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FUN 3 & 4
Digestive Care Upper & Lower
| Question | Answer |
|---|---|
| What is the formula for converting fluid oz. to mL? | # of oz. X 30 = # of mL |
| How many mL are in a fluid oz.? | 30 |
| What is the formula for converting mL to fluid oz.? | # of mL / 30 = # of oz. |
| When a pt. is eating ice chips, how do you calculate the volume of ice chips? | Ice chips = 1/2 the volume of container |
| How do you help visually impaired patient identify what is on their plate? | Use the clock method to tell the patient what food is located where on the plate |
| What of technique is used for insertion of NG tube? | Clean |
| How is the length of the NG tube determined? | Measure from tip of nose to ear to xiphoid process |
| What do you do if patient starts to gag or cough during insertion of NG tube? | Stop, let patient relax and take sip of water |
| What is best way to ensure smooth insertion of NG tube? | Apply lots of lubricant |
| What is used when a NG tube is used for decompression? | Continuous or intermittent suction |
| What needs to be done if suction of NG tube ceases? | Irrigation of tube |
| What do you do to verify placement of NG tube? | Push 30 mL of air into tube while auscultating for a "swishing" sound in abdomen. Pull 30 mL of gastric contents (can be used for pH test). Chest x-ray |
| Define tube feedings | Administration of nutritionally balanced liquefied foods or formula through a tube inserted into the stomach, duodenum, or jejunum by way of the NG tube or feeding ostomy. |
| Define enteral nutrition | Administration of nutrients into the GI tract |
| When is enteral nutrition indicated? | Patient is unable to chew or swallow, has no appetite, or refuses to eat |
| When is tube feeding used? | When all or at least part of the GI tract is functioning |
| How often can tube feeding be done? | Continuously or intermittently |
| What is the most important thing to do prior to administering feeding or medication? | Check for tube placement |
| Define Parenteral Nutrition (PN) | Feeding of a person intravenously, bypassing the usual process of eating and digestion. Pt. receives nutritional formula that contains glucose, salts, amino acids, lipids, vitamins & minerals. (Mixed by a pharmacist) |
| What are the steps to enteral feeding? | Verify orders, verify placement of tube, assess bowel sounds, assess for residual as ordered, follow facility policy re: administration and tube changing, keep HOB up during feeding & for 30 mins after, assess for complications |
| Why do you keep the HOB up during and after feeding? | Avoid aspiration |
| What are possible complications of enteral feedings? | Abdominal distention, nausea, vomiting, diarrhea |
| What do you do if stomach cramps occur during feeding? | Stop feeding & contact physician |
| What are the steps for Parenteral feedings? | Verify orders, assess IV site for complications, follow facility policy for re: administering PN feedings, assess for complications |
| What are complications of Parenteral feedings? | Abdominal distention, nausea, vomiting, diarrhea |
| What are the guidelines for caring for a patient with NG tube? | Check tube placement prior to administration of feeding or medications, Good hand hygiene, hang formula for recommended/ordered amount of time, use only enough for 8hrs, provide oral care, maintain patency of tube |
| Why do you only hang enough formula for 8 hours? | To avoid spoiling |
| What are the characteristics of vomitus? | Color, consistency, and amount |
| What does the quality of vomitus give clues to? | Underlying causes |
| What does coffee ground vomitus indicate? | Bleeding in lower GI tract |
| What does bright red blood in vomitus indicate? | Potential sign of gastric hemorrhage |
| What do you do for a patient that is vomiting? | Provide comfort measures |
| Define characteristics of normal stool | Will vary depending on diet, amount of fiber and fluids, exercised, medications and other habits. Typically stool is soft, formed, light yellowish-brown to dark brown, slight odor & falls into a slightly curved shape |
| Define characteristics of abnormal stool | Liquid-short transit time in bowels; Hard-longer in bowels (water logged); Steatorrhea-Chron's disease (high fat amount) fluffy, floats on water, foul odor; Ribbon shaped-may be due to compressing colon; Clay colored-absence of bile due to poss. blockage |
| What does black / tarry stool indicate? | Bleeding |
| Define constipation | Less frequent, hard, formed stools that are difficult to expel |
