GI ch. 45

Feeding patients through tubes placed beyond the _____ or using _____ agents can decrease the frequency of feeding regurgitation and aspiration.

- pylorus - prokinetic agents

Nasogastric feeding tubes are used for patients who have the ability to _____ and _____ nutrition, fluids, and medications adequately by the gastric route.

- receive - process

What is the Sengstaken-Blakemore tube used for?

Control of bleeding esophageal varices.

A dressing over the tube outlet ad the gastrostomy tube protects the skin around the incision from _____ and _____.

- seepage of gastric acid - spillage of feeding

Gastric-Sump Salem feeding tube

Double-lumen, plastic NG tube about 20 cm in length.

Describe the purpose of gastric intubation.

- Decompress the stomach and remove gas and fluid. - Lavage (flush with water or other fluids) the stomach and remove ingested toxins or other harmful materials. - Diagnose GI disorders. - Administer tube feedings, medications and fluids. - Compress a bleeding site. - Aspirate GI contents for aspirate.

_____ or _____ feeding is indicated when the esophagus and stomach need to be bypassed or when the patient is at risk for aspiration.

- Nasoduodenal - Nasojejunal

The nurse is caring for a comatose patient and administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to NG feedings in the comatose patient? a. Gastroesophageal sphincter is intact, lessening the possibility of regergitation. b. Digestive process occurs more rapidly because the the feedings do not have to pass through the esophagus. c. Feedings can be administered with the patient in the recumbent position. d. The patient cannot experience the deprivational stress of not swallowing.

a. Gastroesophageal sphincter is intact, lessening the possibility of regergitation.

A nurse prepares a patient for insertion of a nasoenteric tube. What position should the nurse place the patient in? a. High-Fowler's position b. Flat in bed c. On the right side d. Semi-Fowler's position with head turned to the left

a. High-Fowler's position

The nurse is inserting a sump tube in a patient with Crohn's disease who is suspected of having a bowel obstruction. What does the nurse understand is the benefit of the gastric (Salem) sump tube in comparison to some of the other tubes? a. The tube is radiopaque. b. The tube is shorter. c. The tube is less expensive. d. The tube can be connected to suction and others cannot.

a. The tube is radiopaque.

What is the visual difference between the color of gastric aspirate and the color of intestinal aspirate?

Gastric aspirate is most frequently cloudy and green, tan, off-white, or brown and may be large in volume. Intestinal aspirate is primarily clear and yellow to bile colored and typically smaller in volume.

Sengstaken-Blakemore feeding tube

Triple-lumen, rubber NG tube (2 lumens are used to inflate the gastric and esophageal balloons).

A patient has had a gastrostomy tube inserted. What does the nurse anticipate the initial fluid nourishment will be after the insertion of the gastrostomy tube? a. Distilled water b. 10% glucose and tap water c. Milk d. High-calorie liquids

b. 10% glucose and tap water

The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, and tachycardia in the patient would indicate to the nurse what common complication? a. A cardiac dysrhythmia b. Fluid volume deficit c. Mucous membrane irritation d. Pulmonary complications

b. Fluid volume deficit

The nurse is inserting a NG tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred? a. The nurse has inserted a tube that is too large for the patient. b. The nurse has inadvertently inserted the tube into the trachea. c. This is a normal occurrence and the tube should be left in place. d. The tube is most likely defective and should be immediately removed.

b. The nurse has inadvertently inserted the tube into the trachea.

Nancy is 37 years old, 5 ft tall, and weighs 140 lbs. She receives 250 mL of a feeding over a 15-minute period every 4 hours through a NG tube. Nancy has had esophageal surgery for carcinoma. 1) Nancy tells the nurse that she has diarrhea. The nurse suspects Nancy is experiencing dumping syndrome. What other possible causes should the nurse eliminate? 2) The nurse notes a residual gastric content of 50 mL. What is the priority action by the nurse? 3) What intervention can the nurse provide to Nancy to decrease perstalsis during feedings? 4) What complications may occur with dumping syndrome that the nurse should monitor for?

1) Caloric density, tubing size, speed of infusion, temperature and volume of feeding, zinc deficiency, contaminated formula, malnutrition, and medication therapy. 2) Return the solution through the tube and administer the next feeding. 3) Administer the feeding at room temperature. 4) Dehydration, hypotension, and tachycardia.

A nasally placed feeding tube is short-term use and should stay in place for no more than _____ weeks before being replaced with a new tube.

4

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted 6-10 cm beyond what length? a. A length of 50 cm (20 in). b. A point that equals the distance from the tip of the nose to the xiphoid process. c. The distance measured from the tip of the nose to the earlobe to the xiphoid process. d. The distance determined by measuring from the tragus of the ear to the xiphoid process.

c. The distance measured from the tip of the nose to the earlobe to the xiphoid process.

When giving an initial tube feeding, the nurse would be looking for _____ around the tube site on the abdomen.

leakage of fluid

Penny is 30 years old ad single. She is 5 ft 7 in tall, weighs 150 lbs, and is receiving parenteral nutrition solution at the rate of 3 L per day. Her postoperative condition warrants receiving nutrients by the IV route. 1) The nurse knows that, to spare body protein, Penny's daily caloric intake should be at what level? 2) The nurse estimates Penny's caloric intake for each 1,000 mL of total parenteral nutrition to yield a glucose concentration of how many calories? 3) The nurse should observe Penny for signs of rapid fluid intake. What signs does the nurse determine would indicate this?

1) Approximately 1,500 calories per day. 2) 1,000 calories. 3) Chills, fever, and nausea.

Name 3 common causes of constipation for a patient who is receiving enteral feedings.

1) Concomitant use of opioids 2) Administration of fiber-free tube feeding formulas 3) Inadequate water intake (tube feedings typically do not meet total fluid needs, so additional water must be administered).

Levin feeding tube

Nasoenteric feeding tube about 6 ft in length.

Dobbhoff or Enteraflo feeding tubes

Single-lumen, plastic, or rubber NG tube about 4 ft in length.

Why must extra caution be taken when inserting a feeding tube with a stylet?

There is a risk of tissue puncture or placement error.

Moss feeding tube

Triple-lumen NG tube that also has a duodenal lumen for postoperative feedings.

The nurse is caring for a patient who has dumping syndrome from high-carbohydrate foods being administered over a period of less than 20 min. What is a nursing measure to prevent or minimize the dumping syndrome? a. Administer the feeding at a warm temperature to decrease peristalsis. b. Administer the feeding by bolus to prevent continuous intestinal distention. c. Administer the feeding with 100 mL of fluid to dilute the high-carbohydrate concentration. d. Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity.

d. Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity.

The nurse is inserting a nasoenteric tube for a patient with paralytic ileus. How long does the nurse anticipate the tube will be required? (Select all that apply.) a. Until bowel sounds present b. Until flatus is passed c. Until peristalsis resumes d. Until the patient stops vomiting e. Until the tube comes out on its own

a, b, c a. Until bowel sounds present b. Until flatus is passed c. Until peristalsis resumes

The physician ordered a nasoenteric feeding tube with a tungsten-weighted tip. The nurse knows to obtain what kind of tube? a. Dobbhoff b. Levin c. Salem d. Sengstaken-Blakemore

a. Dobbhoff

The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly? a. Maintain intermittent or continuous suction at a rate greater than 120 mm Hg. b. Keep the vent lumen above the patient's waist to prevent gastric content reflux. c. Irrigate only through the vent lumen. d. Tape the tube to the head of the bed to avoid dislodgement.

b. Keep the vent lumen above the patient's waist to prevent gastric content reflux.

The nurse is caring for a patient who has a gastrostomy tube feeding. Upon initiating her care, the nurse aspirates the gastrostomy tube for gastric residual volume (GRV) and obtains 200 mL. What is the priority action by the nurse? a. Discontinue the infusion. b. Place the patient in a Fowler's position with the head of the bed at 45 degrees. c. Remove the aspirated fluid and do not reinstill. d. Dilute the gastric tube feeding solution with water and continue the feeding.

b. Place the patient in a Fowler's position with the head of the bed at 45 degrees.

The nurse is inserting an NG tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? a. Spray the oropharynx with an anesthetic spray. b. Have the patient maintain a backward tilt head position. c. Allow the patient to sip water as the tube is being inserted. d. Have the patient eat a cracker a the tube is being inserted.

c. Allow the patient to sip water as the tube is being inserted.

The nurse inserts an NG tube into the right nares of a patient. When testing the tube for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs? a. 1 b. 2 c. 4 d. 6

d. 6

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed? a. When the residual is about 50 mL b. When the residual is between 50 and 80 mL c. When the residual is about 100 mL d. When the residual is greater than 200 mL

d. When the residual is greater than 200 mL

Prokinetic agents can be administered to facilitate _____ movement of the feeding tube into the duodenum.

peristaltic