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NRSG 302 > Week 1- NG and penrose drain > Flashcards

Week 1- NG and penrose drain Flashcards

1
Q

A nasogastric (NG) tube is a ________inserted from _____ into _________

A

flexible
nostril
stomach or upper part of the SI

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2
Q

pediatric and adult size of NG

A

5-12 fr
12-18 Fr

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3
Q

some tubes may have a _______coating

A

hydrophilic coating that needs to be soaked for 5-10 sec to activate it

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4
Q

Indications for NG tube (5)

A

Gain access to GI tract
Decompress stomach (air, toxins, GI contents)
Lavage (wash if there has been a poisoning or oral drug overdose)
Enteral feeding
Instilling medications

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5
Q

contraindications of NG tubes
(2)

A

Should not be performed in facial, head and neck or throat trauma

Should have a gag reflex (or airway needs to be protected with an artificial airway) gagging closes the epiglottis

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6
Q

might be put on suction when have

A

a small bowel obstruction

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7
Q

large bore NG tube

A

hard bore

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8
Q

Salem sump

A

Larger tube
double lumen (main tube/smaller air vent lumen)
With holes near the tip

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9
Q

large bore may also be used for

A

suction as the smaller vent lumen allows for an inflow of air which prevents a vacuum if the tube adheres to the stomach wall.
Decreases tissue damage (blue pigtail section

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10
Q

soft bore NG
- characteristics of tube
- often used with
- most commonly used for
- FR size
- may have a ___ tip
- how often changed
- more often used to put

A

Levin
Single lumen, softer, more flexible
Often used with anti-reflux valve
Most common for enteral feeding in IH
Usually 6 -12 FR diameter
eg. silastic 8 FR
Smaller, more flexible, less irritating
May have weighted tip
Have stylet to assist insertion
Need to be changed monthly
More often used to put fluids into stomach

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11
Q

anti-reflux valve with a

A

Large bore NG

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12
Q

anti- reflux valve
- prevents
- allows
- when stomach pressure exceeds
- attach ends ___ to ____

A

prevents gastricrefluxor leakage through the vent lumen of a double-lumennasogastric tube
thevalveallows the passage of air into the vent lumen when atmospheric pressure exceeds stomach pressure
when stomach pressure exceeds atmospheric pressure thevalveprevents flow of fluids through the tube
Attach ends BLUE to BLUE

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13
Q

Indications for an enteral feeding

A
  • Need a functioning and accessible GI tract
  • Malnourished or at risk of malnutrition
  • To supplement food intake when it is insufficient to meet daily needs
  • Unable to ingest oral foods (eg. surgery, head/neck trauma)
  • Unwilling to take oral feeds (eg. prolonged anorexia)
  • Upper GI tract is impaired (eg. esophageal cancer)
  • Dysphagia (eg. CVA, multiple sclerosis, ALS)
  • Critical illness (eg. severe burns)
  • Malabsorption disorders (eg. crohn’s disease)
  • Decreased LOC, coma
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14
Q

complications of enteral feeding

8

A

*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)

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15
Q

re-feeding syndrome occurs in

A

previously malnourished patients who are fed with high carbohydrate loads.

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16
Q

carbs in feeds can cause

A

a large increase in the circulating insulin level. This results in a rapid and dramatic fall in phosphate, potassium and magnesium - with an increasing extracellular fluid (ECF) volume.

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17
Q

as the body tries to switch from

A

from catabolic (starvation mode) to using exogenous fuel sources
- there is an increase in oxygen consumption
- increased respiratory and cardiac workload.
- Demand for nutrients and oxygen may outstrip supply.
- can lead to multiple organ failure; respiratory and/or cardiac failure, arrhythmias, rhabdomyolysis, seizures or coma, red cell and/or leukocyte dysfunction.

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18
Q

return of enteral feeding in the gut can cause

A

be intolerance to the feed, with nausea and diarrhea.

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19
Q

feeds should be started

A

started slowly and the electrolytes closely monitored and adequately replaced to avoid these problems developing.

