Unit 3: Nutrtition Flashcards
What reason(s) would the doctor order the insertion of a NG tube?
Gavage
Lavage
Decompression
What is the purpose of the larger lumen on the Salem sump?
Larger Lumen: Drain gastric content
What is the purpose of the smaller lumen on the Salem sump?
Smaller Lumen: allow entry of air.
What type of lubricant is used for the insertion of a NG tube? Why?
Water based lubricant is used. Oil based lubricants are not absorbed by the body, and can cause infection if tubing enters the lungs.
When inserting the NG tube into the naris, the nurses asks the patient to do what with their head/neck? Why?
Hyperextending the head/neck facilitates passage of the tube through the normal contours of the nasal passage.
When the tubing reaches the throat, the nurse asks the patient to _______ their head/neck. Why?
Flexing (tilting head down) facilitates passage of tubing into the posterior pharynx.
What signs of respiratory distress does the nurse assess for during insertion of a NG tube.
Gasping
Coughing
Cyanosis
Inability to speak
How is NG tube placement verified?
XRay
Auscultation (while inserting air)
Checking pH of gastric content/residuals.
What is the primary advantage of continuous drip tube feedings?
Gradual introduction of forumla –> optimal absorption of nutrients.
The removal iof pressure caused by gas or fluids in the stomach is called _______.
Decompression.
A patient returns from surgery, and has a NG tube running with low intermittent suction. The patient asks why it is necessary to remove the fluids/gas. How does the nurse respond?
Decompression promotes healing after surgery by preventing post-operative vomiting and distention caused by reduced peristalsis.
The nurse assessing for bowel sounds on a patient with suctioning running through and NG tube should do what before auscultating?
Suction is turned off prior to assessing for bowel sounds.
The process of washing out and organ is referred to as ______.
Lavage
Why is lavage ordered?
Removal of unabsorbed poisons, diagnose gastric hemorrhage or remove liquid/small particles from the stomach.
Name the three types of NG tubes.
Levin
Salem Sump
Small Bore
Which NG tube is useful for short term gavage or lavage?
Levin
Which NG tube contains a double lumen?
Salem Sump
Which NG tube allows for an inflow of air? What is the purpose of the inflow of air?
Salem Sump
Prevents vacuum so gastric tube does not adhere to stomach wall.
Which NG tube is used for decompression?
Salem Sump
Which NG tube contain a stylet the stiffens the tube for insertion?
Small Bore
Which NG tube is often used for extended periods of Gavage?
Small Bore
Which NG tube can be left in for an extended period of time with less irritation to the nasopharyngeal, esophageal, and gastric mucosa?
Small Bore
What type of tube is used when long term gavage is likely?
Gastrostomy tube.
Why is a PEG tube considered safer?
Does not require a general anesthetic when inserted by the physician.
What nursing care is included for patients with G tubes?
Nursing care includes inspecting the insertion site at least every shift.
When are dressings used with G tubes?
A dressing is usually only used immediately after the procedure or if there is any drainage.
What does the physician prescribe in regards to feedings?
Rate of infusion
Formula to be used.
Which method(s) of feeding reduces the risk of abdominal distention?
Continuous pump feedings
Intermittent gravity feedings
What type of feeding uses a syringe to deliver the formula quickly to the stomach?
Intermittent Bolus feedings.
What complications should the nurse be assessing/preventing when the patient is receiving tube feedings?
Nausea, Vomiting, Aspiration, Fluid/Electrolyte imbalance, Diarrhea, intestinal cramping, and tube occlusion.
When do nausea, vomiting, and aspiration occur in regards to tube feedings?
When feeding is administered at a rate faster than the formula can be absorbed.
How does the nurse assess that the formula is being absorbed?
Check the residual volume.
The nurse is preparing to administer an intermittent feeding. The nurse checks the residuals, and notes there are 120mL of residuals. The previous feeding was 200mL. How does the nurse proceed?
Since the residuals are greater than half the previous feeding, the current feeding should be held. Reassess at the next scheduled feeding.l
The nurse is assessing the patient receiving a continual feeding. When checking the residuals, the nurse notes residual content is 45mL. Should feeding continue?
Yes. Continual feeding can continue as long as the residuals are less than 100mL.
What does the nurse assess prior to administering a bolus feeding?
Placement via auscultation and residuals.
Bowel sounds
Abdominal Distention
Residual <50% previous feeding.
How often should the nurse assess proper tube placement?
Q4H
How is aspiration prevented for patients receiving feedings?
Verify placement Q4H
Keep patient in Fowlers (or Right side if unable to tolerate Fowlers) during and 30 following feeding.
High osmolarity formulas can cause:
Diarrhea, intestinal cramping, and fluid loss.
How are severe osmotic shifts prevented?
Diluting formula
Flushing tube with 30-60ml of water q4h.
How is GI intolerance limited?
Slow adminitration
Room Temperature Feeding
How does the nurse prevent tubing from becoming clogged?
Frequent flushing with water.
How much formula should be poured into a feeding bag at one time for patients receiving continuous feedings?
