Seminar 5 Flashcards
What are the top three quadrants of the abdomen called?
Right hypochondriac,
epigastric
left hypochondriac
What are the middle three quadrants of the abdomen called?
right lumbar
umbillical
left lumbar
What are the bottom three quadrants of the abdomen called?
Right illiac
Hypogastric
Left illiac
What 6 structures are found in the right hypochondraic region?
Right lower lobe of liver
Gallbladder
Part of duodenum
Hepatic flexure of colon
Upper half of right kidney
Suprarenal gland
What 6 structures are found in the epigastric region?
Pyloric end of stomach
Part of duodenum
Head of pancreas
Portion of liver
Aorta
Renal arteries
What 6 structures are found in the left hydrochondriac region
Stomach
Spleen
Tail of pancreas
Splenic flexure
Upper portion of left kidney
Suprarenal gland
what 5 structures are found in the right lumbar region
Lower half of right kidney
Hepatic flexure of colon
Ascending colon
Part of duodenum
Part of jejunum
what 5 structures are found in the umbillical region
Lower duodenum
Jejunum
Ileum
Aorta
Femoral arteries
What four structures are located in the left lumbar region
Descending colon
Lower half of kidney
Part of jejunum
Part of Ileum
What 7 structures are found in the right illiac region
Cecum
Appendix
Lower end of ileum
Right femoral artery
Right ureter
Right spermatic cord
Right ovary
what 5 structures are located in the hypogastric region
Ileum
Bladder (if distended)
Uterus (if enlarged)
Aorta
Femoral arteries
What 5 structures are found in the left illiac region
Sigmoid colon
Left ureter
Left spermatic cord
Left femoral artery
Left ovary
In addition to bowel sounds, what sounds are sometimes heard during abdomen auscultation
abdominal bruits
eg. aortic aneurysm
what is enteral nutrition
The administration of nutrients directly into the gastrointestinal tract.
In malnutrition, all lab values will be decreased, what value is typically increased?
Liver enzymes (liver damage)
Parenteral feeding fails to stimulate the gut which results in what three complications?
villous atrophy
loss of gut mass
compromising the physical barrier (decreased surface area)
PARENTERAL Feeding is feeding via
- Feeding via an IV through a central vein
ENTERAL Feeding is feeding via
- Feeding via the stomach or intestine
With cause death if you give enteral food through a parental IV
indications for parenteral feeding? and how is it delivered?
Indicated for patient’s with a non-functioning GI tract, delivered by a CVAD or PICC
Short term enteral nutrition is through
nasogastric, nasoduodenal, nasojejunal
Long term enteral nutrition is through
gastrostomy and Jejunostomy
8 things
complications of enteral feeding
- *Refeeding syndrome
- *Aspiration
- Metabolic problems (eg. deficiency or excess of electrolytes, vitamins, trace elements, and water)
- Over-hydration
- Hypo/hypernatremia
- Tube dislodgement
- Infection
- GI side effects (nausea, abdominal bloating, cramps, regurgitation, diarrhea, constipation)
when does refeeding syndrome occur
This occurs in previously malnourished patients who are then fed with high carbohydrate loads.
Why does refeeding syndrome occur?
After long periods of not eating, insulin levels are low, when you suddenly feed someone fast, carb level (glucose) raises rapidly which also stimulates production of insulin. As insulin bings to our cells, it takes magnesium, potassium, phosphorus with it resulting in a decreased serum level of these electrolytes
Refeeding syndrome can lead to
respiratory and cardiac failure :(
feed slowly
during enteral feeding, watch for signs of aspiration such as?
- Watch for increased SOB, productive cough, sputum, or difficulty swallowing
- Assess gag reflex (if indicated), temperature, heart rate, and respiratory rate
in order to prevent aspiration, what should the nurse do
Ensure HOB elevated while a continuous tube feeding is running and for 1 hour following intermittent feeds
8 things
what contributes to a risk of aspiration with EN feeding?
Head of bed less than 30-degree angle
Impaired level of consciousness (eg. sedation)
Neurological deficits
Poor oral health
Mal-positioned feeding tube
Gastroesophageal reflex
Age over 60 years
Delayed gastric emptying
if a patient is aspirating, how should the nurse position the patient?
Lower head of bed and put client on left side to prevent further seepage of formula into lungs
types of feeding tubes
What is considered Short-Term Feeding:
(less than 4 – 6 weeks)
NG tubes are Inserted a)…?
The patient must have a b).. or c)..
a) into nostril down into the stomach
b) gag reflex
c) cough reflex
what does a anti-reflex valve prevent?
prevents gastricrefluxor leakage through the vent lumen of a double-lumennasogastric tube
what does a anti-reflex valve allow?
thevalveallows the passage of air into the vent lumen when atmospheric pressure exceeds stomach pressure
can hard bore or large bore NG tubes be used for suction?
yes, can be used for suction as the smaller vent lumen allows for an inflow of air which prevents a vacuum if the tube adheres to the stomach wall
HARD bore feeding tube
is the salem sump double or single lumened
double
what size is a large/hard bore feeding tube
Usually 12 – 18 FR diameter
what size is a small bore feeding tube
Usually 6 -12 FR diameter
how often do soft/small bore NG tubes need to be changed?
monthly
When would a naso-enteric tube be used?
(Naso-Duodenal, Naso-Jejunal):
Used for clients at risk of aspiration
Indications for a long term feeding tube?
BOTH of these
Inability to meet nutritional needs orally
Death in not imminent
ONE of these
Longer than 4-6 weeks on NG or OG feed
Low probability of nutritional needs being met orally over the next 4-6 weeks
NG tube is contraindicated
Long term feeding
Gastrostomy Tube or Jejunostomy Tube (G-Tube/J-Tube) are inserted
Inserted through the abdominal wall into the stomach or the jejunem
long term feeding is usually more than a).. weeks
Usually used for more then 6 – 8 weeks
Gastrostomy Tube or Jejunostomy Tube (G-Tube/J-Tube) have a a).. incision
Larger abdominal incision
Percutaneous Endoscopic Gastrostomy (PEG) Tube, and Percutaneous Endoscopic Jejunostomy (PEJ) Tube: have a a).. incision
smaller abdominal incision
With a PEG or PEJ tube, feeding can usually start when?
shorter NPO time (often start feeds by 24 hours).
G-tube/J-tube have longer NPO times
is a PEG tube or G-tube less expensive and timely
A PEG tube is less expensive and saves time
When should long term feeding balloons be checked?
DO NOT check balloon volume for the first four weeks after insertion
***After four weeks, check balloon volume weekly or per facility policy
**
What type of syringe should be used when checking the balloon on a long term feed
Use a slip tip syringe
IF a long term feeding tube becomes dislodged, the nurse should re-insert it!
TRUE OR FALSE
FALSE
Closed System/Continuous Drip can be hung for how long?
Hang-time up to 48 hours (if sterile technique used)
Closed System/Continuous Drip tubing and bag should be changed how often
Tubing change with bag change; up to q48 hours
Open System/Bolus or Intermittent Feed are used when patient is able to
tolerate bolus feeds
how many ml are typically given with open System/Bolus or Intermittent Feed, and over how long are they administered
Usually 300 – 500 mL given several times per day, usually over 30 min time frame
How should the nurse care for open system feeding bags and tubing after intermittent feeds?
Open system feeding bags and tubing need to be rinsed with tap water, drained, and hung to dry following intermittent feeds
All feeding systems need to be labelled with:
Client Information
Date/time
Preparer’s initials
Enteral feeding formula type, rate, strength, and amount
If there is mutiple bags or different access sites, the nurse should label where?
Label the tubing close to the client and at the site close to the source
How often should the moat or cap on the ENfit feeding tube be cleaned
once every 24 hours, and as needed if debris is present.
Tetra pack (ready to use) formula hang time?
8 hours
Reconstituted powder formula hang time?
4 hours
Closed system formula bottles hang time
– 48 hours
How often should a open system bag be changed?
change every 24 hours
How often should a closed system bag be changed
every 48 hours (or when bag empties, whichever comes first)
how often should any attachments (stopcocks or valves) for tube feeding be changed?
weekly
how often should tube feeding accessory equipment be changed
every 24 hours (syringes, bowls, cups, etc.)
What is the most accurate way to check if a feeding tube is in the correct spot
Chest x-ray
what is total free water requirement
Amount of fluid client needs in a 24-hour period to sustain life
what % of free water is in enteral feeds
60 – 85% free water
when on a enteral tube feed, what lab values should be taken daily for 3 days
Lytes, urea, creatinine, random glucose, phosphorus, magnesium
When on enteral feeding, what lab values should be check weekly (every monday) for 3 weeks
CBC, Lytes 4, urea, creatinine, random glucose, ionized calcium, phosphorus, magnesium, albumin
a standard feed should be initated at what rate
Initiate Isosource® 1.2 at 25 mL / H. If tolerated increase at 8H to 50 mL / H.
if at risk for refeeding syndrome, what rate should a enteral feed be initated at?
Isosource® 1.2 at 25 mL / H for minimum of 24H.
increased to 40ml/ H ones lytes are corrected
How often should weight be taken for a client on enteral feed
(usually 2X/week)
external feeding tube length should be documented how often?
once a shift
a nurse should visually monitor tube position a)… during continuous enteral feeding and prior to each use.
q4h
Ensure the HOB is elevated a)… during all feeds
30 - 45 degrees
How often, and how many mL should be flushed with a continous feed
50 mL q4h
how many mls should be flushed before, between and after medications
15-30 before
15 between
30 after
If feeding tube is not in use, how often should the tube be flushed
Flush 50 mL BID if feeding tube not in use
J-tubes are rotated
(true or false)
false, J-tubes are not rotated because it may cause it to become twisted and blocked
how often should gastrostomy tubes be rotated
once a day
If feeding is interrupted (eg. test, surgery)
, resume feeding at same rate unless ordered otherwise
Gastric Residual:
the volume of fluid remaining in the stomach before/during a gastric feed. Increased residuals may indicate delayed gastric emptying
in order to prevent blockage of thick medications (syrups)
Add 5 - 10 mL tap water
