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FUN 3 & 4

Digestive Care Upper & Lower

QuestionAnswer
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