Pour only enough formula that will infuse in 4-6 hours to prevent bacterial growth
How often is tubing/bagging changed?
q24h
How often is the syringe changed?
q24h
What is documented in regards to tube feeding?
The check for placement. Amount of residual. Amount and kind of solution administered. Duration of the feeding. Patient's response to feeding. Assessment of the patient.
Aside from the amount of feeding administered, what other item does the nurse include in the pt’s I&O record?
Amount of H20 used to flush tube.
What does the physician order in regards to Glucose Monitoring?n
Time and Frequency of glucose monitoring.
When is glucose monitoring typically performed?
Morning, Night, and Before Meals
What diagnostic study is done to evaluate the function of the esophagus?
Swallowing Studies
What is measured during a swallowing study?
Pressure in the esophagus during swallowing.
What do the waves look like for normal swallowing in a swallowing study?
Normal swallowing registers a rapid rise and fall in pressure in the esophagus.
What do the waves look like for abnormal swallowing in a swallowing study?
No swallowing waves or strong propulsive waves.
Is sedation used for swallowing studies?
No, sedation can cause a drop in esophageal pressure.
What diagnostic study uses barium to visualize the soft tissues of the gastrointestinal tract?
Upper Gastrointestinal Study or Barium Swallow
How is Barium administered in an upper gastrointestinal study/Barium swallow?
Barium is swallowed.
How long should the patient fast before receiving an upper gastrointestinal study / barium swallow?
8-12 hours.
How much barium mixture is used for an upper gastrointestinal study / barium swallow.
16-20 oz of barium mixture.
What should be monitored following an upper gastrointestinal study / barium swallow? Why?
Bowel Movement, Barium causes Constipation.
The patient tells the nurse their stool was chalky colored following their Upper Gastrointestinal Study. Is this normal?
Yes.
What diagnostic study allows for visualization of the lining of the esophagus, stomach, and duodenum?
Esophagogastroduodenoscopy (EGD)
How long must the patient fast before an EGD?
8-12 hours
Which diagnostic study allows for the use of twighlight sleep?
EGD
What position is the patient in for an EGD?
Left Lateral recumbent position.
What is air used to during and EGD?
Allow for better visualization of the GI tract.
How is gag reflex assessed post EGD?
Touching the back of the throat with a tounge blade.
How is a sore throat soothed following an EGD?
Throat lozenges or warm saline gargle.
What are the possible causes of difficulty chewing?
Ill-fitting dentures, gingivitis, dental caries, and oral surgeries.
Why is difficulty chewing a concern?
People who have difficulty chewing may have trouble eating enough nutrients.
What are the possible causes of difficulty swallowing?
Gag reflex is absent due to CVA, or muscle weakness. Obstruction to oropharnyx secondary to tumor or edema.
Define Anorexia:
loss of appetite.
What are the possible causes of anorexia?
Depression, GI dyfunction, illnesses, malignancies and side effects of many medications. Discomfort before or after eating.
Name the factors that can affect INGESTION
Difficulty Chewing
Swallowing Impairment/Dysphagia
Change in Food Intake/Anorexia
Name the factores affecting DIGESTION
Obstruction of the GI tract.
What type of diet would a patient who has an active GI obstruction be placed on?
NPO… Intestinal obstructions usually necessitate withholding all oral intake until the obstruction has been resolved or surgically corrected.
What causes malabsorption syndromes?
The inability to tolerate certain foods.
What are the possible causes of abdominal distention?
Constipation, intestinal inflammation, excess flatulence.
What are the possible causes of Nausea and Vomiting?
Food allergy, medications, stomach disorders
What are the possible causes of hyperactive bowel sounds?
Diarrhea, gastroenteritis.
What are the possible causes of hypoactive bowel sounds?
manipulation of the bowel during surger or peritonitis.
Diarrhea, stress and HYPERthyroidism can cause weight ______..
Weightloss.
HYPOthyroidism, depression, and anxiety can cause weight______.
Weightgain.
Poor wound healing may be a sign of poor absorption of _____ __, ________ and _______.
Vitamin C, Protein, Zinc
Poor _____ _______ is a sign of hypovolemia.
Skin Turgor
What would a nurse look for in a patient who with poor Iron intake?
Confusion
Define: Cholecystectomy:
Excision of the gallbladder.
Define: Deglutition
Act of swallowing.
Define: Dyspepsia
Indigestion
Define: Dysphagia
Difficulty swallowing
Define: Eructation
Act of belching
Define: Gastrectomy
Partial or complete removal of the stomach
Define: Hematemesis
Vomiting blood.
Define: Stomatitis
Inflammation of the mouth.
How does the nurse clear gastric content from the NG tube when removing the NG tube?
Flush with 20mL’s of air.
What is the NG tube flushed with air prior to removal instead of water?
Prevent aspiration.
What should the nurse intruct the patient to do just prior to NG tube removal?
Take a deep breath and hold it..
A normal Fasting Blood Sugar range for adults is ____ - _____.
70-99
Between meals, a normal blood sugar range is ___ - ___.
80-120
What type of nutrion is provided via IV?
Parenteral
