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NRSG 302 > Week 1: NG Tubes and Wounds > Flashcards

Week 1: NG Tubes and Wounds Flashcards

1
Q

What is the purpose of the NG tube?

A

A flexible plastic tube that is inserted through the nostrils, down the nasopharynx and into the stomach or upper portion of the small intestine to provide nutrition or remove contents

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2
Q

What are the standard NG tube sizes for children and adults?

A

Children: 5-12 French
Adults: 12-18 French

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3
Q

Describe a Levin tube

A

single lumen tube with holes near the tip
connects to either a drainage bag or intermittent bag
smaller bore
softer
more flexible
less irritating for patient

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4
Q

Describe a salem sump tube

A

two lumina, one removes gastric contents and one provides an air vent
blue pigtail

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5
Q

NG Tube Indications

A

Gain access
decompress
treatment
lavage
prevent
enteral feeding

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6
Q

NG Tube safety considerations

A

DO NOT lie flat, semi fowlers
no oral intake (unless ordered)
check tube position prior to med administration
elevate HOB 30-60 mins after feeding
provide oral care in patient unable to do so
tape in place to reduce irritation from movement
pin to gown to prevent pulling

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7
Q

NG tube complications

A

tissue trauma
aspiration
abdominal pain/discomfort
patency compromised
dehydration

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8
Q

NG Tube assessment pieces (12)

A

suction set to rate/pressure
amount and quality of gastric contents
check canister and tubing secured
check equipment function
check for placement/length changes
assess oral/mucus membrane health
assess abdominal distension, BS, N/V, flatus, BM
check tube irrigation
positioning
skin breakdown
no coiling tube in back of mouth
patients ability to speak

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9
Q

NG Tube procedure steps

A
  1. Assess nares
  2. prepare tube (lube, prep pin/tape, measure)
  3. Prepare patient (high fowlers, basin, water)
  4. Insert tube
  5. Check back of throat for coiling, check placement, initiate suction/feed
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10
Q

technique to insert NG tube

A
  1. slowly into nostril along nasal floor towards the ear
  2. Advance steadily with rotating motion till tube reaches oropharynx
  3. Pause one resistance felt, may gag /cough, encourage water
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11
Q

What should the nurse do if the patient is having severe/continuous gagging or coughing?

A

STOP, withdraw the tube and reassess the patient. when respiratory pattern and oxygenation return to baseline reattempt

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12
Q

What are some alternate forms of checking placement?

A

assessing stomach secretions, clear, colourless or pale yellow/green
injecting air into tube while auscultating stomach, flush tube with 20 mL or air and observe whooshing sound

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13
Q

NG removal steps

A
  1. Check order
  2. Apply blue pad to chest, remove tape and unpin gown
  3. May install 50 mL of water into tube to prevent aspiration
  4. Instruct patient to take deep breath an half
  5. remove in smooth fluid motion
  6. inspect tip to ensure intact
  7. provide oral/nasal care
  8. document
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14
Q

What components of the NG tube insertion
process need to be documented

A

size, type, length of tube
external length measurement/securement
which nare was used for insertion
confirmation of placement done
suction rate and characteristics of output
type and rate of enteral feeding
assessment performed
patients tolerance

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15
Q

What 3 factors contribute to the development of a pressure injury

A
  1. pressure intensity
  2. pressure duration
  3. tissue tolerance
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16
Q

Describe an open (passive system)

A

uses a soft, flexible rubber tube to maintain an opening in tissue to prevent a buildup up of fluid, the fluid makes it way out of the tissues and is deposited onto a sterile covering dressing, it may be sutured in place to prevent accidental removal

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17
Q

Woven Gauze Dressings

A

Packing material

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18
Q

Transparent Film Dressings

A

self-adhesive, occlusive and trap moisture over the wound providing a moist environment

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19
Q

Non-adherent contact layer dressings

A

provide protection to fragile granulating tissue while allowing interstitial fluid and moisture to evacuate

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20
Q

Soft silicone dressing

A

atraumatic contact wound layer that can be removed with no damage to the wound bed

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21
Q

Hydrocolloid

A

adhesive and occlusive, forms a gel as it absorbs moisture

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22
Q

Hydrogel

A

donate moisture to the wound bed

23
Q

Calcium alginate

A

highly absorbent

24
Q

Composite

A

combination of two different dressings types - provide both absorption and autolysis

25
Q

Hypertonic

A

go on dry and drain wet wounds, decrease edema and improves blood flow to the site (its high sodium concentration pulls fluid)

26
Q

Cadexomer Iodine

A

iodine targets bacteria in the wound bed, changes colour to cream where iodine has been absorbed

27
Q

Silver Dressings

A

antimicrobial against 150 pathogens

28
Q

Gentian Violet/Methylene Blue

A

Provides bacteriostatic coverage

29
Q

NPWT

A

A machine that applies localized negative pressure to the wound surface pulling up the base of the wound and enhancing healing rates

30
Q

What must a nurse do to prepare a patient for a dressing change?

A

administer analgesics
describe procedure
gather supplies
observe wound + change dressing
answer questions

31
Q

Hyperbaric Oxygen Therapy

A

Systemic delivery of oxygen at 1.5-3.0x atmospheric pressure to accelerate granulation tissue formation and wound closure

32
Q

Electrical Stimualtion

A

Electrical charge delivered to the wound bed to produce a physiological response

33
Q

Open (passive) System

A

uses a soft, flexible rubber tube to maintain an opening in tissue to prevent a build up of fluid, the fluid makes it way out of the tissues and is deposited onto a sterile covering dressing, it may be sutured in place to prevent accidental removal i.e. Penrose Drain

34
Q

Close (active) system

A

uses vacuum system to withdraw fluid and collect in reservoir, a perforated silastic tube is placed in the surgical opening during the surgical procedure i.e. Jackson Pratt Drain 100ml, Hemovac Drain 500ml

35
Q

Supplies for drain care

A

Wound care kit
Sterile normal saline
Clean gloves
Hand sanitizer
Sterile gloves
Sterile safety pin
Sterile scissors
Specimen container
Alcohol swabs
Covering dressing
Tape
Suture scissors/blade
Y Dressing

36
Q

Procedure for JP and Hemovac emptying

A

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 pin hanging BELOW wound
Note (amount, color, consistency, odor) and document

37
Q

Procedure for JP and Hemovac removal

A

Required physician order to be remove
Empty rain 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 patient take deep breath and slowly exhale
Smoothly remove drain with exhale in steady motion
Apply pressure over site for 2 minutes
Observe end of drain is intact
Cleanse drain site when removing 4x4 gauze
Cover with sterile dressing
Assess site 30 minutes after removal for dressing dry an intact of shadowing
Document

38
Q

JP and Hemovac Documentation

A

Wound assessment
Characteristics of drainage on old dressing
Wound care provided
Characteristics of drainage from active drain
Type of dressing applied

39
Q

Procedure for Penrose shortening

A

Shortening amount and timeline will be ordered by physician
Done as routine sterile dressing change
Set up sterile field (with sterile scissors, safety pin, suture blade)
After cleansing of site, remove suture
Pull penrose out of tissue per shortening order
Insert sterile safety pin at new length and cut 2 cm above new pin site
Apply Y dressing around tube site, secure covering dressing
Document procedure

40
Q

Documentation for Penrose shortening

A

Wound assessment
Characteristics of drainage on old dressing
Wound care provided
Shortening length of penrose drain
Type of dressing applied

41
Q

Describe partial thickness wound repair process

A

heals by inflammatory response, epithelial proliferation/migration and re-establishment of epidermal layer

42
Q

Describe the process of healing for full thickness wounds

A

Heals by inflammatory, proliferative and remodelling

43
Q

Describe the inflammatory phase

A

begins within minutes of injury and lasts up to 3 days where the vessels constrict and platelets aggregate to stop bleeding, macrophages and leukocytes eat the debris

44
Q

Describe the proliferative phase

A

lasts from 3-24 days where new blood vessels appear, the wound is filled with granulation tissue

45
Q

Describe the remodeling phase

A

Can take up to 2 years depending on the extent of the wound, a collagen scar continues to reorganize and gain strength for several months

46
Q

Describe a venous ulcer

A

superficial and irregular in shape, large amounts of exudate from edema in tissue, controlling the edema is essential

47
Q
A
47
Q
A
48
Q

what causes an arterial ulcer

A

inadequate blood flow

49
Q

Wound irrigation basics

A

use 19 gauge needle or angiocatheter
hold 2.5cm above
drain until drainage return is clear

50
Q

What are some complications of post op wound healing

A

hemorrhage, infection, dehiscence, evisceration, fistula

51
Q

What category is removal of a JP/hemovac and shortening/removal of a Penrose?

A

Category A: Must always be directly supervise by a registered nurse

52
Q

How does one advance the NG tube If the patient is unable to have fluids?

A

Dry swallow

53
Q
A

NRSG 302 (6 decks)

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