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nasogastric tubes

Intubation the placement of a tube by nose or mouth into a body structure like stomach or intestine
Orgogastric intubation or orogastric tube the insertion of a tube through the mouth into the stomach
Nasogastric intubation the insertion of a tube through the nose into the stomach
Nasointestinal intubation the insertion of a tube through the nose to the intestine
Orogastric, nasogastric and nasointestinal intubation are used to? remove gas or fluids and to administer liquid nourishment
Ostomy a surgically created opening
What are some reasons in which gastric or intestinal tubes are used? perform lavage or gavage, administer oral meds which clients can't swallow, obtain sample of secretions for testing, promote decrompression, control gastric bleeding
Gavage to provide nourishment
Lavage to remove substances from the stomach
Decrompression to remove gas and liquid contents from the stomach or bowel
Tamponade pressure
What does each number on the French sacle equal? 0.33 mm
What is the type of orogastric tube? Ewald tube
What is the purpose of the Ewald tube? lavage
Which type of tube is used in an emergency to remove toxic substances that has been ingested? orogastric tube or Ewald tube
What are the characteristics of an Ewald tube? large diameter, single lumen, and multiple distal openings for drainage
Nasogastric tube a tube placed through the nose and advanced to the stomach
Lumen channel
What are the types of nasogastric tubes? Levin, Salem sump, and sengstaken-Blakemore
What is the purpose of the Levin tube? lavage, gavage, decompression, or diagnostics
What are the characteristics of the levin tube? usual adult size is 14-18 F, single lumen, 42-50 in long, and has multiple drain openings
Sump tubes double lumen tubes
What is the purpose of sump tubes? decompression
What are the characteristics of the salem sump tube? same diameter as levin tube, double lumen, pigtail vent, 48 in long, marked at increments to indicate depth of insertion, and radiopague
What is the purpose of Sengstaken-Blakemore tube? compression or drainage
What may clients complain of with nasogastric tubes? nose and throat discomfort
What may occur if the tubes diameter is too large or pressure from the tube is prolonged? tissue irritation or breakdown
Gastric tubes tend to dilate the esophageal sphincter which may lead to? gastric reflux
Gastric reflux the reverse flow of gastric contents
Nasointestinal tubes tubes inserted through the nose for distal placement below the stomach
What does the added length permit of a nasointestinal tube? the tube to be placed in the small bowel
What are the types of nasointestinal tubes? Keofeed and maxter tubes
What is the purpose of a Keofeed tube? gavage
What are the characteristics of the keofeed tube? small diameter 8F and 36 in long, polyurethane or silicone, weighted tip, flexible, radiopague, and bonded lubricant becomes activated with moisture
How long may keofeed tubes be left in place? 4 weeks or longer
What do keofeed nasointestinal tubes reduce the potential for and why? gastric reflux; they deliver liquid nutrition beyond the stomach
What is the purpose of the maxter tube? intestinal decompression
What are the characteristics of the maxter tube? usual size 18 F, 100 in, double lumen, weighted tip, and graduated markes every 10 in
Stylet metal guidewire
Intestinal decompression the removal of gas and intestinal contents
Transabdominal tubes tubes placed through the abdominal wall
What are the types of transabdominal tubes? gastrostomy and jejunostomy
Gastrostomy tube a transabdominal tube located within the stomach
What is the purpose of a gastrostomy tube? gavage; can be used for decrompression while client is fed through jejunostomy tube
What are the characteristics of the gastrostomy tube? size 12-24 for adults, rubber or silicone, may have additional side ports for balloon inflation to maintain placement, may be capped or plugged between feedings, and radiopague
Jejunostomy tube a trasabdominal tube that leads to the jejunum of the small intestine
What is the purpose of a jejunostomy tube? gavage
What are the characteristics of a jejunostomy tube? size 5-14 F for adults, silicone or polyurethane and radiopague
Percutaneus endoscopic gastrostomy tube (PEG tube) a transabdominal tube inserted under endoscopic guidance
Percutaneous endoscopic jejunostomy tube (PEJ tube) tube thats passed through a PEG tube into the jejunum
What type of tube is used instead when clients require an alternative to oral feeding for more than 1 month? transabdominal tubes
What are some ways to reduce anxiety when having to place an NG tube down a client? tell client the diameter of tube is smaller than most pieces of food, explain procedure, allow client to assist while tube is being placed, establish a signal for if client needs to pause, give client some form of control
Before NG tube insertion, the nurse conducts a focused assessment. What does this assessment include? loc, weight, bowel sounds, abdominal distention, integrity of nasal mucosa, ability to swallow cough or gag, and any nausea or vomiting
What is a major goal of the assessment before inserting the NG tube? to determine which nostril is best to use and the length of tube placement
When inspecting the nasal area, what things excludes a nostril for tube insertion? presence of nasal polyps, deviated septum, and narror nasal passage
NEX measurement length from nose to earlobe to the xiphoid process
What is the first mark that is made prior to NG tube insertion? What does this indicate? from nose to earlobe; distance to nasal pharynx or tip at back of throat above gag reflex
What is the second mark made prior to NG tube insertion? from earlobe to xiphoid process
What are the nurses primary concerns when inserting a nasogastric tube? to cause as little discomfort as possible, to preserve the integrity of nasal tissue, to locate the tube within the stomach not in respiratory passages
What are some ways to verify the locations of the NG tube placment? aspirate fluid, asucultate abdomen, test pH, and x ray
What color should the aspirated fluid be if proper placement of NG tube? clear, brownish yellow, or green
When checking placement of NG tube, how do you auscultate the abdomen? while listening with stethoscope over abdomen, instill 10 mL of air or more. If swooshing sound is heard, tube is in stomach
When belching is occuring, with a client that has just had an NG tube placed, what has likely happened? the tip of the tube is in esophagus
What confirms the acidic gastric contents of NG tube placement? testing the pH
What are the most accurate ways to check NG tube placement? x ray and pH test of gastric contents
What is the pH of stomach contents? 1-3 (acidic)
What does a pH of 7 or more indicate in regards to aspiration of gastric contents? tube is in respiratory tract
What can continuous suctioning with an unvented tube cause? the tube to adhere to the stomach mucosa which results in localized irritation and interferes with drainage
The suctioning setting is prescribed by the physican. What is the normal pressure setting for NG tube? 40-60 mm Hg
When does the NG tubes need to be clamped or plugged if client is ambulating or after instilling medications
How does the nurse assess for NG tube patency? monitors volume and characteristics, signs and/or symptoms of an obstruction
What are some signs/symptoms of possible obstruction within the tube? nausea, vomiting, abdominal distention
What must the nurse obtain before attempting an irrigation? a medical order
In an NG tube, if the drainage holes are adhering to the gastric mucosal wall, what can the nurse do? turn off suction momentarily and change client's position
In an NG tube, if a tube is displaced above the esophageal sphincter, what can the nurse do? if measured mark is not at tip of nose, remove tape, advance tube, check placement and resecure
In an NG tube, if the drainage container is filled beyond capacity, what can the nurse do? empty and record amount of drainage in suction container
In an NG tube, if the vent is acting as a siphon, what can the nurse do? instill a bolus of air into the vent and restore patency
In an NG tube, if the vent is capped or plugged, what can the nurse do? remove cap and restore the port to an atmospheric pressure
In an NG tube, if the suction is inadequate what can the nurse do? check that the pressure is 40-60 mmHg
In an NG tube, if the cover of the suction container is loose what can the nurse do? resecure lid to container
In an NG tube, if a solid particle or thick mucus obstructs the lumen what can the nurse do? increase suction pressure for a moment and obtain and implement a medical order for irrigation
Enteral nutrition nourishment provided through the stomach or small intestine rather than by the oral route
When do nurses remove a nasogastric tube? when a client's condition improves, when tube becomes obstructed and not able to clear obstruction, and according to agency's policy
How often are unobstructed larger diameter NG tubes usually removed or changed? at least every 2 to 4 weeks for adults
How often are small diameter flexible NG tubes removed or changed? every 4 weeks to 3 months depending on agencys policy
How do you estimate the length of a nasointestinal tube? determine the NEX measurement then add 9 in
After insertion of a nasointestinal tube, an X ray is taken to confirm placement. HOw do nurses check placement after that x ray? using a 50 mL syringe and obtain sample of fluid
Who inserts transabdominal tubes physician
Why is care so important with transabdominal tubes, especially G tubes? G tubes can leak which leads to skin breakdown
What are some causes of gastrostomy leaks? disconnection between feeding delivery tube and G tube, clamped G tube while tube feeding is infusing, mismatch in size of G tube and stoma, increased abdominal pressure, underinflation of balloon
In which clients are tube feedings used? clients with intact stomach or intestinal function but unconscious, extensive mouth surgery, difficulty swallowing, or esophagel or gastric disorders
Nasointestinal tubes reduce the potential for what? enteritis or inflammation of intestines
Nasointestinal tubes increase the potential for what? gastric reflux
What type of tube may cause dumping syndrome? a nasointestinal tube
Dumping syndrome a cluster of symptoms from the rapid deposition of calorie dense nourishment into the small intestine
What are the symptoms of dumping syndrome? weakness, dizziness, sweating, nausea, low blood glucose, diarrhea
In dumping syndrome,what can cause the weakness, dizziness, sweating and nausea? when fluid shifts from the circulating blood to the intestine
In dumping syndrome, why may diarrhea occur? when hypertonic formula is administered
What factors are considered on determining the type of formula needed? weight, nutritional status, concurrent medical conditions, projected length of therapy, and feeding schedule
What type of formula would benefit clients with or who are at risk for pressure ulcers? formulas fortified with additional zinc, protein, and other nutrients
What are the types of tube feeding formulas? standard (isotonic), high calorie, high protein, fiber containing, and partially hydrolyzed
Which type tube feeding are routine formulas for clients with normal digestion and absorption, don't alter H2O distribution and provide about 1.0cal/mL? standard(isotonic): osmolite, isocal, nutren 1.0
Which type of tube feeding provides up to double the amount of calories of standard formulas for client who require a fluid restriction or have high calorie needs? high calorie: comply, nutren 1.5, nutren 2.0 or deliver 2.0
What type tube feeding, provides up to double the amount of protein of standard formulas? high protein: promote, isocal HN,or ultracal HN plus
Which type of tube feeding provides fiber to normalize bowel function in clients with diarrhea or constipation? Fiber containing: jevity, compleat, ultracal
What type of tube feeding, provides nutrients in simple form requiring little or no digestion for clients with impaired digestion or absorption? partially hydrolyzed: criticare HN, optimental, or vivonex TEN
How often can tube feedings be administered? bolus, intermittent, cyclic or continuous
Bolus feeding the instillation of liquid nourishment in less than 30 minutes 4-6 times a day
What is the usual amount given in a bolus feeding? 250-400 mL of formula per administration
The bolus feeding schedule is the least desirable. Why? it distends the stomach rapidly causing gastric discomfort and increased risk for reflux
Intermittent feeding the gradual instillation of liquid nourishment 4-6 times a day
How much is usually administered with intermittent tube feedings? 250-400 mL per administration
How long are intermittent tube feedings usually administered over? 30-60 minutes
How are intermittent feedings generally administered? by gravity drip or feeding pump
With intermittent feeding, what is required to reduce the growth of microorganisms? thorough flushing after each feeding
How often are tube feeding administration sets replaced with intermittent feedings? every 24 hours
Cyclic feeding the continuous instillation of liquid nourishment for 8-12 hours followed by a 16-12 hour pause
Which time schedule of tube feeding is often used to wean clients from tube feedings while maintaining adequate nutrition? cyclic feedings
When are cyclic feedings usually administered? during late evening and hours of sleep
With cyclic feedings, are clients allowed to eat food orally? yes
COntinuous feeding the instillation of liquid nutrition without interruption
When administering continuous feedings, what is the usual rate? 105 mL/minute
What is used to regulate the instillation of continuous tube feedings? feeding pump
What does instilling small amounts of fluid beyond the stomach do? reduce the risk of vomiting and aspiration
What are some standard daily assessments nurses make when a client is on a tube feeding? weight, I&O, bowel/lung sounds,temperature, breathing pattern, gastric complaints, vomiting, bowel elimination patterns, status of abdominal distention, bowel elimination patterns, condition of nasal & oral mucous membrane, skin condition of tube
gastric residual the volume of liquid within the stomach
Why does the nurse measure the gastric residual? to determine whether the rate or volume of feeding exceeds the clients physiologic capacity
In regards to tube feedings, what can overfilling the stomach cause? gastric reflux, regurgitation, vomiting, aspiration, or pneumonia
When checking the gastric residual, there should be no more than how much of the previous hours tube feeding volume? no more than 100mL or 20%
What should the nurse do if the gastric residual is high? stop feeding and recheck gastric residual every 30 minutes until its within a safe volume for resuming the feeding
What are feeding tubes smaller than 12F usually more prone to? obstruction
What is the best way to maintain patency within a feeding tube? use a 30-60mL of water immediately before and after administering a feeding or medications every 4 hours if continuously fed and after refeeding gastric residual
What does the nurse do if an obstruction occurs in a tube feeding? consult the physician
If a tube feeding obstruction can't be cleared, what has to be done? tube has to be removed and another tube inserted
Usually tube feedings are about 80% water but usually clients require additional hydration. How much do adults usually require? 30mL of water per kilogram of body weight or 1mL/kcal on daily basis
How does the nurse determine if a clients hydration needs are being met? identify the amount of water on the label of formula
If an older adult is recieving tube feedings, what things should the nurse look for? fluid and electrolyte disturbances, capillary blood glucose levels, agitation or confusion or change in mental status
Older adults on tube feedings are at risk for fluid and electrolyte disturbances which can lead to what? hyperglycemia
Older adults on tube feedings may experience hyperglycemia. How ofter should capillary blood glucose levels be checked? every 4 hours for a 48 hour period
What is an early sign of fluid and electrolyte imbalance in older adults? change in mental status
If a client goes home on tube feeding, what problems do you need to instruct the client to report? weight loss, reduced urination, weakness, diarrhea, nausea/vomiting, or breathing difficulties
How is a nasointestinal decompression tube removed? disconnect from suction, remove tape from face, withdraw tube 6-10 in at 10 minute intervals, withdraw last 18 in pulling gently from nose, and provide oral and nasal hygiene
Created by: 1115060100