UGI Disorders & Tube Feedings Flashcards
How long is an NG tube? Is it safe to advance it, if it is coming out?
NG tubes are 22-26 inches long and it is safe to advance it 6-8 inches if it is coming out.
Which three organs can enteral nutrition be administered?
1) Stomach
2) Duodenom
3) Jejunum
What are the 4 characteristics of a Levine Tube?
1) Single lumen
2) 14-18 French
3) Has multiple openings at the end
4) Used with LIS (30-40 mm Hg) to prevent gastric erosion or tearing of the stomach lining.
What are the 4 characteristics of Gastric or Salem Sump Tube (SST)?
1) Double lumen (larger lumen for suction and smaller/blue lumen for venting).
2) 12-18 French
3) Used with continuous low suction
4) Has an anti-reflux valve that is used to prevent reflux of fluids up through the venting tube.
What are the 3 characteristics of postpyloric tubes?
1) Continue past the stomach and enter the Duodenom or Jejunom (110-140 cm)
2) smaller bore (8-10 French)
3) Single lumens
Which medication is indicated for the insertion of Nasointestinal tubes and how does it work?
Metoclopromide - Increases gastric and small intestine motility, which aids in the insertion of the tube. It should be administered 10 mins before the procedure.
Why is placing a patient on their right side helpful in the advancement of a tube?
Because gravity may assist the tube in passing through the pyloric sphincter and into the small intestine.
What is a normal Pre-albumin level? What does the following Pre-Albumin levels represent?
1) 0-5 mg/dL
2) 5-10 mg/dL
3) 10-15 mg/dL
Normal Pre-Albumin levels are 19-38 mg/dL
1) 0-5 mg/dL - Severe protein depletion
2) 5-10 mg/dL - Moderate protein depletion
3) 10-15 mg/dL - Mild protein depletion
Why is tube insertion contraindicated in a patient with low Pre-Albumin levels?
Low Pre-Albumin levels are caused by starvation and result in protein depletion which translates to a higher risk for perforation when inserting tubes.
(T/F) When administering meds through a tube, a nurse should know that crushing extended release tablets are prohibited but time-released capsules are permitted to be opened (not crushed).
True
What should the nurse be sure to do, regarding the HOB, when administering tube feeding?
1) Raise the head or the bed at least 30 degrees.
2) Keep the HOB elevated for 30-60 mins for intermittent delivery
3) Keep the HOB in semi-fowler’s position for continuous feeding
4) Keep the HOP in high fowler’s for 30-60 mins after feeding
What are the 7 General Nursing Considerations associated with Tube feeding?
1) Take daily weights
2) Assess for bowel sounds before feedings
3) Take accurate I&Os
4) Take initial glucose checks
5) Label the date and time started
6) Replace formulas q4h and tubings tubings q24h
7) Formula should be room/body temp
What 4 things can the nurse do to help prevent vomiting from tube feeding?
1) Assess the rate of infusion (too fast = vomiting)
2 Assess the temperature of of the formula
3) Replace the formula every 4 hours
4) Replace tube feeding container and tubing q24hrs
What 3 things can cause a tube fed patient to develop nausea and vomiting?
1) Change in formula
2) Feeding rate that is too fast
3) Inadequate gastric emptying
What 4 things can cause a tube fed patient to develop diarrhea?
1) Hyperosmolarity of feedings
2) High milk content
3) Contaminated feedings
4) High-fiber feedings
What 3 things can cause a tube fed patient to develop constipation?
1) Low-fiber feedings
2) Dehydration
3) Opioid use
What 4 things can cause a tube fed patient to aspirate?
1) Improper tube placement
2) Vomiting with aspiration of high residual volume
3) Flat HOB
4) Use of a large tube
What 3 methods can be used to prevent a clogged tube?
1) Use liquid meds if possible
2) Flush with 30-50 mL of water after feedings
3) Flush with water q4h with continuous feeding
What are the 5 gerontological considerations of tube feeding?
1) They are more vulnerable to complications
2) They are more vulnerable to F & E imbalances
3) They have more glucose intolerances
4) They have a ⬇ ability to handle large volumes
5) They have an ⬆ risk of aspiration
(T/F) Anticholinergic drugs can ⬆ LES pressure and cause GERD
True
What are the 3 complications of GERD that were discussed in class?
1) Barrett’s esophagus - Replacement of normal squamous epithelium with columnar epithelium.
2) Respiratory problems - Due to irritation of upper airway by secretions.