| What can cause constipation? | Excessive laxative use, decreased activity level, inadequate fluid intake, decreased fiber in diet, ignoring urge to defecate |
| What are ways to prevent constipation/fecal impaction? | Exercise regularly, increase fiber & fluid intake, provide privacy, positioning, do not delay toileting when urge to defecate occurs |
| What is fecal incontinence? | Inability to maintain stool in the rectum |
| What are the steps for enema? | Verify orders, verify pt. identity, provide privacy, place in sims position, hand hygiene before & after gloving, insert tip 3-4" into rectum, ht. of container of solution should be 12" above anus, assist to bathroom (esp. elderly for safety) |
| What do you do when pt. experiences cramping with enema? | Lower height of solution container and may need to clamp tubing briefly |
| What do you do if there is bleeding during enema? | STOP enema and notify physician |
| Why is a medicinal enema used? | Decrease inflammation of the walls of the rectum & colon; or to exchange substances (ex: Kayexate pulls off excess K) |
| Why are cleansing enemas used? | To relieve constipation, but also used to empty & cleanse bowels prior to surgery or test |
| What are commonly used cleansing enemas? | Tap water, normal saline solution, soapsuds, & commercially packaged small volume oil or sodium phosphate solutions (ex; Fleet) |
| Define ileostomy | Bowel diversion created in the ileum portion of the small intestine. Performed on pt. with inflammatory bowel conditions and cancer of the large intestine; stool is liquid & continuous |
| When caring for ostomy, what is the most important thing to remember? | Skin care around the stoma |
| Where is the ascending colostomy located & what kind of stool? | RUQ / stool is liquid |
| Where is the transverse colostomy located & what kind of stool? | LCQ / stool is loose or soft |
| Where is the sigmoid colostomy located & what kind of stool? | LLQ / stool is formed |
| Where is the descending colostomy located & what kind of stool? | LUQ / stool is formed |
| What are the steps to ostomy care? | Assess what pt. knows re: colostomy & care, teach pt. & family supplies needed & how to use, including assessing skin around stoma & empty bag when 1/3 - 1/2 full, teach pt. to avoid foods that cause gas, maintain eye contact, encourage family to assist |
| What are the characteristics of a new stoma? | Pink to red, shiny, & moist |
| What are the characteristics of an established stoma? | Smaller, pinkish-red, and drier in appearance |
| What should the peristomal skin be free of? | Irritation, excoriation (chaffing), and erythema |
| What is the correct fit for ostomy appliances around the stoma? | Allow 1/3"-1/4" of peristomal skin to show |
| How often is the faceplate (wafer) changed? | Every 3-5 days or sooner if the adhesive backing becomes loose from the skin |
| What is the best way to achieve regular elimination of a sigmoid colostomy? | Irrigation |
| Define nutrition | Total of all processes involved in the taking in & utilization of food involving substances for proper growth, functioning, and maintenance of health |
| How does the nurse promote good nutrition? | Help pt. understand the importance of diet & encouraging dietary compliance; Serving meal trays to pt. in prompt & positive manner; assisting pt. w/eating process; taking & recording wt.; record pt. intake |
| What is a therapeutic diet? | Diet used as medical treatment |
| What is modifying diet? | Adding or taking away specific nutrients or calories in a diet or a change in the consistency of a diet |
| What do therapeutic diets include? | Changes in thickness, consistency, texture or are modified (ex: pureed, soft, full, or thickened diets) |
| What is a clear liquid diet & foods it may contain? | Non-irritating diet consisting of liquids that are easily digested & absorbed, leave little residue in GI tract. (Bouillon, gelatin, tea, coffee, ginger ale, apple juice) |
| What is a full liquid diet & foods it may contain? | More nutritionally complete than a clear liquid diet, but is still lacking in some nutrients (strained cereals & soups, ice cream, puddings, milk/milkshakes, & fruit juices) This diet lacks iron & fiber |
| What is a soft diet and foods it may contain? | Generally low in fiber, includes foods from all 5 food groups and is nutritionally adequate except for fiber (ex: baked chicken) |
| What is a low residue diet and foods it may contain? | Similar to soft diet, but also includes restrictions of milk, because it leaves more residue in the colon |
| What is a mechanical soft diet and foods it may contain? | Eliminates foods that are difficult to chew or swallow (no teeth/dentures) |
