Nutrition & Bowel Elimination Flashcards
What are special considerations when administering medications through a tube?
*Use liquid when possible
*Crush medications - CHECK with pharmacy
*Capsules - CHECK with pharmacy
*Warm/room temperature water
*Elevate HOB to prevent reflux
*CHECK tube placement prior to administration
How to give medications via a tube?
*Flush w 15 ccs before/after each med
*Give each med separately
*If connected to suction, leave off for 20-30 mins after administering
*Tube feeding? Check compatibility (ex:Some meds cannot be given with food)
What are you looking for in a Post-Op GI assessment?
*Assess bowel sounds (listen for a full minute in each of the 4 quadrants of the abdomen)
*Abdominal distension
*Passing flatus or stool?
What nursing interventions are important for post-op GI patients?
*Privacy when in bathroom
*Laxatives/stool softeners (bowel regimen should be in place to prevent constipation - ex: docusate, miralax, senna)
*Increased food/fluids - increased fiber, fruit juices
What are nursing actions to help with post-op rest and comfort?
ADD
What’s included in measurement of I’s & O’s?
ADD
The energy required to carry out involuntary activities; body at rest
Basal metabolism
What laboratory values are used to evaluate nutrition status?
Albumin - more long-term (months back)
Prealbumin - more recent measure (days back)
When assessing dietary intake, what do you include in a 24 hr recall?
-All food consumed
-Portion size
How does dehydration affect H/H levels?
H/H will be high
Nasogastric tube (NG)
Through nose into stomach
Risk of aspirating tube feeding into lungs
Decompression & healing
What is a common adverse reaction to an Nasointestinal tube (NI)?
Dumping syndrome
How do you check the placement of an NG tube/NI tube?
-X-ray
-Check gastric contents and pH (however pH may be altered due to medications and tube feedings)
A condition that can occur after gastric surgery or tube feedings when food rapidly moves from the stomach into the small intestine. Symptoms may include nausea, vomiting, abdominal cramps, diarrhea, lightheadedness, and sweating
Dumping syndrome
What are the options for a long-term feeding tube?
ADD
What nursing interventions are important for patients receiving tube feedings?
Monitor tolerance
Keep HOB elevated
What might make stool black?
-Iron
-Upper GI bleed
Before giving immodium, what do you want to rule out?
C diff
Paralytic Ileus
Temporary stoppage of peristalsis in the small intestine for 3-5 days
What body system does low sodium affect most?
Neuro
What are signs of low potassium?
Weakness
Fatigue
Muscle cramps or twitching
Constipation
Arrhythmia
What are signs of low magnesium?
Nystagmus
Convulsions
Fatigue
Muscle spasms or cramps
Muscle weakness
Numbness
Is incontinence a normal part of aging?
No, it’s a sign of underlying disease
Surgically formed opening from inside to outside or organ
Ostomy
What are the expected findings when assessing a stoma?
Pink or red in color, moist, shiny
Ileostomy vs colostomy
Ileostomy is in the small intestine; colostomy is in the colon
ileostomy has more liquid stool; colostomy more formed
when would an NI tube be chosen over an NG tube?
-pt is at increased risk for aspiration due to impaired gag reflex or slow gastric motility
-gastric tumor
-pt cannot have HOB elevated
-GERD
symptoms of dumping syndrome
Distention of the small intestine, gas, bloating, nausea, diarrhea, cramping, and lightheadedness
techniques to check tube placement
-x-ray
-measurement of tube length and marking the tube
-visual assessment and/or checking pH of aspirate
-monitoring of CO2
when checking for placement of an NI tube what is an indication the tube has moved into the stomach?
sudden increase in the volume of the aspirate
the most common feeding schedule for gastric tubes
intermittent feeding
the most common feeding schedule for intestinal tubes (NI tube, jejunostomy)
continuous (prevents dumping syndrome)
This feeding tube schedule involves administering continuous feeding for a portion of the 24-hour period, most often 12 hours overnight. This allows the patient to attempt eating regular meals during the day, if this is possible, making ambulation and activity easier
cyclic feeding
a muscular ring that regulates the size of the opening at the end of the stomach, controls the movement of chyme from the stomach into the small intestine.
pyloric sphincter
the three parts of the small intestine
duodenum, jejunum, ileum
The connection between the ileum of the small intestine and the large intestine
Ileocecal valve
how long is the small intestine?
20 ft
how long is the large intestine?
5 ft
Just for review
youre doing great
how much fiber and water should a person have in a day to promote bowel elimination?
25 -30 g of fiber
2 -3 L of fluids
what are some ways to avoid aspiration for a pt receiving tube feedings?