3) Dental erosion
What are the 2 types of drug therapy approaches used to treat GERD?
1) Step up - Antacids with OTC H2R blockers > prescription H2R blockers > PPIs
2) Step down - PPIs > prescription H2R blockers > Antacids with OTC H2R blockers
What are the 6 characteristics of the drug class H2R blockers, used to treat GERD?
1) Names end with “tidines”
2) They suppress secretion of gastric acid
3) They ⬇ symptoms and promote healing in 50 % of patients
4) Side effects are uncommon
5) They are best taken at bed time
6) Caution should be taken with Cimetidine because it increases the bioavailability of many drugs.
What is the common name for the following H2R blockers:
1) Famotidine
2) Ranitidine
3) Cimetidine
4) Nizatidine
1) Famotidine - Pepcid
2) Ranitidine - Zantac
3) Cimetidine - Tagamet
4) Nizatidine - Axid
What are the 5 characteristics of the drug class PPIs, used to treat GERD?
1) Their names end with “prazoles”
2) They suppress gastric acid secretion
3) They promote healing in 80-90 % of patients
4) Used to treat active ulcers & esophageal strictures
5) they should be taken 30 mins before the first meal of the day
What are the 4 side effects of PPIs?
1) Headache
2) Diarrhea
3) Abd pain
4) Nausea
What are the 4 characteristics of the drug class Antacids, used to treat GERD?
1) Relief is quick but short-lived
2) They neutralize stomach acid
3) They should be taken 1-3 hours after meals/bedtime
4) They should not be taken within 1 hour of other meds
(T/F) Aluminum containing Antacids can decrease calcium and lead to Osteoperosis.
True
What are the common names for the following PPIs:
1) Omeprazole
2) Esomeprazole
3) Rabeprazole
4) Pantoprazole
5) Lansoprazole
1) Omeprazole - Prilosec
2) Esomeprazole - Nexium
3) Rabeprazole - Aciphex
4) Pantoprazole - Protonix
5) Lansoprazole - Prevacid
What are the 2 side effects of the Calcium-Carbonate Antacids, such as Mylanta and Tums?
1) Constipation
2) Burping and flatulence d/t release of CO2 in the stomach
What are the 4 characteristics of Milk of Magnesia?
1) Rapid acting
2) May cause diarrhea
3) Should be used with caution in renal patients because of Mg toxicity
4) Often given in combo with aluminum prep
What are the 3 positive and 1 negative aspects of using Cholinergics in the treatment of GERD?
1) ⬇ LES pressure
2) ⬆ esophageal emptying
3) ⬆ gastric emptying
4) Negative - Stimlates HCl secretion
Give an example of a Cholinergic drug used to treat GERD
Bethanechol (Urecholine)
What drug did we discuss in class that stimulates GI motility?
Antiemetics - Specifically Metoclopramide
(T/F) Research has shown that patients are at higher risk for C.difficile when on PPIs. Why or why not?
True - It blocks acid production which would have killed food-borne pathogens
Blocking acid production with H2R blocker and PPIs also decreases Intrinsic Factor. Why is IF important?
Intrinsic Factor is needed for the metabolism of B12 by the small intestine.
What 4 things is Vitamin B12 essential for?
1) Brain health
2) Nerve health
3) RBC production
4) Happiness
Which 6 foods discussed in class are rich in Vitamin B12?
1) Citrus fruits
2) Dried beans
3) Green leafy vegetables
4) Liver
5) Nuts
6) Organ Meats
What is Gastritis?
Gastritis is an inflammation of the gastric/stomach mucosa
What are the 6 causes of Acute Gastritis?
1) Contaminated food
2) Irritating/spicy foods
3) Over use of aspirin and NSAIDs
4) Alcohol
5 Bile reflux
6 Radiation Therapy
What are the 5 SxS of Acute Gastritis?
1) Abd discomfort
2) Anorexia
3) N & V
4) Headache
5) Hiccups
What are the 7 causes of Chronic Gastritis?
1) Ulcers
2) H. pylori
3) Dietary factors
4) Medications
5) Alcohol
6) Smoking
7) Reflux
What 2 methods can be used to Dx Gastritis?
1) Testing of breath, urine, stool, serum and gastric tissue for presence of H. Pylori
2) Endoscopy with biopsy
What would a person without a stomach need B12 injections for life?
