Week 5 Flashcards
What are the potential complications of enteral feeding and what can you do as a nurse to prevent them?
Insertion complications
Aspiration Trauma Vomiting Gagging/coughing/choking Laryngeal spasm Pain Epistaxis on insertion
HOB 30 degrees No more than 3 attempts X-ray after insertion Analgesia Withdraw tube
GI/Metabolic complications
Not meeting caloric requirements Hyper/hypoglycaemia Over dehydration Diarrhoea/constipation Altered electrolytes
Conduct regular blood and urinalysis tests
Mechanical complications
tube migration
Tube blockage/obstruction
Secure tube with tape and change daily
Measure external length of tube every shift
Flush 50mL water before and after meds and feeds
Avoid crushing tablets - alternate route or obtain elixirs
Infection complications
Aspiration pneumonia
Tube contamination
Contamination of feed
Clean NTT when handling feeds
Check batch expedite and use by date prior to administration
Hand hygiene before and after tube manipulation
Change feed set every 24 hours
Do not have feed hanging >8/24 hours
Keep patient >30 degrees when feeding or left lateral position with bed head tilted to reduce risk of aspiration
What types of patients would you expect to see having NGT intubation and why?
Long term care patients - nutritional support
Surgical - removal of gastric contents and gas
Pancreatitis - removal of gastric acid and stomach contents
Pre-term infants - nutritional support due to lack of suckling and swallow reflexes
What are the signs of intolerance to enteric feeding?
Respiratory distress
Nausea
Vomiting
Diarrhoea
Constipation
Cramps
Aspiration
GORD
blood sugar fluctuations
When administering medication via NGT, what 3 things should the nurse do?
Flush before, between and after giving meds
Use elixirs if possible
Check with pharmacy if OK to crush tablets
How does the nurse prevent NGT complications?
6 hourly flush with water
Check and document tube length every shift
Clear blockages with water, carbonated water or effervescent vitamin C
Regular oral hygiene
Replace tape when loose
Give oral meds by another route if on free drainage
Check nares each shift for evidence of pressure injury
When is NGT position verified?
After insertion
Every shift
Every 4 hours in critical care or when continuous feeding
Prior to administration of anything down the tube
If tube has not been used for some time
If patient had been sick or coughed violently
What type syringe is used for flushing the NGT?
Disposable 50mL catheter tip syringe
When passing the NGT, what does coughing and choking indicate?
Tube has entered the trachea
What 2 checks are done to check position of the NGT?
X-ray
Aspiration
How many attempts can be made to insert a NGT?
No more than 3 attempts!
How is a NGT measured and what is the average length for an adult?
From tip of nose to ear
From ear to xiphoid process
Note mark on tube
54cm
What are the contraindications for NGT insertion?
Max-fax disorders, surgery, trauma
Pts post larygngectomy
Oesophageal tumours or related surgery
Confirmed or suspected skull fracture
Unstable cervical spinal injuries (vertebra 4>)
Clotting issues/disorders
Ingestion of corrosive material
What are the 3 types of NGTs?
Ryles (drainage) tube
Salem sump
Core-flow fine-bore nasogastric feeding tube
What is a Tiger Tube?
Fine bore specialty device used for longer term use in patients unable to tolerate nasogastric feeds.
The tube is inserted into the stomach then advances into the small intestine.
Has small protrusions on outside of catheter.
What is a Hiatus Hernia and what are the symptoms and treatment?
Hiatus hernia is a hernias ion of a portion of the stomach through the oesophageal hiatus in the diaphragm.
Asymptomatic or GORD symptoms Gastric reflux Heartburn Pain Bleeding Anaemia Retching/vomiting when bending over or laying down.
Lifestyle changes
Meds as per GORD
Surgery
What organs are in each of the quadrants of the abdomen?
RUQ
lower part of liver
Gall bladder
Part of large intestine
LUQ lower spleen Part of pancreas Some stomach Duodenum
RLQ
appendix
Large and small intestine loops
LLQ
bowel loops
Descending colon
What is GORD and what are the symptoms and treatment?
Gastro oesophageal reflux disease
Relaxation of gastro-oesophageal sphincter causes exposure to acidic stomach contents.
