach contents; no longer recommended
  • Auscultation; no longer recommended
  • Has to be performed every time a tube is inserted, and before the first feed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Checking tube placement: pH testing

A
  • Draw contents up with syringe through tube
  • pH lower than 5 suggestsgastric placement
  • pH higher than 5 may indicate intestinal or respiratory placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Care of the patient with an NG tube

A
  • We never lay the patient down flat; try hard to avoid
  • Having them sit up at least 30 degree is important; some patients that’s not enough and has to be higher
  • Leave them up for 30 minutes minimum before changing positions (post-feeding)
  • Tape can be placed to anchor tube; ensure it’s clean dry and intact
  • Skin around nares is dry, clean, intact
  • If attached to face; well anchored, skin integrity
  • Where it should be coming out of the nose; checking before feeding
  • Making sure you flush the tube; (i.e. order: flush tube with 30mL of water before and after med administration)
  • Remember some medications cannot be crushed; may clog up the tube, finely crush as possible when applicable
  • Ensure tube is clear; give with water
  • If no contraindication about fluid and water intake; be mindful of giving more water (most people in hospital are dehydrated)
  • Certain types of tubes that get clogged need to go back to surgery to unclog
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Administering enteral feeding

A

1) Bolus feeding
- Community/home settings
- Give however much food goes into and drain into stomach
- Have to work up to it

2) Intermittent
3) Continuous

Kangaroo system – has food in one contain and water for flushing in another and machine dolls it out
- Many other machines only have one feeding and you have to flush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How to unclog a tube

A
  • Bicarb products
  • Warm water
  • Coca-Cola
  • Be careful with using smaller syringe; increase PSI and can damage tip of tube and break it
  • Some tubes if clogged have to be surgically removed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Best practice in enteral feeding

A
  • Preparation, storage and administration
  • Hang time
  • Selection, verification of location & maintenance of enteral access devices
  • Initiation and advancement of EN feeding
  • Patient position
  • Water safety
  • Flushes
  • Enteral tube misconnections
  • Medication administration (ISMP, 2010)
  • Gastric residual volume (GRV)
24
Q

Potential complications of enteral feeding

A
  • Aspiration
  • Delayed gastric emptying
  • Diarrhea
  • Constipation
  • Occlusion of tube
  • If tube not running; start at patient and work way out assessing for kinks, clogs, or compression
  • Sometimes you can feel where the clog is, medications or high fat foods
25
Q

Four purposes of NG tubes

A

1) Feeding (gavage)
2) Decompression
3) Lavage
4) Compression (rare)

26
Q

Feeding/gavage

A

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

27
Q

Decompression

A
  • Removal of secretions and gaseous substances from the GI tract to prevent or relieve ABDOMINAL DISTENSION
  • Examples of NG tubes used: Salem sump, Levin
  • Tube drains by gravity or via suction

Why it might be used?

  • Types of bowel surgery
  • Removing gases and fluids
  • Prevents build up
  • Gives bowels a rest
28
Q

Lavage

A
  • Irrigation of the stomach in cases of active bleeding, poisoning, or gastric dilation
  • Gets contents out of stomach and cleans
29
Q

Compression

A
  • Lacerations in the stomach
  • Put in, blow it up and pressure stops the bleeding
  • Not common anymore, other ways to deal with bleeding
30
Q

Stay connected - program

A
  • Reducing the risk of medical device tubing misconnections
  • A global design standard for tubing connectors will improve patient safety by reducing the incidence of medical device tubing misconnections.
  • ENFit connectors available in US, Canada, Puerto Rico
31
Q

Parenteral nutrition

A
  • Client receives nutrients through vascular access [central venous catheter (CVC) or central venous access device (CVAD)]
  • Involves IV infusion of highly concentrated solutions of protein (in form of amino acids) and CHO (in form of glucose) as well fat as a lipid emulsion plus electrolytes, vitamins, trace elements and fluid
  • Not using the GI tract at all; for whatever reason (need rest, can’t tolerate, etc.)
  • Always given through central line; not peripheral - the end of the tip of the catheter ends at the base of the heart
  • Reasons being; if they get into peripheral tissue, they will damage it greatly
  • Highly concentrated proteins, carbs, lipids, etc.
  • Created in pharmacy we do not touch the composition
  • Sterile procedure
  • Vitamins, supplements added
32
Q

Why give parenteral nutrition

A
  • Non-functional GI tract
  • Extended bowel rest
  • Preoperative TPN
33
Q

Complications of PN

A
  • Infection
  • Air embolism
  • Catheter occlusion
  • Sepsis
  • Electrolyte imbalance
  • Hyper- or hypo-glycemia
  • Pneumothorax
  • Refeeding syndrome
34
Q

Assessment of elimination patterns

A
  • Nursing history
  • Physical exam
  • Laboratory tests [stool for C & S, stool for O & P, stool for guaiac (FOBT-fecal occult blood test)]
  • Fecal characteristics
35
Q

Diagnostic examinations of GI tract

A

Direct visualization:
- endoscopy

Indirect visualization

  • Barium swallow
  • Enema
  • X-ray (flat plate of abdomen)
  • Ultrasound imaging
36
Q

Constipation

A

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

37
Q

Common causes of constipation

A

• Ignoring the urge to defecate
• Sedentary lifestyle, including lengthy bed rest or lack of regular exercise
• A low-fibre diet high in animal fats (e.g., meats, dairy products,
eggs) and refined sugars (e.g., rich desserts)
• A low non-caffeinated fluid intake
• Prolonged and overuse of laxatives
• Polypharmacy
• Comorbidities such as Parkinson’s disease, multiple sclerosis, rheumatoid arthritis, chronic bowel diseases, depression, eating disorders, hypothyroidism, hypocalcemia, or hypokalemia
• Neurological conditions that block the nerve impulse to the colon (e.g., spinal cord injuries, tumours

38
Q

Fecal impaction

A
  • Collection of hardened feces in the rectum

Signs and symptoms:

  • Inability to pass stool despite urge to defecate
  • Oozing of diarrheal stool
  • Loss of appetite
  • Abdominal distention with cramping
  • Rectal pain
39
Q

Diarrhea

A
  • Increase in the number of stools (several bowel movements per day) and the passage of liquid, unformed feces

Possible causes

  • GI bug
  • Medications
  • New tube feeding
  • Lots of reasons

Complications

  • Worry about C diff. in hospital (if on antibiotics) – particular odour to diarrhea
  • Problematic for older people, immunocompromised people, etc.
  • They become very dehydrated very quickly; especially if they are unwell to begin with

Nursing care:

  • Rehydrate & correct for electrolyte imbalance
  • Administer antidiarrheal medication if appropriate
  • Take additional precautions – isolation, PPE, soap & water
  • Obtain stool sample if indicated

If incontinent:

  • Use incontinence products
  • Provide meticulous skin care
  • Insert rectal tube if indicated
40
Q

Fecal incontinence

A
  • Inability to control the passage of feces and gas from the anus
  • May contribute to social isolation
  • Ensure good care of skin; stool can be very acidic and cause quick skin breakdown
  • Lots of products available to prevent and treat
41
Q

Flatulence

A
  • Accumulation of flatus (gas) in the lumen of the intestines causing bowel wall to stretch and distend
  • Usually expelled through the mouth (belching) or the anus
  • Ask people about it
  • Can use rectal tube if need to be lessen build up

Signs and symptoms

  • Abdominal fullness
  • Pain and cramping
42
Q

Hemorrhoids

A
  • Dilated, engorged veins in the lining of the rectum
  • May be internal or external
  • Can progress to a point that they need to be removed if they interfere with the ability to pass stool
  • Products available to help take away itch
43
Q

Promoting regular or normal defecation

A
  • Privacy
  • Positioning (sitting upright is best)
  • Nutrition (high fiber & fluid intake)
  • Regular exercise
  • Bowel retraining
44
Q

Administration of suppositories

A
  • Laxatives is least invasive intervention
  • Might need to administer suppository
  • Different kinds;
  • Glycerin (softens the stool)
  • Medicated
  • Often laxative in evening and suppository or enema in morning
45
Q

Enemas

A
  • An enema is the instillation of a solution into the rectum and sigmoid colon which promotes peristalsis
  • The volume instilled breaks up the fecal mass, stretches the rectal wall, and initiates the defecation reflex
46
Q

Types of enemas

A

1) Cleansing enema:
- Tap Water
- NS (normal saline)
- Hypertonic (Fleet enema)
- Soapsuds (Castile soap)

2) Oil Retention
3) Carminative enema
4) Medicated enema

47
Q

Administering an enema

A
  • Have client lying on left side (Sims position)
  • Place waterproof pad under buttocks
  • Insert rectal tube
  • adult 7.5-10 cm
  • child 5-7.5 cm
  • infant 2.5-3.75 cm
  • If tap water/soap suds/NS enema: instill solution slowly
48
Q

Digital removal of stool

A
  • Digital removal of fecal impaction
  • Physician’s order
  • Vital signs before and after procedure
  • Observe for bradycardia. - Monitor for 1 hour.
  • Unpleasant
49
Q

Bowel diversions

A
  • Certain diseases cause conditions that prevent the passage of feces through the rectum
  • May also be used to rest bowel (temporary)
  • Creation of an artificial opening (stoma) through the abdominal wall
  • Surgical opening (ostomy)
  • Depending on which part of the intestine is ending at the stoma is the name it’s given
50
Q

Care of clients with ostomies

A
  • Keeping the area clean
  • Fitting the right size; one and two piece types
  • Often clients are aware of how to care for the ostomy, ask them their preference
51
Q

Factors that can cause anorexia in acute care settings

A
  • The ketosis that accompanies starvation can further suppress appetite, as can the pain that results from surgical procedures and trauma
  • Mealtimes are often interrupted or the patient is too fatigued or uncomfortable to eat
  • Worries about family, finances, employment , or illness may interfere with getting an adequate diet
  • Medications can impair taste, cause nausea, interfere with absorption, or affect metabolism
  • Diagnostic testing may disrupt mealtimes or require NPO status
52
Q

Ways that an RN can promote appetite

A
  • Eliminate unpleasant odours
  • Provide oral care as needed to remove disagreeable tastes
  • Maintain patient comfort
53
Q

Valsalva maneuver

A
  • Pressure can be exerted to expel feces through a voluntary contraction of the abdominal muscles and the diaphragm while maintaining forced expiration against a closed airway
  • This action should be avoided by patients, particularly those with heart disease, as the increased intrathoracic pressure, immediate tachycardia, and reflex bradycardia can cause cardiac arrest
54
Q

Factors that influence elimination

A
  • Diet
  • Fluid intake
  • Physical activity
  • Personal bowel elimination habits
  • Privacy
55
Q

Complications of digital removal of stool

A
  • Irritation to the mucosa
  • Bleeding, perforating the bowel wall
  • Stimulation of the vagus nerve, which result sin a reflex slowing of the HR
56
Q

Proper positioning for using a bedpan

A
  • Patient is positioned high in bed
  • Raise the patient’s head about 30 degrees to prevent hyperextension of the back and to provide support to the upper torso.
  • Raise the hips by bending the knees and lifting the hips upward

NUR350 Final (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions