GI Tubes & Testing

The management of the client's gastrostomy is an assessment priority for the home care nurse. What statement would indicate that the client is managing the tube correctly? "I clean my stoma twice a day with alcohol." "The only time I flush my tube is when I'm putting in medications." "I flush my tube with water before and after each of my medications." "I try to stay still most of the time to avoid dislodging my tube."

"I flush my tube with water before and after each of my medications."

What are the contraindications

- Basilar skull fractures - Maxillofacial surgery (Including transsphenoidal approaches) - Facial trauma - Uncontrolled coagulation abnormalities

What are some examples for reasons you would do parenteral feedings?

- Burns - sepsis - Cancer - Crohns disease - Paralytic ileus - Psychiatric disorders (Anorexia or schizophrenia) - Bowel surgery

What are some ways to give a parenteral feeding?

- CVAD - PICC - Tunneled central catheter - Imported vascular ports

What are the 6 purposes of GI intubation?

- Decompress the stomach - Lavage the stomach (Wash out stuff) - Dx GI disorders - Administer meds and feedings - Compress bleeding - Aspirate contents for analysis

What three things does formula and feeding depend on?

- Dietary and caloric needs - Tube type and placement - Patients tolerance

What are the s/s if dumping syndrome a few hours after eating?

- Flushing - Sweating - Dizziness - Weakness - Tachycardia

What are the five goals of parenteral feedings?

- Improve nutritional status - establish a positive nitrogen balance - Maintain muscle mass - promote weight maintenance or gain - Enhance the healing process

What are the three reasons you would do parenteral vs enteral feeding?

- Inability to digest adequate oral food or fluids within a 7-10 dat timeframe. - Patient unwilling or unable to ingest adequate nutrients orally or enterally - Prolonged preoperative and postoperative nutritional needs

What are the s/s of dumping syndrome about 10-30 minutes after eating?

- N/V/D - Bloated/cramping - Flushing - tachycardia

What are some patient identifiers for PN?

- Nutritional status has decreased oral intake for more than a week - Weight loss 10% or more of usual weight - Muscle wasting, decrease tissue healing - Persistant N/V

What are some complications of parenteral feedings?

- Pneumothorax/air embolism - Clotted catheter - CLABSI - Sepsis - Hyperglycemia - Rebound hypoglycemia - Fluid overload

What are the indications for enteral feeding

- Short term feeding - Able to receive and process nutrition, fluids, and meds by gastric route - Have gastric motility

What are some complicaitons of PEG tubes and J tubes?

- Wound infections - Leakage - GI bleeding - Premature dislodgment of tube

About what is the rate of a basal or continuous feeding?

30/40 mL/Hr

How do you assess the residual contents with an enteral feeding tube? And what should the findings be?

Aspirate content with large syringe before bolus feeding. If around 50 ml then its ok to continue with the feeding. If it is 200 ml after 3-4 hrs notify provider. Return residual back to stomach.

A client who underwent abdominal surgery and has a nasogastric (NG) tube in place begins to complain of abdominal pain that he describes as "feeling full and uncomfortable." Which assessment should the nurse perform first? Measure abdominal girth. Auscultate bowel sounds. Assess patency of the NG tube. Assess vital signs.

Assess patency of the NG tube.

During a colonoscopy with moderate sedation, the patient groans with obvious discomfort and begins bleeding from the rectum. The patient is diaphoretic and has an increase in abdominal girth from distention. What complication of this procedure is the nurse aware may be occurring? Infection Bowel perforation Colonic polyp Rectal fissure

Bowel perforation

What is something that can go wrong with a continuous suction when suctioning the stomach?

Can attach to the stomach wall (Ulcer)

What is the contraindication for enteral feedings?

Can tolerate enteral feedings

Why is intermittent suction the best choice?

Chance for the tube to float away from the stomach lining not creating an ulcer.

The nurse is caring for a group of clients. Which client(s) would be a candidate for total parenteral nutrition (TPN)? Select all that apply. Child with short bowel syndrome Young adult with gastroenteritis Middle-aged man with acute pancreatitis Woman with superficial burns Man with two-thirds of his colon removed

Child with short bowel syndrome Middle-aged man with acute pancreatitis Man with two-thirds of his colon removed

The nurse is caring for a client who requires enteral nutrition. For which reasons will the nurse anticipate the client having a gastrostomy tube inserted? Select all that apply. Client is comatose History of diverticulosis Hyperactive bowel sounds Frequent bouts of constipation Enteral support needed for over 6 weeks

Client is comatose Enteral support needed for over 6 weeks

A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure? Colonoscopy Barium enema ERCP Upper gastrointestinal fibroscopy

Colonoscopy

A client's new onset of dysphagia has required insertion of a nasogastric (NG) tube for feeding. What intervention should the nurse include in the client's plan of care? Confirm placement of the tube prior to each medication administration. Have the client sip cool water to stimulate saliva production. Keep the client in a low Fowler position when at rest. Connect the tube to continuous wall suction when not in use.

Confirm placement of the tube prior to each medication administration.

What is a kangaroo pump?

Delivers food at a set rate (Continuous or bolus)

The nurse is scheduling a client for a gastrointestinal motility study. The nurse knows that this type of diagnostic test will aid in determine which of the following alterations? Esophageal varices Dumping syndrome Diabetic gastroparesis Duodenal disease Disorders of gastric motility

Dumping syndrome Diabetic gastroparesis Disorders of gastric motility

How often are the pumps changed out during feedings?

Every 24 hrs because they can grow bacteria

When assessing placement of a enteral tube first you check by what and then every time after that how do you check the placement?

First check with an X-ray, after that check with the length of tube and markings documented.

The nurse teaches a client scheduled for a colonoscopy. Which instruction should be included as part of the preparation for the procedure? Consume at least 3 quarts of water 30 minutes before the test. Do not void for at least 30 minutes before the test. Follow the dietary and fluid restrictions and bowel preparation procedures. Spray or gargle with a local anesthetic.

Follow the dietary and fluid restrictions and bowel preparation procedures.

What is dumping syndrome?

Food moving too fast through the small bowel

What di the colors mean on a suction regulator?

Green = low Yellow = moderate Orange = High Red = Super high

What is the blue part of a salem sump tube used for?

Helps keep tube funcitonable and get rid of extra air out of the pts stomach.

Why are central line feedings used?

Highly concentrated hypertonic, which is distilled in the bloodstream quickly, and then the formula becomes isotonic when distilled.

What do periodic flushes help with?

Hydration of the patient and are due to the formulas being very concentrated.

Which type of feedings have a risk of causing dehydration

Hypertonic

A client has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurse's priority intervention? Administration of antiemetics Insertion of a nasogastric (NG) tube for decompression Infusion of hypotonic IV solution Administration of proton pump inhibitors as prescribed

Insertion of a nasogastric (NG) tube for decompression

What does enteral mean?

Into the stomach

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? Maintain intermittent or continuous suction at a rate greater than 120 mm Hg. Keep the vent lumen above the patient's waist to prevent gastric content reflux. Irrigate only through the vent lumen. Tape the tube to the head of the bed to avoid dislodgement.

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

What assessment do you have to do before administering medication via tube?

Listen for bowel sounds so you know that the med will be absorbed.

he nurse is managing the care of a client needing gastrointestinal suction and decompression with a Levin tube. Place the steps of initiating suction and decompression in the order the nurse should perform them. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 Locate the suction source. 2 Select suction according to health care provider prescription. 3 Insert the gastric decompression tube. 4 Connect the decompression tube to the suction.

Locate the suction source. Select suction according to health care provider prescription. Insert the gastric decompression tube. Connect the decompression tube to the suction.

Is a PEG tube more short term or long term

Long

What are PEG and J tubes used for and what is a pro to these v.s. NG tubes?

Long term use and reduced risk of aspiration

A client with a recent history of rectal bleeding is being prepared for a colonoscopy. Initially, how should the nurse position the client for this test? Lying on the right side with legs straight Lying on the left side with knees bent Prone with the torso elevated Bent over with hands touching the floor

Lying on the left side with knees bent

What is enteral feeding and how long is it used?

Orally or nasally placed feeding for short term use

How do you insert a NG tube?

Pt hyperextends their neck, insert, then tilt head forward and ask pt to swallow as inserting it further, keep HOB elevated.

What is a side effect of central line feedings you have to watch for?

Rebound hypoglycemia

A nursing instructor is preparing a class about gastrointestinal intubation. Which of the following would the instructor include as reason for this procedure? Select all that apply. Remove gas and fluids from the stomach Diagnose gastrointestinal motility disorders Flush ingested toxins from the stomach Evaluate for masses in the large colon Administer nutritional substances

Remove gas and fluids from the stomach Diagnose gastrointestinal motility disorders Flush ingested toxins from the stomach Administer nutritional substances

What is the process of using a NG tube for med admin?

See if med is able to be crushed, crush meds, mix with fluid, and flush tube.

When is peripheral line feeding used and why is this not the best form of parenteral feeding?

Short term feeding (5-7 days) - Formula has to be less than 10% dextrose to not irritate the veins but this is not enough dextrose to be a sufficient source of nutrition

How do you tx dumping syndrome?

Slow down feeding or include fluids

If feeding bolus gastrostomy by gravity how do you get it to speed up and how do you get it to slow down?

Speed up = Raise above stomach Slow down = Lower tube below stomach

What fluid do you use to irrogate a tube of a immunocompromised pt?

Sterile water

How is a PEG tube inserted?

Surgically

What is a PEG tube?

Tube that bypasses the throat and pt is fed directly into stomach

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

Until bowel sound is present Until flatus is passed Until peristalsis is resumed

What are connectors for on a suciton?

Used to redirect the suciton

When would you slow down a bolus tube feeding?

When the pt complains of nausea and cramping.

What is a consideration you have to be aware of with central line feedings?

You have to decrease the or wean them off the central line feedings because the body gets used to the amount of dextrose on those feedings.

When do you flush a feeding tube?

before administration, between each medication

What is a salem sump tube?

double lumen of NG tube used to decompress the stomach and is the most frequently used.

What is parenteral feeding?

feeding into the vein

What is another reason that peripheral feedings are not the best besides the dextrose and what is a way this combated?

its to hypertonic so lipids are also simultaneously to buffer the vein.

are NG tubes short term or long term?

short term (Few days or weeks)

How do you measure a NG tube?

tip of nose to earlobe to xiphoid process (Can go up to 15 cm linger than that but not shorter)

What type of fluid do you use to irrigate a tube?

water, can be tap water.