Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CNUR 103 > Unit 9 and 10: NG tube, Enteral nutrition, & Ostomy care, medication administration > Flashcards

Unit 9 and 10: NG tube, Enteral nutrition, & Ostomy care, medication administration Flashcards

1
Q

What is the distinction between gastric and small-bowel feeding?

A

The pyloric sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is enteral (tube feed) nutrition?

A

Delivery of nutrients through a tube that has been inserted into GI tract.
Direct entrance to the GI tract through the abdominal wall is best for long-term tube feeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is enteral feeding used for?

A

Patients who cannot ingest, chew, or swallow food.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indications for enteral feeding

A

1) Where normal eating is unsafe due to high risk for aspiration
- Altered mental status, swallowing disorders, impaired gag reflex, mechanical ventilation, esophageal conditions, delayed gastric emptying

2) Conditions that interfere with normal ingestion/absorption, or create a hypermetabolic state
- Surgery of oropharynx, intestinal obstructions, pancreatitis, burns, severe pressure injuries

3) Conditions where diseases or treatments reduce oral intake due to symptoms
- Anorexia, nausea, pain, fatigue, SOB, depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

tube feeding timing

A
  • Bolus
  • Intermittent
  • Continuous
  • Cyclical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Types of tubes for enteral feeding

A
  • Percutaneous refers to the fact that the tube is through the skin
  • Endoscopic means that the tube is usually inserted endoscopically
  • Gastrostomy: gastro means stomach, ostomy means surgical creation of an opening.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can happen if enteral feed is administered straight into small bowel?

A
  • Bloating
  • Cramping
  • Diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nursing responsibilities for enteral feeds

A
  • Inserting NG or OG tube
  • Verifying and maintaining proper position of tube
  • Keeping tube patent through flushing
  • Assessing tissue around tube, providing oral & nasal care
  • Administering nutrient formula through tube
  • Administering medications through tube
  • Keeping patient NPO unless ordered otherwise
  • Preventing complications
  • Documentation, monitoring I&O
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Enteral feeding guidelines: Assessment

A
  • Allergies (inc. food allergies)
  • Abdomen (bowel sounds, edema, distension, stools, cramping)
  • Weight
  • Fluid volume status (excess or deficit)
  • Serum electrolytes
  • Blood glucose
  • Verify order
  • Confirm correct placement
  • Keep HOB at 30-45 degrees
  • Change tubing q24h or per manufacturer’s standards
  • Keep formula at room temperature
  • Check gastric residual volume and flush tube with 30mL sterile water before bolus or intermittent feeds, or q4-6h during continuous feeds.
  • Clean bag and tubing with water between feeds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Transition from enteral to oral intake

A
  • Chewing and swallowing assessments must be done
  • Formula changed to one with intact protein
  • Dietician orders oral diet to progress slowly
  • Daytime oral intake with nighttime tube feeds
  • Food and fluid intake must be monitored
  • Enteral feeds discontinued when patient eats ¾ of oral food and 1L of water daily
  • Monitor food intake until 100% of nutrition needs are consistently met
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Indications for NG intubation

A
  1. Enteral feeding
  2. Decompression
  3. Compression
  4. Lavage: irrigation of stomach
  5. Gastric analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Types of NG tubes:

A
  • Small-bore feeding tube
  • Levine tube
  • Salem sump tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Assessment for NG tube insertion

A
  • Verify physician’s order
  • Inspect patient’s nares, nasal and oral cavity; pt to breathe through each naris.
  • Note history of nasal surgery, allergies, deviated septum, nosebleeds, facial trauma, etc
  • Determine whether the patient is on anticoagulation medication(s)
  • Auscultate for bowel sounds; palpate abdomen for distension, pain, rigidity
  • Assess LOC and ability to follow instructions
  • Ask if patient had previous NG tube, and which naris was used
  • Assess patency of bilateral nares & for skin breakdown
  • Stand on the same side of the bed as the naris you’re inserting into
  • Position patient in high- Fowler’s
  • Determine how far to insert tube by measuring: tip of nose to earlobe to xiphoid process
  • Lubricate tube before insertion
  • Do not advance during inspiration or coughing (r/f intubation into respiratory tract)
  • Check for positioning with penlight and tongue blade
  • Keep HOB at 30-45 degrees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NG intubation: Check for correct placement

