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210 Ch. 36

Gastro intubation, nutritional malaties

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