Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
210 Ch. 36
Gastro intubation, nutritional malaties
| Question | Answer |
|---|---|
| Where do you place a GI tube | past pyloric sphincter into duodenum/jejunum |
| What r fxs of GI intubation? | decompress stomach of gas/fluid, lavage and remove toxins, diagnose disorders, adm meds/feedings, compress bleeding site, aspirate gastric contents for analysis |
| What are two common gastric tubes | Levin: single lumen, short for suction, not feeding. Use low intermittent suction. Gastric Sump: double lumen, blue vent(keep above pt waist) |
| What are enteric tubes | provide nutrients |
| what is key nsg mgmt for tube placement? | check placement with xray, air(unreliable) bubble ea time meds/liquids adm, once a shift for continuous feedings |
| How else should nurse measure placement of tube | Measure exposed portion of tube and document |
| what is diff in gastric aspirate and intestinal? | gastric: cloudy, green, tan, off-white, or brown. intestinal: clear, yellow to bile |
| What is pH of gastric vs pH of intestinal | gasstric: 1-5 intestinal: 6 and higher respiratory: 7 or higher |
| How to measure NG tube for placement | 1. measure from nostril to tip of lower earlobe 2. Then measure from earlobe to tip of xiphoid process. 3. Add 6-10cm and mark |
| How often should you irrigate an NG tube? How often should you check for discharge of NG tube? | Irrigate q4-6h discharge q4-8h |
| Before removing NG tube what is good idea to do before? | 1.Clamp it for trial period to test for nausea/vomiting. 2. Flush with 10ml water/ns so tube is free of gastric lining |
| What is normal osmolality of body? How to avoid dumping syndrome? | 300mOsm/kg slow formula, room temp, semi-fowlers for 1h, minimal water to flush b4 and after feeding |
| what is dumping syndrome? | solutions high in osmolality pulls water into stomach/sm int from organs and vascular. s/s: nausea/dehydration/hypotension/tachycardia |
| What are main nsg goals for enteral & parenteral feedings | Achieve positive nitrogen balance, wt maintenence or gain w/o discomfort or diarrhea |
| what is positive nitrogen balance | protein synthesis is greater than protein breakdown resulting in tissue growth |
| How often are residual gastric volumes measured and what is acceptable amount? | intermittent feedings: b4 ea feeding continuous: q4-8h Residual vol >200 signal alarm for aspiration *Always return residual back to pt |
| Patients at risk for delayed gastric emptying include | gastroparesis, poorly controlled diabetes mellitus, gastric outlet obstruction, ileus, recent surgery, trauma, or sepsis and those using a large amount of narcotic pain medication. |
| B4 adm of meds/feeding, after checking residuals, q4-6h of continuous feed, interrupted tube feeding, unused tube feeding...what should nurse always do? | flush wtih 30-50ml water or NS and record as intake |
| how often should tubing be changed with tube feedings? How long can bag of formula hang | q24-72h formula good for 4h |
| what is priority in assessing pt with tube feeding? | 1.check placement(below pylorus is best), elevate HOB 2.check residual |
| What are nsg interventions for diarrhea and enteral therapy | 1.check rate of flow and temp of formula(hyperosmolar feeding, cold) 2.avoid pro motility meds(reglan) 3. asses F&E levels |
| nsg interventions for nausea/vomiting for enteral therapy | 1.review meds 2.check residuals (inadequate gastric emptying, ileus, gastric block, infection) |
| nsg interventions for gas/bloating for enteral therapy | keep tubing free from air |
| nsg intervention for constipation for enteral therapy | flushes to hydrate, cathartics(inadequate fluid/fiber, opioid use) |
| what can cause aspiration pneumonia? | improper tube placement, vomiting w/ aspiration of tube feeding, supine Intv: assess resp, check placement |
| Causes of tube displacement | coghing/vomiting, unsecured tube, tracheal suctioning, airway intubation Intv: stop feeding, call Dr |
| Causes of tube obstruction | inadequate flushing/formula rate Intv: declog, get liquid meds, flush |
| causes of hyperglycemia, dehydration, azotemia(excess urea in blood) | glucose intolerance, hyperosmolar feedings, low fluid intake Intv: assess dehydration s/s, change feedings or formula, hydrate |
| How should enteric coated, timed released tablets be adm wtih tube feedings? | Never crush! Call pharmacy for alternate form |
| what is a gastrostomy? | PEG tubes opening in stomach to insert feeding tube or decompression. Usually used if enteral nutrition needed for longer than 4 weeks, preferred for coma pt(regurgitation less) |
| What is usual first feeding of peg/jejunostomy tube | tap water, NS, 10% dextrose at slow rate 10-20ml/hr, or small bolus 30-60ml |
| what are nsg goals with gastrostomy? what are intv for ea? | pain, prevent infection, GI bleeding, skin integrity, body image Intv: gauze b/n skin & tube, pH check of contents, check amt if suctioned: low(clamp off), high(check F&E) |
| What is parenteral nutrition and when is it indicated to use? | nutrition through IV route b/c pt not ingest oral food in 7 days |
| How much PN is adm usually over 24h? What is sig about IVFE(intravenous fat emulsions)? | 1-3L; inspect for separation and don't use if oily appearance IVFE: can be along with PN thru Y connector. Don't filter |
| What kind of pump is always used for PN | infusion pumps |
| PPN(peripheral parenteral nutrition) can supplement oral nutrition thru peripheral vein...what precautions are needed to protect the vein? | Not adm >10% dextrose solutions cause of phlebitis and lipids are adm with to protect them. |
| what are 4 types of CVADs(central venous access devices) to adm CPN? Where are they inserted? | Nontunneled(percutaneous) central catheters: subclavian vv Peripherally catheters(PICC): basilic/cephalic vv Tunneled catheters: long term Implanted ports: Huber needle Inserted in subclavian veins usually |
| what is key for nsg intv when doing dressing changes and working with CVADs? | sterile technique incl mask |
| what is important nsg assessment with PN adm? | Assess I/O q8h to assess fluid imbalance. If solution runs out infuse 10% dextrose & water til next PN |
| What is cause and nsg intv, prevention for pneumothorax complicationg of PN? | cause: improper catheter placement, punture of pleura Intv: Folwer's, monitor VS, prepare for chest tube Prvt: Pt still in Trend @ insert |
| What is cause and nsg intv, prevent for embolism complication of PN? | Cause: tubing disconnect, cap missing from port, blocked vascular segment intv: replace tube/cap/call Dr, turn pt to left side and head lowered prvt: examine tubing connection sites |
| What is cause and nsg intv, prevent for clotted catheter line complication of PN? | cause: inadequte hep flush, disruption of infusion intv: flush per Dr order prvt: moniter infusion rate hourly, inspect line integrity |
| What is cause and nsg intv, prevent for sepsis complication of PN? | cause: separation of dsg, bad solution, inf at insertion site intv: change dsg quickly, call Dr/monitor VS prvt: maintain sterile tech |
| What is cause and nsg intv, prevent for Hyperglycemia complication of PN? | cause: glucose intolerance intv: call Dr for insulin prvt: monitor glucose/urine output/assess for stupor/confusion/lethargy |
| What is cause and nsg intv, prevent for fluid overload complication of PN? | cause: infusion too rapid intv: decr rate, monitor VS, call Dr., sit upright if resp distress or give O2 as needed prvt: verify correct infusion rate ordered |
| What is cause and nsg intv, prevent for rebound hypoglycemia complication of PN? | casue: feeding stopped too abruptly intv: assess for s/s(weakness/tremors/diaphoresis/HA/hunger/apprehension prvt: gradually wean pt |
Created by:
palmerag
Popular Nursing sets