Gastro intubation, nutritional malaties
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Where do you place a GI tube | past pyloric sphincter into duodenum/jejunum
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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
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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)
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What are enteric tubes | provide nutrients
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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
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How else should nurse measure placement of tube | Measure exposed portion of tube and document
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what is diff in gastric aspirate and intestinal? | gastric: cloudy, green, tan, off-white, or brown.
intestinal: clear, yellow to bile
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What is pH of gastric vs pH of intestinal | gasstric: 1-5
intestinal: 6 and higher
respiratory: 7 or higher
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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
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How often should you irrigate an NG tube? How often should you check for discharge of NG tube? | Irrigate q4-6h
discharge q4-8h
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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
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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
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what is dumping syndrome? | solutions high in osmolality pulls water into stomach/sm int from organs and vascular.
s/s: nausea/dehydration/hypotension/tachycardia
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What are main nsg goals for enteral & parenteral feedings | Achieve positive nitrogen balance, wt maintenence or gain w/o discomfort or diarrhea
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what is positive nitrogen balance | protein synthesis is greater than protein breakdown resulting in tissue growth
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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
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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.
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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
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how often should tubing be changed with tube feedings? How long can bag of formula hang | q24-72h
formula good for 4h
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what is priority in assessing pt with tube feeding? | 1.check placement(below pylorus is best), elevate HOB
2.check residual
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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
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nsg interventions for nausea/vomiting for enteral therapy | 1.review meds
2.check residuals (inadequate gastric emptying, ileus, gastric block, infection)
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nsg interventions for gas/bloating for enteral therapy | keep tubing free from air
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nsg intervention for constipation for enteral therapy | flushes to hydrate, cathartics(inadequate fluid/fiber, opioid use)
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what can cause aspiration pneumonia? | improper tube placement, vomiting w/ aspiration of tube feeding, supine
Intv: assess resp, check placement
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Causes of tube displacement | coghing/vomiting, unsecured tube, tracheal suctioning, airway intubation
Intv: stop feeding, call Dr
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Causes of tube obstruction | inadequate flushing/formula rate
Intv: declog, get liquid meds, flush
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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
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How should enteric coated, timed released tablets be adm wtih tube feedings? | Never crush! Call pharmacy for alternate form
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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)
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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
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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)
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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
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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
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What kind of pump is always used for PN | infusion pumps
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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.
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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
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what is key for nsg intv when doing dressing changes and working with CVADs? | sterile technique incl mask
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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
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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
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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
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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
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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
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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
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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
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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
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