A

When? - q4-6 hours, before instilling feeds/flushes/medications, prn
How?
- X-ray: this is best practice for determining placement
- Test gastric pH level: ≤5 indicates correct placement in stomach
- Monitor external length of tube and observe appearance and volume of fluid aspirated; most intestinal aspirates are stained yellow by bile, while gastric aspirates are not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Possible complications from NG tubes

A
  • Discomfort – during insertion, and while tube is in situ
  • Intubation into respiratory tract
  • Migration of NG tube
  • Tissue breakdown & pressure injuries – in the intubated nares and into the GI tract
  • Aspiration of gastric contents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pharmacokinetics

A

Study of how medications enter the body, reach the site of action, metabolized and exit the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What factors impact th effectiveness of Meds?

A
  • Absorption: the passage of medication molecules into the blood
  • Distribution: from the blood to the tissues and organs
  • Site of Action: biotransformation (the breakdown of the medication) occurs primarily in liver but also in lungs kidneys, blood and intestine
  • Excretion: process by which medications exit the body through the lungs, exocrine glands, bowel, kidneys, and liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Unbound medicine

A

utilized within the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Therapeutic effect

A
  • The intended or desired effect/response of a medication

- Knowing its therapeutic response allows the nurse to evaluate and provide patient teaching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Adverse effect

A
  • Unintended, undesirable, and/or unpredictable effects of medication
  • May be apparent right away or after a long period
  • Harmful incident, no-harm incidents, or near misses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Vanessa’s law

A
  • Passed in November 2014 - To ensure all reporting of adverse drug reaction and medical device incidence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Side effects

A
  • Predictable and often unavoidable
  • May be secondary effects of medication
  • Need to report side effects as these may be adverse reactions
23
Q

Toxic effects

A

Develop over a prolonged period of medication accumulation. Due to inability to breakdown or excrete medication.

24
Q

Idiosyncratic Reactions

A

Unpredictable overreaction or underreaction to medication, or any reaction different from normal

25
Q

Allergic Reactions

A

The initial dose causes the patient to be sensitize immunologically causes antibodies to develop
Repeated administration causes patient to develop an allergic response

26
Q

Medication Tolerance

A

occurs over time and requires the patients to need higher doses to produce the therapeutic effect

27
Q

Medication dependence

A

Not the same as tolerance; can be physiological (physiological disturbances when drug withheld) or psychological (based on a patient’s desire for effect of the medication)

28
Q

Safe therapeutic range

A

Between the minimum effective concentration and the toxic concentration

29
Q

Half-life

A

The time it takes for excretion process to lower the serum medication concentration by half

30
Q

Time intervals of medication action

A
  • Onset of action: time it takes for medication to produce a response
  • Peak: time it takes to reach highest effect
  • Trough: minimum blood serum level of before next scheduled dose
  • Plateau: Blood serum concentrations reached and maintained after repeated fixed doses
31
Q

Nonparenteral routes of medication administration

A
  • Oral, Buccal into side of cheek
  • Sublingual
  • Topical
  • Suppository (vaginal or rectal)
32
Q

Parenteral routes of medication administration

A
  • Intermuscular
  • Subcutaneous
  • Intradermal
  • Epidural
  • Intravenous
33
Q

Oral, Buccal, Sublingual Routes: Advantages and disadvantages

A
  • Advantages: Easy to administer, economical, easy to access produce both local and systemic effects
  • Disadvantages: gastric secretions destroy medications, NPO patients, cannot administered if altered LOC, irritate GI tract (Ex. NSAIDs), teeth (staining) or taste bad
34
Q

Topical for skin: Advantages and disadvantages

A
  • Advantages: primarily local effect, usually painless, limited side effects
  • Disadvantages: extensive application require dressings, not for open skin, may be absorbed by person applying it (person applying should wear gloves)
35
Q

Transdermal for skin: Advantages and disadvantages

A
  • Advantages: Prolonged applications provide systemic effect, route is painless, limited side effects
  • Disadvantages: application leaves oily or pasty substance and stains clothing, some patients may be sensitive to adhesive
36
Q

Mucous membranes medication administration: Advantages and disadvantages

A

Mucous membranes: Eyes, ears, nose, sublingual, vagina, rectum, throat.