*check tube placement
*Elevate HOB at least 30 degrees during feeding and 1 hour after
*Give small, frequent feedings
*Avoid oversedation of patient
*Check residual volume per policy
when do you flush the tube for tube feedings?
before and and after feeding
every 4 hours during continuous feeding
after withdrawing aspirate
how much water do you use to flush a feeding tube initially?
30 mL water with a 50 or 60 mL syringe
a potentially life-threatening condition that can occur when a malnourished individual is reintroduced to nutrition too quickly, particularly with high-calorie or high-carbohydrate intake
refeeding syndrome
what are some questions to ask a pharmacist about regarding enteral medications?
-risk of drug clogging the tube
-drug-nutrient interactions
-drug-drug interactions
-whether the location of the feeding tube’s distal end allows safe and adequate drug delivery
what do you use to dilute medications given through an enteral tube and flush tubing?
water only
what forms of medication can be given through an enteral tube?
Crushed immediate release solid or oral liquid dosage forms
what patients are at high risk for dysphagia?
-Acute stroke
-Parkinson’s disease
-dementia
-history of prolonged or multiple endotracheal intubations or tracheostomy
What should you do before proceeding with a swallow screen?
Make sure the patient can voluntarily cough, clear his throat, and swallow saliva
How do you do a swallow screen?
Offer pt sips of water and observe carefully for cough, drooling, or voice change (especially wet or gurgling quality). If any of these occur, notify the provider immediately
What should you NOT offer to a patient who can’t swallow saliva or voluntarily cough and clear his throat?
-Solids, liquids, or semisolids (including oral medications)
-Sedatives or hypnotics (if possible) because they can impair the cough reflex and swallowing
what is the hang time for a closed EN system?
24-48 hours
What is included in intake for strict I/O’s?
-All foods liquid at room temp
-Sips of water
-Flushes
-Liquid medications
What is included in ouput in strict I/O’s?
Voiding, diarrhea, vomiting, drainage, heavy perspiration
O2 carrying protein of RBC
Hemoglobin
A measurement of the volume of red blood cells in relation to the total blood volume
Hematocrit
Protein found in red blood cells that binds to oxygen and carries it from the lungs to the tissues throughout the body. Reflect the blood’s capacity to carry oxygen
Hemoglobin
how can dehydration mask malnutrition?
Dehydration may falsely inflate albumin levels because albumin will be at higher concentration
In situations where there is muscle wasting or significant muscle loss, such as in malnutrition or certain illnesses, decreased _______ production may be observed.
creatinine
what are the options for long-term feeding tubes (>4 weeks)?
-PEG Tube
-J-tube (jejunostomy)
-LPGD (low-profile gastrostomy device)
A type of feeding tube that sits flush against the skin after placement. It is similar to a PEG tube in terms of being inserted into the stomach, but it has a low-profile design that is less prone to catching on clothing or being dislodged
Low profile gastrostomy device (LPGD)
a tube that is inserted directly into the stomach through a small incision in the abdominal wall; typically used for long-term enteral feeding when a patient cannot consume adequate nutrition orally
PEG tube
a tube that is inserted directly into the jejunum (the second part of the small intestine) through either a surgical procedure or endoscopy. Used when there is a need to bypass the stomach entirely, such as in cases of gastric motility disorders, gastroparesis, or significant gastric dysfunction
J-Tube (Jejunostomy Tube):
What is the starting rate for tube feedings?
10-40mL
How do you monitor patients for tolerance to tube feedings?
-No nausea/vomiting
-Gastric residual minimal to none
-No diarrhea/constipation
-No ABD pain/distension
-Presence of bowel sounds
How many mL do you use to flush before and after tube feedings?
30-50mL
How do you position patients for tube feedings?
HOB 30-45 degrees during & 1 hour post
this part of the brain stem plays a significant role in the control and regulation of defecation
medulla
what are the options for long-term feeding tubes (>4 weeks)?
-PEG Tube
-J-tube (jejunostomy)
-LPGD (low-profile gastrostomy device)
Antibiotics tend to have a ____ effect
laxative
How is paralytic ileus generally managed?
-NPO / IV fluids
-Early ambulation
-NG decompression to relieve distension
what are some causes of occult blood?
-ulcer disease
-inflammatory bowel disease
-colon cancer
Guaiac Fecal Occult Blood Test (FOBT)
a type of screening test used to detect the presence of hidden (occult) blood in the stool
what are the options for long-term feeding tubes (>4 weeks)?
-PEG Tube
-J-tube (jejunostomy)
-LPGD (low-profile gastrostomy device)
what are the options for long-term feeding tubes (>4 weeks)?
-PEG Tube
-J-tube (jejunostomy)
-LPGD (low-profile gastrostomy device)
what are the options for long-term feeding tubes (>4 weeks)?
-PEG Tube
-J-tube (jejunostomy)
-LPGD (low-profile gastrostomy device)