Pain (sharp or burning) Dysphasia Sweating Reduced diet/fluid intake Cough at nighttime Barrett's oesophagus seen on endoscope (cells that line the oesophagus are abnormal; risk of cancer)
Lifestyle changes
Medication
Surgery
What are oesophageal varicies and what are the symptoms and treatment?
Varicose veins in the GIT
Mortality 30-50% on first bleed
Formed as direct result of liver dysfunction resulting in raised oesophageal venous pressure.
Pain Nausea Melaena MASSIVE blood loss Hypovolaemia Collapse DEATH
pharmacological - meds to reduce portal hypertension and prevent bleeding
Endoscopic - banding; sclerotherapy
Balloon tamponade - last resort as high risk and controversial
What are the nursing interventions for oesophageal varices?
DRABCDE IV access NGT Estimate volume and appearance of blood loss Blood transfusion Support Close observation
What is a Mallory-Weiss tear?
Small tear in oesophageal tissue
Blood loss usually minor
Self-limiting
Usually asymptomatic
May suffer anaemia if bleeding from site is chronic
What is a peptic ulcer and what are the symptoms?
Ulcer that occurs in the stomach and duodenum.
Caused by damage to areas exposed to acid and pepsin containing secretions.
Pain (burning, usually localised)
Dyspepsia (indigestion)
Belching
What is helicobacter pylori?
Bacteria found in the inner lining of the stomach that produces chemicals that invade and damage the mucosal lining of the stomach.
Persistent in nature.
Affects 40% of people over 40
Affects 10% of children
Method of transmission/infection is unknown
Present in 75-80% of patients with gastric ulcers
Present in 95% of duodenal ulcers
What health issues are linked to helicobacter pylori?
Anaemia Thrombocytopenia Rosaea Chronic itching Psoriasis Severe morning sickness Pre-eclampsia Growth retardation Systemic sclerosis Otitis media Nasal polyps Guillian-Bare syndrome Autoimmune and endocrine disorders
How is helicobacter pylori diagnosed and what is the treatment?
Diagnosis
Blood Biopsy Breath test Endo/gastrocopy Stool - HP antigen test
Treatment
Eradication therapy Antibiotics HP7 Antacids Discontinue NSAIDs/aspirin Dietary advice Smoking cessation
What does coffee ground vomit indicate?
Serious symptom
Notify physician immediately
Indicative of bleeding in the upper GIT
When assessing the abdomen, what 4 assessments are conducted?
Inspection
Auscultation
Percussion
Palpation
What are you looking for when inspecting the abdomen?
Skin changes (colour, texture)
Scars from previous surgery or trauma
Symmetry of abdomen
Bulging/distension
Visible peristaltic waves
Check patient for stoma
When percussing the bowel, what sounds are head?
Tympany - hollow, drum like sound
Dullness - organs, obstruction, solid mass
Percussion helps to determine if abdominal distension is due to a solid or cystic tumour, ascites or gas.
What type of palpation is conducted on the abdomen?
Light palpation to identify tenderness and/or swollen areas
Deep palpation to identify deep masses and areas of discomfort
When visually inspecting the perianal area, what are you looking for?
Excoriation (scratches, abrasions) Rash External haemorrhoids Fissures or fistula openings Exudate Odour Bleeding (pre/post bowel motion)
What are the diagnostic interventions for abdominal investigation?
Stool sample
Faecal occult blood test (cancer screening)
Hydrogen breath test (h. Pylori)
Barium enema
Imaging studies (CT, MRI, X-ray, scintigraphy)
What are the 4 types of endoscopic procedures and why are they performed?
Gastroscopy
Direct visualisation of oesophageal, gastric and duodenal mucosa
Sigmoidoscopy
Evaluate multiple gastrointestinal issues
Colonoscopy
Cancer screening
Ongoing surveillance
Treat bleeding and strictures
Laparoscopy
Diagnose gastrointestinal conditions
When auscultation the abdomen, what are the sounds that can be heard?
How long is the abdomen auscultated for?
Normal - sounds heard every 5-20 sec
Hypoactive/scant - 1-2 sounds every 2 minutes
Hyperactive - 5/6 sounds in less than 30 seconds
Absent - no sounds heard in 3-5 minutes
Auscultate for full 3-5 minutes