  • Advantages: provides local application to involved sites; may provide alternative to oral route
  • Disadvantages: may be highly sensitive to some medication concentrations, rectal/vaginal may cause embarrassment, any alteration to route such as surgery to rectal area or rupture of eardrop, route is contraindicated
37
Q

Inhalation: Advantages and disadvantages

A
  • Advantages: rapid relief of local respiratory problems

- Disadvantages: Serious systemic effects, improper administration=medication is ineffective

38
Q

Subcutaneous, Intramuscular, Intravenous, Intradermal, Epidural Routes: Advantages and disadvantages

A

Advantages: alternative to oral route, rapid absorption’
Disadvantages: higher risk of infection, medication is expensive, bleeding risk, damage to skin after repeated injections, higher absorption = high risk of side effects. Also rapid adverse reactions.

39
Q

What are the 10 rights of medication administration

A
  1. Right Patient
  2. Right Dose
  3. Right Medication
  4. Right Route
  5. Right Time
  6. Education
  7. Right to Refuse
  8. Right Assessment
  9. Right Evaluation
  10. Right Documentation
40
Q

Right patient

A

Ask patient their name and date of birth.

Ensure the correct MRN or date of birth

41
Q

Right dose

A
  • Best practice notes that the patient-specific dose should be dispensed to the hospital unit in an oral syringe
  • Nurse can use an independent double check with a second nurse to verify the dose.
42
Q

Some consideration for proper medication administration

A
  • Graduated cups
  • Splitting meds: Should be done by pharmacy.
  • Crushed medication: Make sure meds can be crushed, should not be mixed with food.
43
Q

Right medication

A
  • ALWAYS compare the medication administration record with the physician’s order
  • Long-term care comparison between what is being prescribed and physician’s orders is done at the end of every week.
  • Acute care comparison between what is being prescribed and physician’s orders is done every day.
44
Q

Now

A

Within 90 mins of ordered time.

45
Q

Stat

A

Right away and only once.

46
Q

3 medication checks

A

1) before removing the container from the supply drawer or shelf
2) As the prescribed medication is removed from the container
3) At the bedside before administration

47
Q

Right route

A

When preparing a label for a medication syringe ensure you indicate route or location of administration.

48
Q

Right time

A
  • Nurses can alter the timing of medication administration
  • Time-sensitive medication: have a 30 minutes before and 30 minutes after scheduled time
  • Non-time sensitive medication: have a 1-2 hour before and after schedule time
  • Nurses need to note medications that need to be given at certain times of the day or at specific intervals
49
Q

Right education

A
  • Understanding what the medication is/does
  • Desired effect
  • Side Effects
  • Nurse should ask about allergies
50
Q

Right to refuse

A
  • Every patient or legal decision maker has the right to refuse any medication
  • It is the nurses role to ensure that the patient or decision maker is aware of the consequences of the refusal.
51
Q

Right assessment

A

Based on the assessment, if the medication is deemed not safe to administer the nurse will hold the medication until they notify the health care provider

52
Q

Right evaluation

A
  • Assess the effectiveness of the medication
  • Is the patient experiencing any Side effects
  • Is the patient experiencing any adverse effects
  • Is the patient experiencing any allergic reactions
53
Q

Right documentation

A

Prescriptions and medications forms need to include:

  • Patient’s name
  • Medication name
  • Medications dosage
  • Medication route
  • Frequency of administration

Regarding medication administration the nurse need to accurately document the time of medication

Documentation is also required for PRN medications, and refusal of medication

54
Q

Medication administration and the older adult

A
  • Pulmonary function is reduced
  • Blood pressure gradually increases
  • Slowed gastrointestinal tract
  • Reduced bladder size and men may have increase in prostate
  • Decrease in immune system
  • Increase in Polypharmacy

CNUR 103 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions