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Perioperative Nursing Exam #2 > UGI Disorders & Tube Feedings > Flashcards

UGI Disorders & Tube Feedings Flashcards

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0
Q

How long is an NG tube? Is it safe to advance it, if it is coming out?

A

NG tubes are 22-26 inches long and it is safe to advance it 6-8 inches if it is coming out.

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1
Q

Which three organs can enteral nutrition be administered?

A

1) Stomach
2) Duodenom
3) Jejunum

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2
Q

What are the 4 characteristics of a Levine Tube?

A

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.

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3
Q

What are the 4 characteristics of Gastric or Salem Sump Tube (SST)?

A

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.

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4
Q

What are the 3 characteristics of postpyloric tubes?

A

1) Continue past the stomach and enter the Duodenom or Jejunom (110-140 cm)
2) smaller bore (8-10 French)
3) Single lumens

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5
Q

Which medication is indicated for the insertion of Nasointestinal tubes and how does it work?

A

Metoclopromide - Increases gastric and small intestine motility, which aids in the insertion of the tube. It should be administered 10 mins before the procedure.

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6
Q

Why is placing a patient on their right side helpful in the advancement of a tube?

A

Because gravity may assist the tube in passing through the pyloric sphincter and into the small intestine.

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7
Q

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

A

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

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8
Q

Why is tube insertion contraindicated in a patient with low Pre-Albumin levels?

A

Low Pre-Albumin levels are caused by starvation and result in protein depletion which translates to a higher risk for perforation when inserting tubes.

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9
Q

(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).

A

True

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10
Q

What should the nurse be sure to do, regarding the HOB, when administering tube feeding?

A

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

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11
Q

What are the 7 General Nursing Considerations associated with Tube feeding?

A

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

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12
Q

What 4 things can the nurse do to help prevent vomiting from tube feeding?

A

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

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13
Q

What 3 things can cause a tube fed patient to develop nausea and vomiting?

A

1) Change in formula
2) Feeding rate that is too fast
3) Inadequate gastric emptying

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14
Q

What 4 things can cause a tube fed patient to develop diarrhea?

A

1) Hyperosmolarity of feedings
2) High milk content
3) Contaminated feedings
4) High-fiber feedings

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15
Q

What 3 things can cause a tube fed patient to develop constipation?

A

1) Low-fiber feedings
2) Dehydration
3) Opioid use

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16
Q

What 4 things can cause a tube fed patient to aspirate?

A

1) Improper tube placement
2) Vomiting with aspiration of high residual volume
3) Flat HOB
4) Use of a large tube

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17
Q

What 3 methods can be used to prevent a clogged tube?

A

1) Use liquid meds if possible
2) Flush with 30-50 mL of water after feedings
3) Flush with water q4h with continuous feeding

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18
Q

What are the 5 gerontological considerations of tube feeding?

A

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

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19
Q

(T/F) Anticholinergic drugs can ⬆ LES pressure and cause GERD

A

True

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20
Q

What are the 3 complications of GERD that were discussed in class?

A

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

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21
Q

What are the 2 types of drug therapy approaches used to treat GERD?

A

1) Step up - Antacids with OTC H2R blockers > prescription H2R blockers > PPIs
2) Step down - PPIs > prescription H2R blockers > Antacids with OTC H2R blockers

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22
Q

What are the 6 characteristics of the drug class H2R blockers, used to treat GERD?

A

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.

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23
Q

What is the common name for the following H2R blockers:

1) Famotidine
2) Ranitidine
3) Cimetidine
4) Nizatidine

A

1) Famotidine - Pepcid
2) Ranitidine - Zantac
3) Cimetidine - Tagamet
4) Nizatidine - Axid

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24
Q

What are the 5 characteristics of the drug class PPIs, used to treat GERD?

A

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

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25
Q

What are the 4 side effects of PPIs?

A

1) Headache
2) Diarrhea
3) Abd pain
4) Nausea

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26
Q

What are the 4 characteristics of the drug class Antacids, used to treat GERD?

A

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

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27
Q

(T/F) Aluminum containing Antacids can decrease calcium and lead to Osteoperosis.

A

True

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28
Q

What are the common names for the following PPIs:

1) Omeprazole
2) Esomeprazole
3) Rabeprazole
4) Pantoprazole
5) Lansoprazole

A

1) Omeprazole - Prilosec
2) Esomeprazole - Nexium
3) Rabeprazole - Aciphex
4) Pantoprazole - Protonix
5) Lansoprazole - Prevacid

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29
Q

What are the 2 side effects of the Calcium-Carbonate Antacids, such as Mylanta and Tums?

A

1) Constipation

2) Burping and flatulence d/t release of CO2 in the stomach

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30
Q

What are the 4 characteristics of Milk of Magnesia?

A

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

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31
Q

What are the 3 positive and 1 negative aspects of using Cholinergics in the treatment of GERD?

A

1) ⬇ LES pressure
2) ⬆ esophageal emptying
3) ⬆ gastric emptying
4) Negative - Stimlates HCl secretion

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32
Q

Give an example of a Cholinergic drug used to treat GERD

A

Bethanechol (Urecholine)

33
Q

What drug did we discuss in class that stimulates GI motility?

A

Antiemetics - Specifically Metoclopramide

34
Q

(T/F) Research has shown that patients are at higher risk for C.difficile when on PPIs. Why or why not?

A

True - It blocks acid production which would have killed food-borne pathogens

35
Q

Blocking acid production with H2R blocker and PPIs also decreases Intrinsic Factor. Why is IF important?

A

Intrinsic Factor is needed for the metabolism of B12 by the small intestine.

36
Q

What 4 things is Vitamin B12 essential for?

A

1) Brain health
2) Nerve health
3) RBC production
4) Happiness

37
Q

Which 6 foods discussed in class are rich in Vitamin B12?

A

1) Citrus fruits
2) Dried beans
3) Green leafy vegetables
4) Liver
5) Nuts
6) Organ Meats

38
Q

What is Gastritis?

A

Gastritis is an inflammation of the gastric/stomach mucosa

40
Q

What are the 6 causes of Acute Gastritis?

A

1) Contaminated food
2) Irritating/spicy foods
3) Over use of aspirin and NSAIDs
4) Alcohol
5 Bile reflux
6 Radiation Therapy

41
Q

What are the 5 SxS of Acute Gastritis?

A

1) Abd discomfort
2) Anorexia
3) N & V
4) Headache
5) Hiccups

42
Q

What are the 7 causes of Chronic Gastritis?

A

1) Ulcers
2) H. pylori
3) Dietary factors
4) Medications
5) Alcohol
6) Smoking
7) Reflux

43
Q

What 2 methods can be used to Dx Gastritis?

A

1) Testing of breath, urine, stool, serum and gastric tissue for presence of H. Pylori
2) Endoscopy with biopsy

44
Q

What would a person without a stomach need B12 injections for life?

A

Because the stomach secretes the protein called Intrinsic Factor which is necessary for the absorption of B12

45
Q

What are the 6 SxS of Chronic Gastritis?

A

1) Anorexia
2) N & V
3) Belching
4) Heartburn after eating
5) Sour taste in mouth
6) Vitamin B12 deficiency

46
Q

What is another name for Vitamin B12?

A

Cobalamin

47
Q

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?

A

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)

48
Q

What is Peptic Ulcer Disease (PUD)?

A

PUD is a break in the mucosal lining of the esophagus (5%), stomach (15%), or duodenum (80%)

49
Q

What is the difference of the effect of food on Gastric ulcers versus duodenal ulcers?

A

Food irritates gastric ulcers and alleviates duodenal ulcers

50
Q

What are the nursing considerations when administering the following Antibiotics:

1) Amoxicillin
2) Clarithromycin
3) Metronidazole (Flagyl)
4) Tetracycline

A

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.

51
Q

(T/F) Bismuth Salts aka Pepto Bismol should be taken on an empty stomach.

A

True

52
Q

What are the 5 things discussed in class that destroy the mucosal barrier?

A

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

53
Q

What are the differences between Gastric and Duodenal ulcer pains?

A

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

54
Q

(T/F) A board-like abdomen is a sign of Peritonitis

A

True

55
Q

What are the 3 major complications of PUD?

A

1) Hemorrhage
2) Perforation
3) Gastric outlet obstruction

56
Q

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?

A

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

57
Q

What are the 4 causes of Gastric Outlet Obstruction as a complication of PUD?

A

1) Edema
2) Inflammation
3) Pylorospasm
4) Fibrous scar tissue formation

58
Q

What are the 3 clinical manifestations of Gastric Outlet Obstruction as a complication of PUD?

A

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

59
Q

What 6 classes of drugs are used to treat PUD?

A

1) H2R Blockers
2) PPIs
3) Antibiotics to treat H. pylori
4) Antacids
5) Anticholinergics
6) Cytoprotective drugs

60
Q

What are the 2 types of Cytoprotective drugs used to treat PUd and what are 4 characteristics of each?

A
  • 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
61
Q

What are the 5 Surgical Procedures used to treat PUD?

A

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.

62
Q

What is the most common postoperative complication of the PUD surgeries and what 5 patient teachings used to prevent it?

A
  • 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
63
Q

What are the 5 SxS of Dumping Syndrome discussed in class?

A

1) Tachycardia
2) Sweating
3) Nausea
4) Diarrhea
5) Cramps

64
Q

Describe the color of the patient’s NG output after PUD surgery.

A

Bright red at first with darkening within the first 24 hours, then the color changes to yellow-green within 36-48 hours.

65
Q

What are the 2 types of Hiatal Hernia?

A

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.

66
Q

What are the 2 causes of Hiatal Hernia?

A

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.

67
Q

What are the 5 lifestyle modification you can teach your patient with Hiatal Hernia?

A

1) Eliminate alcohol
2) Elevate the HOB
3) Stop smoking
4) Avoid lifting/straining
5) Weight reduction, if appropriate

68
Q

What are the 3 postoperative teaching appropriate for a patient who had surgery for a Hiatal Hernia?

A

1) 6 small meals, and do not have fluids with meals
2) Sit up for one hour after meals
3) Avoid Anticholinergics

69
Q

What are the 5 risk factors for Esophageal Cancer?

A

1) Smoking
2) Excessive alcohol intake
3) Barrett’s Esophagus
4) Diets low in fruits and vegetables
5) Central obesity

70
Q

What part of the body does the word “phrenic” refer to?

A

The diaphragm

71
Q

What are the 3 common causes of Esophageal Strictures?

A

1) GERD
2) Ingestion of strong acids or alkali
3) Trauma - Causes scar tissue which causes strictures

72
Q

What are the 3 complications/results of Esophageal Strictures?

A

1) Dysphagia
2) Regurgitation
3) Weight loss

73
Q

What is Achalasia?

A

A rare disorder in which there is narrowing and loss of peristalsis in the lower 2/3 of the esophagus.

74
Q

What are the 7 symptoms of Achalasia?

A

1) Dysphagia - most common symptom
2) Substernal chest pain
3) Halitosis
4) Inability to belch
5) GERD
6) Regurgitation and
7) Weight loss

75
Q

What are the 2 treatments used for Achalasia that were discussed in class?

A

1) Pneumatic dilation

2) Botox injections - Relaxes muscles so the esophagus will open

76
Q

Describe Esophageal Varices?

A

EV are dilated torturous veins found in the esophagus, that have a good risk or bursting and bleeding out. (Aka hemorrhoids in the throat)

77
Q

What is the connection between Esophageal Varices and Portal Hypertension?

A

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.

78
Q

What are the two treatments discussed in class that are used for Esophageal Varices?

A

1) Endoscopic Variceal Ligation (aka banding)

2) Scleropathy - An agent is injected into the Varices to promote thrombosis and sclerosis.

79
Q

What are the 2 Nursing Considerations of when giving Amoxicillin?

A

1) Causes diarrhea

2) Not given to patients with Penicillin allergies

80
Q

What are the 3 Nursing Considerations of when giving Clarithromycin?

A

Causes GI upset, headaches and altered taste

81
Q

What are the 5 Nursing Considerations of when giving Metronidazole (Flagyl)?

A

1) Causes anorexia
2) Causes Metallic taste
3) ⬆ Blood thinning effects of Warfarin
4) Should be given with meals
5) Patient should avoid alcohol

82
Q

What are the 4 Nursing Considerations when giving Tetracycline?

A

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

Perioperative Nursing Exam #2 (8 decks)

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