Because the stomach secretes the protein called Intrinsic Factor which is necessary for the absorption of B12
What are the 6 SxS of Chronic Gastritis?
1) Anorexia
2) N & V
3) Belching
4) Heartburn after eating
5) Sour taste in mouth
6) Vitamin B12 deficiency
What is another name for Vitamin B12?
Cobalamin
Because H. Pylori quickly becomes resistant, more than one antibiotic is used for Gastritis therapy. What are the types of drug therapies used for Gastritis?
1) Double Drug Therapy - Bismuth salts and one antibiotic (Clarithromycin)
2) Triple Drug Therapy - PPIs or Bismuth salts and 2 antibiotics (Clarithromycin and Amoxicillin)
3) Quadruple Drug Therapy - PPIs and Bismuth salts and 2 antibiotics (Tetracycline metronidazole)
What is Peptic Ulcer Disease (PUD)?
PUD is a break in the mucosal lining of the esophagus (5%), stomach (15%), or duodenum (80%)
What is the difference of the effect of food on Gastric ulcers versus duodenal ulcers?
Food irritates gastric ulcers and alleviates duodenal ulcers
What are the nursing considerations when administering the following Antibiotics:
1) Amoxicillin
2) Clarithromycin
3) Metronidazole (Flagyl)
4) Tetracycline
1) Amoxicillin - Causes diarrhea and should not be used in patients allergic to penicillin
2) Clarithromycin - Causes GI upset, headaches and altered taste.
3) Metronidazole (Flagyl) - Should be given with meals, may cause anorexia and metallic taste. PT should avoid alcohol, and it ⬆ blood thinking effects of warfarin.
4) Tetracycline - Causes Photosensitivity, GI upset, dairy products ⬇ effectiveness, and should be used with caution in PTs with renal and hepatic problems.
(T/F) Bismuth Salts aka Pepto Bismol should be taken on an empty stomach.
True
What are the 5 things discussed in class that destroy the mucosal barrier?
1) H. Pylori - Produces the enzyme urease
2) Aspirin & NSAIDs - Inhibits synthesis of prostaglandins causing abnormal permeability.
3) Corticosteroids - ⬇ rate of mucosal cell renewal
4) Lipid-Soluble Cytotoxic Drugs - Passes through and destroys it
5) ⬆ Vagal Nerve stimulation - ⬆ HCl acid
What are the differences between Gastric and Duodenal ulcer pains?
1) Gastric Ulcer Pain - High in epigastrium, 1-2 hrs after meals
2) Duodenal Ulcer Pain - Midepigastric region beneath the xyphoid process, back pain, and 2-4 hours after meals
(T/F) A board-like abdomen is a sign of Peritonitis
True
What are the 3 major complications of PUD?
1) Hemorrhage
2) Perforation
3) Gastric outlet obstruction
When a peptic ulcer penetrates the serosal surface with spillage of contents into the Peritoneal cavity, Peritonitis can happen. What are the 5 clinical manifestations of this?
1) Severe upper Abd pain that spreads throughout the abdomen
2) Shoulder pain
3) Rigid, board-like abdominal muscles
4) No bowel sounds
5) N & V
What are the 4 causes of Gastric Outlet Obstruction as a complication of PUD?
1) Edema
2) Inflammation
3) Pylorospasm
4) Fibrous scar tissue formation
What are the 3 clinical manifestations of Gastric Outlet Obstruction as a complication of PUD?
1) Pain worsens towards the end of the day as stomach fills and dilates
2) Relief is obtained by belching or vomiting
3) Projectile vomiting is common
What 6 classes of drugs are used to treat PUD?
1) H2R Blockers
2) PPIs
3) Antibiotics to treat H. pylori
4) Antacids
5) Anticholinergics
6) Cytoprotective drugs
What are the 2 types of Cytoprotective drugs used to treat PUd and what are 4 characteristics of each?
- Misoprostol (Cytotec)
1) Secretes bicarbonate and Cytoprotective mucus
2) Give with meals
3) Can cause diarrhea and abdominal pain
4) Do not use if pregnant - Sucralfate (Carafate)
1) Creates a protective barrier
2) Take on an empty stomach
3) May cause constipation
4) Take 2 hours apart from other meds
What are the 5 Surgical Procedures used to treat PUD?
1) Total Gastrectomy - Removal of the stomach with attachment of esophagus to duodenum or jejunom.
2) Billroth I (Gastroduodenostomy) - Partial Gastrectomy with removal of distal 2/3 of stomach and anastomosis of gastric stump to dudenom.