| What is a high fiber diet? | Variation of regular diet that doubles the intake of dietary fiber; foods with high fiber should replace similar foods with little or no fiber. This diet is sometimes used for treatment of some GI disorders |
| What are the primary goals for medical nutrition therapy? | Improve metabolic control by achieving & maintaining optimal blood glucose; Provide adequate energy for maint. of a reasonable body wt.; Prevent acute & chronic complications of diabetes; Improve overall health thru optimal nutrition |
| What is Type 1 Diabetes? | Many still in childhood or adolescence at the time of diagnosis, the eating plan needs to provide adequate kilocalories for normal growth & development. Balance carb. intake with insulin administration & exercise |
| What is Type 2 Diabetes? | Occurs in adults who are overweight and are insulin resistant. Mild-moderate weight loss (5-7% of starting weight) has been show to improve metabolic control |
| What is hypoglycemia? | Consumption of inadequate carbohydrates causes the blood sugar to drop. |
| What is dumping syndrome? | May occur after surgery in which a portion or all of the stomach is removed. Stomach contents may empty too rapidly into the jejunum; the body reacts by sending water to the intestinal tract, thus reducing BP, increasing peristalsis, leading to diarrhea |
| What does diet therapy involve? | Giving small, frequent meal that are higher in protein & fat & lower in carbohydrates |
| What is lactose intolerance? | Occurs as a result of a lack of the digestive enzyme lactase. GI can't break down lactose |
| What are symptoms of lactose intolerance and why do they occur? | Nausea, cramps, bloating, flatulence, and diarrhea. Occur after eating milk products |
| What are fat controlled / low fat diets used to prevent? | Atherosclerosis, heart disease, and hyperlipidemia |
| What does fat controlled / low fat diet limit? | Total fats, saturated fats, and trans-fatty acids |
| What does a low cholesterol diet limit? | High cholesterol intake, no fried foods. |
| What foods should you eat if you are on low cholesterol diet? | Baked foods, chicken, fruits, beans |
| When you are on a protein restricted diet, what foods can you substitute? | Potatoes for protein |
| What is a sodium restricted diet? | Restrictions range from "no salt added' to as little as 500mg of sodium per day. Used to treat hypertension, water retention, edema, and CHF |
| What does the acronym DASH diet mean? | Dietary Approaches to Stop Hypertension |
| What is a potassium modified diet? | Increased intake may help with BP control; Encourage fruits, vegetables, and low-fat dairy products |
| What is a fluid modified diet? | Fluid is restricted to 500mL-750mL / day, plus an amount equal to daily urine output during end-stage renal disease. Fluid restrictions may also be implemented during CHF, directly after MI, or hepatic coma/ascites |
| What may a patient experience while on a fluid restricted diet and what can be done to help? | Excessive thirst; rinse mouth with cold mouthwash, lemon in cold water, freezing fluids, cold fruits & vegetables, breath mints/hard candies, brushing teeth, and occasional ice chips |
| What mineral is part of thyroxin which allows thyroid gland to function properly? | Iodine |
| How many lab specimens does a patient have during hospitalization? | At least one |
| What types are lab specimens are there? | Urine, stool, sputum, blood and wound drainage |
| What do lab specimens provide? | Important information about body functions & contributes to the assessment of health status |
| What do laboratory test facilitate? | Diagnosis of health care problems, provide info about the stage & activity of disease process, and measure response to therapy |
| What techniques do you use to collect specimens? | Aseptic |
| Why do you use aseptic techniques to collect specimens? | Prevent contamination which can cause inaccurate test results |
| What do you label the lab specimen with? | Patients name, date of collection, time of collection, initials of person collecting specimen |
| Why are stool samples collected? | Determine presence of infection, bleeding, or hemorrhage. |
| What is another term for presence of occult blood in stool? | Guaiac |
| How many samples do you get when collecting a stool samples? | Two samples from different parts of the stool |
| What is a normal basic human function? | Bowel elimination |
| What does normal bowel elimination depend on? | Described for documentation as moderate in amount, brown & soft in consistency and is expelled every 1-3 days |
Created by:
tandkhopkins
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