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20
Q

Aspiration Risk Factors (for all feeding tubes)

A
  • 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
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21
Q

Abnormal Blood Results in Malnutrition:

A

Decreased albumin/pre-albumin and total protein
Decreased Hgb/Hct (if anemic)
Decreased Iron/components
Decreased lymphocytes (or increased if infection)
Decreased blood glucose
Decreased K+ and calcium (and other electrolyte imbalances)
Decreased BUN and CR (but increased if hypovolemic from dehydration eg. renal failure)
Increased liver enzymes (eg. liver damage)
Decreased serum vitamin and mineral levels

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22
Q

Radiography is for

A

checking NG placement

23
Q

safety for NG tube
- DO NOT
- No
- Check
- Elevate HOB ____mins
- Provide
- Tape
- Pin

A

Lie flat (especially if on feed)
no oral intake unless ordered
check position of NG tube prior to administrating meds
elevate HOB 30-60 mins after enteral feeding
provide oral care if pt unable to do
tape in place to reduce irritation from movement with external measurements visible
pin the gown to prevent pulling

24
Q

potential complications

A

Aspiration
Abdominal pain, discomfort, nausea
Tissue trauma
Patency of tube can become compromised
Dehydration (r/t NPO status - NG losses replacement usually done with IV fluids (big risk if on suction

25
assessment prior to insertion
Previous nasal surgery? Nasal septal deviation Gag reflex Patency of nares Patient cooperation
26
Check canister and tubing are
securely connected and free of kinks and tension
27
Assessment and nursing care of NG - suction - amount and quality of - check - check - check - assess - assess - irrigation - position - provide - monitoring - ensure - ensure - assess - confirm
Suction set to prescribed pressure/rate Amount and quality of gastric contents/residuals Check canister and tubing are securely connected and free of kinks and tension Check equipment for functioning Checking for placement, length changes Assess oral health, sore throat, irritation, lip and mouth dryness Assess abdominal distention, BS, N&V, flatus, BM, tolerance of feeds (if indicated) Irrigation of tubing as ordered or required Positioning for comfort Provide regular mouth care Monitoring for skin breakdown of nares Ensure pinned to gown and taped is secure Ensure no coiling of tubing in back of throat Assess patient’s ability to speak Confirm external measurement with permanent felt pen mark is at nare
28
NG insertion procedure assess prepare prepare insert check check
- Assess nares - breakdown, occlusions, best inhalation, SpO2 monitoring, VS - Prepare tube - conform and soften, measure and mark, lubricant, prep pin, prep tape - Prepare patient - high fowler's, basin, blue pad, glass of water with straw basin, moisten mucous membrane, chin tucked slightly down - Insert tube - advance with swallowing, tape to nose and cheek, pin to gown - Check back of throat to see that tubing has gone down and not coiling - Check placement, complete assessment, initiate suction or feed (after xray)
29
In case of severe/continued gagging/coughing, signs of respiratory distress or decreased SpO2,
STOP. This may indicate that the tube is malpositioned in the airway. Withdraw the tube and reassess the patient. Do not attempt reinsertion until patient respiratory pattern and oxygenation return to baseline
30
how to measure NG length for insertion
nose to earlobe to xiphoid plus 15 cm
31
insertion procedure - slowly - pause once - wait until - in case of severe - DO NOT
Slowly insert tube into nostril along nasal floor slowly rotating until it reaches nasophayrynx Pause once resistance is felt. Coughing or gagging may ensue Wait until gagging subsides and ask patient to swallow water In case of severe gagging of coughing, signs of respiratory distress or decreased SpO2, STOP. This may indicate the tube is malpositioned in the airway. Withdraw, reassess and do not reattempt until patient’s respiratory pattern has returned to baseline DO NOT LET GO until it is secured in place
32
placement can be checked by
- assessing stomach secretions, clear, colorless or ,yellow or green - injecting air into NGT while auscultating stomach, flush tube with 20 mL or air using 20-60 mL syringe, whooshing sound - must be confirmed with X ray prior to feeding/med initiation
33
Nasal bridle
Additional training is required before inserting/ removing a nasal bridle Using a nasal bridle is an option for securing an NG tube. Useful for clients that have difficulty maintaining the tube
34
NG removal procedure
- check orders - apply blue pad, remove tape and unpin from gown, pt must sit upright with head flexed slightly forward - my instill 50 ml of water or air into NG to prevent aspiration 30-60 min. prior to removal - instruct pt to take deep breath and hold (closes epiglottis) - remove in smooth fluid motion - inspect tip - provide oral and nasal care - document procedure
35
documentation | NG
- Size, type and length of tube - External length measurement and securement - Confirmation of placement done - Suction rate and characteristics of output - Type and rate of enteral feeding - Assessments performed (abdomen, GI, distention, which nare used, tolerance if feeds) - Patient’s tolerance of procedure (insertion or removal)
36
ins and outs
Must be documented on In/Out Characteristics of contents and any procedures on nurses notes
37
open passive drain systems uses a
soft flexible rubber tape to maintain an opening in tissue to prevent build up of fluid use safety pin so doesn't go back into skin ex. penrose
38
closed systems
withdraw fluid and it is collected in resevoir perforated silastic tube is placed in surgical opening during surgical procedure
39
example of closed system | ho wmuch they hold
hemovac (500 ml) JP (100 ml)
40
Removal of Jackson Pratt and Hemovac drain Shortening and removal of Penrose drain must be | student SOP
always be directly supervised by a Registered Nurse
41
leave post op dressing intact for
24-48 hours unless otherwise ordered
42
JP & Hemovac Emptying - gradually - empty - maintain - cleanse - re - secure - note - document
Gradually reduce the charge [pressure] of the drain, face away Empty contents into a specimen container Maintain sterility of port Cleanse port with alcohol Re-charge and close port Secure device to gown with safety pin hanging below wound Note characteristics - amount, color, consistency, odor Document procedure
43
JP & Hemovac Removal - requires - empty cleanse remove stabilize have smoothly apply observe cleanse cover assess document
Requires physician order to be removed, may be for post op timing or amount of drainage (i.e. POD2, or when <30ml/24hr) Empty drain and leave uncharged Cleanse wound first, then drain site starting at insertion site and working away Remove suture if in place Stabilize skin over drain insertion site with 4x4 gauze Have the patient take a deep breath and slowly exhale Smoothly remove drain with exhale in a steady motion Apply pressure over drain site for 2 minutes Observe that end of drain is intact Cleanse drain site when removing 4x4 gauze Cover with sterile dressing Assess site dressing 30 minutes after removal for dressing dry and intact or shadowing Document procedure
44
penrose drain shortening
Shortening amount and timeline will be ordered by the physician Set up sterile field with added sterile scissors, safety pin and suture blade Pull penrose out as per shortening order ( ie. 1 inch per day) Insert sterile safety pin at new length and cut 2 cm above new pin site Apply Y dressing around tube site, secure covering dressing
45
documentation for penrose shortening
Wound assessment Characteristics of drainage on old dressing Wound care provided Shortening length of penrose drain Type of dressing applied Patient tolerance of procedure
46
stages of wound healing
hemostasis inflammatory proliferation remodeling
47
Dr. orders read: RL @ 100mL/h Replace ½ of NG losses > than 200 mL with Ringer’s Lactate Over the shift the patient has 625 mL of fluid loss out their NG. You need to calculate how much fluid to add onto the next 12 hour shift to replace the fluid loss.
117.7 ml/hr
48
Patient has TPN running and an NG or ileostomy which has output Dr. orders read: TPN + RL =125 mL/h Replace ostomy (or NG) losses 1:1 with RL for volumes above 500mL/shift The patient had a loss of 720 mL at the end of the shift then you would do the following TPN running at 66
77.3
49
position for insertion of NG tube for unconscious patient
laterally on right side
50
optional ways to check NG tube placement
- check bilirubin stomach should be 5-7 - check pH: 1-5 - inject 10-30ml or air and listen for wooshing
51
if salem sump tube is used attach a and place
anti reflux valve to vent port and position above the waist
52
if felt resistance when inserting tube
relubricate insert in other nare
53
steps for removing NG tube
- client in semi fowlers or fowler - instill 15 ml of water 30 mins prior - tell pt to take a deep breath in and hold - withdraw tube - check intactness

NRSG 302 (8 decks)

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