3) Billroth II (Gastrjejunostomy) - Partial Gastrectomy with removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunom.
4) Vagotomy - Severing of the vagus nerve thereby ⬇ HCl production
5) Pyroplasty - Surgical enlargement of pyloric sphincter thereby enhancing gastric emptying.
What is the most common postoperative complication of the PUD surgeries and what 5 patient teachings used to prevent it?
- Dumping Syndrome, teach patient to:
1) Avoid sugar, salt and milk
2) Eat a high-protein, high-fat, low-carb diet
3) Eat six small meals
4) Avoid fluid with meals
5) Lie down after meals
What are the 5 SxS of Dumping Syndrome discussed in class?
1) Tachycardia
2) Sweating
3) Nausea
4) Diarrhea
5) Cramps
Describe the color of the patient’s NG output after PUD surgery.
Bright red at first with darkening within the first 24 hours, then the color changes to yellow-green within 36-48 hours.
What are the 2 types of Hiatal Hernia?
1) Sliding - Stomach slides into the thoracic cavity when supine, and goes back into the abdominal cavity when standing upright.
2) Paraesophageal or Rolling - Esophageal junction remains in place, but fundus and greater curvature of stomach roll up through diaphragm.
What are the 2 causes of Hiatal Hernia?
1) Structural Changes - Weakening of the muscles in the diaphragm.
2) Increased Abdominal Pressure - Can be caused by obesity, pregnancy, heavy lifting, tumors, or ascites.
What are the 5 lifestyle modification you can teach your patient with Hiatal Hernia?
1) Eliminate alcohol
2) Elevate the HOB
3) Stop smoking
4) Avoid lifting/straining
5) Weight reduction, if appropriate
What are the 3 postoperative teaching appropriate for a patient who had surgery for a Hiatal Hernia?
1) 6 small meals, and do not have fluids with meals
2) Sit up for one hour after meals
3) Avoid Anticholinergics
What are the 5 risk factors for Esophageal Cancer?
1) Smoking
2) Excessive alcohol intake
3) Barrett’s Esophagus
4) Diets low in fruits and vegetables
5) Central obesity
What part of the body does the word “phrenic” refer to?
The diaphragm
What are the 3 common causes of Esophageal Strictures?
1) GERD
2) Ingestion of strong acids or alkali
3) Trauma - Causes scar tissue which causes strictures
What are the 3 complications/results of Esophageal Strictures?
1) Dysphagia
2) Regurgitation
3) Weight loss
What is Achalasia?
A rare disorder in which there is narrowing and loss of peristalsis in the lower 2/3 of the esophagus.
What are the 7 symptoms of Achalasia?
1) Dysphagia - most common symptom
2) Substernal chest pain
3) Halitosis
4) Inability to belch
5) GERD
6) Regurgitation and
7) Weight loss
What are the 2 treatments used for Achalasia that were discussed in class?
1) Pneumatic dilation
2) Botox injections - Relaxes muscles so the esophagus will open
Describe Esophageal Varices?
EV are dilated torturous veins found in the esophagus, that have a good risk or bursting and bleeding out. (Aka hemorrhoids in the throat)
What is the connection between Esophageal Varices and Portal Hypertension?
Because of increased obstruction of the portal vein, venous blood from the intestinal tract and spleen seeks seeks return of blood to the right atrium. The effect is ⬆ pressure, particularly in vessels in the sub mucosal layer of the lower esophagus and upper part of the stomach.
What are the two treatments discussed in class that are used for Esophageal Varices?
1) Endoscopic Variceal Ligation (aka banding)
2) Scleropathy - An agent is injected into the Varices to promote thrombosis and sclerosis.
What are the 2 Nursing Considerations of when giving Amoxicillin?
1) Causes diarrhea
2) Not given to patients with Penicillin allergies
What are the 3 Nursing Considerations of when giving Clarithromycin?
Causes GI upset, headaches and altered taste
What are the 5 Nursing Considerations of when giving Metronidazole (Flagyl)?
1) Causes anorexia
2) Causes Metallic taste
3) ⬆ Blood thinning effects of Warfarin
4) Should be given with meals
5) Patient should avoid alcohol
What are the 4 Nursing Considerations when giving Tetracycline?
1) Causes Photosensitivity
2) Causes GI upset
3) Daury products ⬇ it’s effectiveness
4) Should be used with caution in patients with renal and hepatic problems
