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Nursing Skills
Test 4 - N/G Meds and Enteral Tubes Part 2
| Question | Answer |
|---|---|
| When would an enteral feeding tube be used? | Administration of medications or feedings in those unable to take oral nutrition. (i.e. cancer, anorexia, neuromuscular disorders, etc.) |
| Type of enteral feeding tube is determined based on | Length of time needed |
| Short term (less than 6 weeks) tube what two types of tubes could be selected? | Nasogastric( NG) or nasointestional route is selected |
| The nasogastric tube goes from the ___ to the _____. The nasointestional goes from____ to the ______. | Nose, stomach, Nose, small intestine |
| What in the NG tube allows for removal of gastric secretions and introductions of solutions into the stomach | Hollow lumen |
| NG tube typically for short term management of nutritional situations during acute illness and recovery | Nasogastric tube ( Small bore) |
| What are advantages of NG tube? (3) | You are able to retain all functions of the stomach – manage chyme, use acidic environment to kill bacteria, prevents “dumping”syndrome |
| What are disadvantages of NG tube? (2) | Aspiration or migration into the lungs |
| Advantages of nasointestional tube? | minimal risk for aspiration |
| Disadvantages of nasointestinal tube? | type of dumping syndrome may develop because of the pyloric valve in the stomach, which normally slows transit of food into the intestine. |
| Used for extended length of enteral feeding | Long term feeding tube |
| For long term enteral feeding, there is a surgical creation of an _______ in the intestines by incision through the _________. This procedure is called an ____. | Artificial fistula, abdominal wall,enterostomy |
| Can the artificial fistula be placed along various points along the GI tract? | Yes |
| Type of long term feeding tube that is placed endoscopically and does not require surgery | Percutaneous endoscopic gastrostomy (PEG) |
| Can a PEG be inserted and removed safely at bedside or in an outpatient setting? | Yes |
| What is an advantage of the PEG? | Economical |
| How do you care for a G tube if it is newly inserted versus if it is established? | New Insertion - with sterile saline Established - with warm soap and water |
| What do you do if a G tube is leaking? (2) | Check tension of tube. If there is too much slack between the internal guard and the external bumper, fluid can leak out of site ( it should not be able to move up on tubing more than an inch). Make sure the balloon is inflated fully. |
| Most NG patients will be ____________ thus need frequent __________ to protect mucus membranes and the teeth. | Mouth breathers, oral hygiene |
| Tubes require ___________of the exit site until healing occurs. | surgical asepsis |
| The G tube bumper requires ____________ to relieve pressure on the skin. | daily rotation |
| Delivery of nutrients through a gastrointestinal tube | Enteral Feedings |
| Do clients who receive enteral feedings have a compromised GI tract? | No, it is functional |
| What are the benefits of enteral vs parenteral? | Enhance utilization of nutrients , Maintain gut integrity via GI stimulation, Lower infection compared to vascular access for Parenteral , More cost effective, Lower complications (safer) |
| When administering a tube feeding, what system will you assess and what will you assess for? | Abdominal assessment – distension, bowel sounds, palpation, pain, tenderness, nausea |
| How do you verify placement of intial insertion of enteral feeding tube? | radiographic examination |
| When do you verify position of enteral feeding tube after initial insertion? (2) | Before beginning a feeding or instilling liquids, and at a regular interval during continuous feedings |
| What is the best way for determining correct internal placement of a feeding tube? | pH |
| NH tubes can ____ when negative pressure is applied secondary to being ____. | Collapse, less rigid |
| Aspiration can be dependent on where the ____ is in relation to the ______. | Port, gastric contents |
| What are three ways to externally verify the placement of an NG tube? | Permanent markings on tube, secured tape on nose, documented length of tube from tip of nose to end of tubing |
| How do you aspirate PH? (4) | Obtain 5-10 mL aspirate, look at color, appearance and pH of aspirate |
| How do you measure the pH of the aspirated GI contents? | by dipping the pH strip into the fluid or by applying a few drops of the fluid to the strip. |
| What pH level would indicate that the tube is in the stomach? With H2 blockers? | 0 to 4, with H2 blockers could be 4-6 |
| What is the pH of the lungs | Greater than 7 |
| Is it okay to insert air to auscultate routinely for verification of placement? | No! |
| When tube feeding, at what angle should the head of the bed be at during and for one hour after feeding? | 30-45 degrees |
| Notify MD if residual is consistently more than ____ or the policy at the healthcare facility that you are at. | 100 cc’s |
| Flush enteral feeding tube before and after feeding with | 30 mL water using a 60CC syringe ( no smaller) |
| Specific amount given several times a day via gravity through a large bore syringe. | Bolus tube feeding |
| How is the rate of a bolus tube feeding regulated? What is the standard? | By the height the large bore syringe is held. 18” above patient |
| What are the complications of using a bolus tube feeding? | Dumping syndrome due to high osmolarity |
| Type of feeding given over 1-2 hours several times a day using a tube feeding pouch with tubing and clamp to regulate the flow | Intermittent ( can be given by gravity pump) |
| Type of feeding fed via infusion pump over 20-24 hours | Continuous |
| What should you do after each use of the bolus? | Rinse the syringe |
| When using the bolus, what should you do with the can itself? | Wipe off with alcohol wipe, allow to dry, check expiration date and go through five rights |
| With intermittent, when do you clean the bag and tubing? | After each feeding |
| With intermittent and continuous, how often do you change syringe, bag and tubing | Every 24 hours or per agency policy |
| With intermittent and continuous, up to how long can feeding hang? | up to 24 hours depending on type of container-feeding cans are usually hung over 4 hours, or per agency policy , shorter time for pediatric formulas |
| What are ways that contamination can be prevented? | Wash hands, Wear non-sterile gloves, Wear a mask if you have a cold, Don’t add new formula to old, Use system medication ports for med. Administration, Swab off medication port with alcohol before administering medications,goggles |
| Before giving medications enterally, assess the abdomen for | contraindications for medication administration |
| Before giving medications enterally, be aware of ant | Fluid restriction |
| How is enteral medicine prepared? | It is crushed, disoloved or liquified and mixed with 5-10 mL of warm tap water |
| Before preparing an extended release med or capsule for enteral administration, what should you do? | Check with pharmacist |
| After preparing enteral medications, what should you do? | Remove clamp from the tube and use the recommended procedure for checking tube placement and residual(readminister). Follow appropriate policy with residual amount |
| When administering enteral medications use plunger from ___cc syringe and connect to ___, the patient should be in bed in ______ position | 60, tubing, fowler’s |
| How much water should you flush with prior to administering enteral meds. Adults? Children? | 13-30 mL, 5-10 mL |
| Can you give more than one enteral medicine at a time? | No |
| How much water should be instilled between each medication that is being administered enterally? | 10 mL |
| How much water should be instilled after all medications have been taken enterally? | 30-60 mL |
| To prevent tube clogging, don’t mix meds with | TF formulas |
| Make sure you have the proper type of med for the enteral route—try to get ___ form. | Liquid |
| When do you use NG flushing/Irrigation | When tube patency is in doubt |
| What type of patients will often need NG flushing/irrigation? | Needed with patients on NG feedings and frequent medication administration as contents may become thick or medication can clog tube if not flushed appropriately. |
Created by:
anastasia158
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