Ostomies, NGs, and tube feedings lab exam

A client has had a gastrostomy tube inserted. What does the nurse anticipate the initial fluid nourishment will be after the insertion of the gastrostomy tube? Distilled water at 60 mL/h Sterile water at 30 mL/h Formula feeding at 50 mL/h High-calorie liquids at 50 mL/h

Sterile water at 30 mL/h

What knowledge should guide the nurse when caring for a client with a new ileostomy? A. Expect the stoma to start draining 72 hours after surgery. B. Explain that the drainage can be controlled with daily irrigations. C. Anticipate that emotional stress can increase intestinal peristalsis. D. Be aware that bleeding from the stoma is a medical emergency.

C. Anticipate that emotional stress can increase intestinal peristalsis.

A client with pancreatitis has been receiving total parenteral nutrition (TPN) for the past week. Which nursing intervention helps determine if TPN is providing adequate nutrition? A. Accelerating the infusion if it falls behind schedule B. Ensuring that the TPN tubing has an in-line filter C. Monitoring the client's weight every day D. Recording fluid intake and output

C. Monitoring the client's weight every day

Peristomal skin

Skin around a stoma

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance? Press the adhesive faceplate from the stomal edge inward Ask the client to remain inactive for 5 minutes. Ensure that no air is trapped in the pouch Ensure that there are no holes in the pouch

Ask the client to remain inactive for 5 minutes.

A client has a nasogastric tube for continuous tube feeding. The nurse does all the following every shift to verify placement (select all options that apply): Compares exposed tube length with original measurement Visually assesses the color of the aspirate Checks the pH of the gastric contents Confirms the tip of the tube with radiology Inserts 30 mL of tap water through the nasogastric tube

Compares exposed tube length with original measurement Visually assesses the color of the aspirate Checks the pH of the gastric contents

4 indications for NG tubes

Decompression (removal of gases or stomach contents to relieve distention, N/V - usually with Bowel obstruction or ileus. Frequently post surgical patients.) Feeding (route of administering nutritional supplements when oral route contraindicated) Lavage (washing out of stomach to treat overdose or ingestion of poison) Compression: (applied pressure using an internal balloon to prevent hemorrhage) This is the Sengstaken Blakemore tube for esophageal varices. Don't confuse compression with decompression!

The nurse is to administer a cyclic feeding through a gastric tube. It is most important for the nurse to Check the residual volume before the feeding. Accurately assess the amount of fluid infused. Elevate the head of the bed to 45 degrees. Change the tube feeding container and tubing.

Elevate the head of the bed to 45 degrees.

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? Cutting the faceplate opening no more than 2? larger than the stoma Gently washing the area surrounding the stoma using a facecloth and mild soap Scrubbing fecal material from the skin surrounding the stoma Maintaining wrinkles in the faceplate so it doesn't irritate the skin

Gently washing the area surrounding the stoma using a facecloth and mild soap

A nurse is preparing to perform a dressing change to the site of a client's central venous catheter used for parenteral nutrition. Which equipment and supplies would the nurse need to gather? Select all that apply. Masks Clean gloves Skin antiseptic Alcohol wipes Sterile gauze pads Extension set tubing

Masks Skin antiseptic Alcohol wipes Sterile gauze pads

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

Irritation dermatitis

caused by ostomy effluent on the skin

Ostomy Adhesive Spray

easy-to-use, medical-grade silicone formulation that helps improve the adhesive contact between the skin and the skin barrier and/or tape. It helps to provide a secure seal.

The nurse is attempting to insert an NG tube and, as the tube is passing through the pharynx, the client begins to retch and gag. What nursing interventions are appropriate in this situation? Select all that apply. -Inspect the other nostril and attempt to pass the nasogastric tube down that nostril. -Ask the client if he needs to pause before continuing insertion. -Continue to advance tube when the client relates that he is ready. -Have the emesis basin nearby in case client begins to vomit. -Give small air boluses until gastric contents can be aspirated. -Insert a nasointestinal tube.

-Ask the client if he needs to pause before continuing insertion. -Continue to advance tube when the client relates that he is ready. -Have the emesis basin nearby in case client begins to vomit.

The nurse attempts to unclog a client's feeding tube. Attempts with warm water agitation and milking the tube are unsuccessful. The nurse uses evidence-based practice principles when subsequently using which technique to unclog the tube? A. digestive enzymes and sodium bicarbonate B. cola mixed with cranberry juice C. sodium bicarbonate mixed with water D. meat tenderizer diluted with saline

A. digestive enzymes and sodium bicarbonate

Stoma powder

•Only used on broken skin around the stoma •Not designed to prevent irritated skin, only to treat •Can use skin protectant over powder

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation? A. Dry skin thoroughly after washing B. Apply barrier powder C. Apply triamcinolone acetonide spray D. Dust with nystatin powder

A. Dry skin thoroughly after washing

Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the: A. Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration. B. Digestive process occurs more rapidly as a result of the feedings not having 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 regurgitation and aspiration.

The nurse cares for a client who receivies continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct? A. Monitoring the feeding closely. B. Increasing the feeding rate. C. Lowering the head of the bed. D. Flushing the feeding tube.

A. Monitoring the feeding closely.

Stomal retraction

Stoma retracts into the skin usually caused by: -tension of the intestines -obesity Most common in patients with ileostomies Has a concave, bow-shaped appearance causes a poor pouching surface, leading to frequent peristomal skin complications. Typical therapy is use of a convex pouching system and a stoma belt. If obtaining a pouch seal is a problem and the patient has recurrent peristomal skin problems from leakage, stoma revision should be considered

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). What actions would the nurse perform while the client receives PN? Select all that apply. Weigh the client every day. Check blood glucose level every 6 hours. Cover insertion site with a transparent dressing that is changed daily. Use clean technique for all catheter dressing changes. Document intake and output.

Weigh the client every day. Check blood glucose level every 6 hours. Document intake and output.

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, what must the nurse remain alert for? diaphoresis, vomiting, and diarrhea. manifestations of electrolyte disturbances. manifestations of hypoglycemia. constipation, dehydration, and hypercapnia.

diaphoresis, vomiting, and diarrhea.

A nurse is assessing a client receiving tube feedings and suspects dumping syndrome. What would lead the nurse to suspect this? Select all that apply. -Hypertension -Diarrhea -Decreased bowel sounds -Tachycardia -Diaphoresis

-Diarrhea -Tachycardia -Diaphoresis

stomal prolapse

Stoma is much longer Causes include: -large abdominal-wall openings -inadequate bowel fixation to the abdominal wall during surgery -increased abdominal pressure -lack of fascial support -obesity -pregnancy -poor muscle tone. Unless the patient complains of pain, has a circulatory problem, or has signs or symptoms of bowel obstruction, conservative treatment is used for uncomplicated stoma prolapse Can normally be reduced by having the patient lay in a supine position After reduction, applying a hernia support binder often helps. A prolapsed stoma may require a larger pouch to accommodate the larger stoma. Some clinicians use cold compresses and sprinkle table sugar on the stoma; the sugar provides osmotic therapy or causes a fluid shift across the stoma mucosa and reduces edema.

The nurse prepares to administer all of a client's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes which type of oral medication on the client's medication administration record? A. simple compressed tablets B. buccal or sublingual tablets C. enteric-coated tablets D. soft, gelatin capsules filled with liquid

C. enteric-coated tablets

The client is on a continuous tube feeding. The nurse determines the tube placement should be checked every A. shift. B. hour. C. 12 hours. D. 24 hours.

A. shift

A nurse is caring for a client receiving parenteral nutrition at home. The client was discharged from the acute care facility 4 days ago. What would the nurse include in the client's plan of care? Select all that apply. -Daily weights -Intake and output monitoring -Calorie counts for oral nutrients -Daily transparent dressing changes -Strict bedrest

-Daily weights -Intake and output monitoring -Calorie counts for oral nutrients

The nurse is educating a client with a new colostomy on how to regain bowel control. Which action would the nurse emphasize as a priority? A. an irrigation routine of the ostomy B. a soft, low-residue diet that will allow three formed bowel movements per day C. management of fluid intake to control the volume of bowel products D. selection of a high-protein diet

A. an irrigation routine of the ostomy

The nurse is preparing to administer an intermittent feeding to a client who has a feeding tube. The nurse is unable to aspirate gastric contents and realizes that the tube is clogged. Which action is correct? A. Connect a syringe filled with warm water to the feeding tube and flush it out using gentle pressure. B. Insert a stylet until resistance is felt, and then gently rotate the stylet until resistance decreases. C. Mix meat tenderizer with 30 mL of warm water, instill the mixture into the feeding tube, wait 15 minutes, and then flush vigorously. D. Advance the tube no more than 4 in (10 cm), auscultate for bowel sounds, and then attempt to aspirate again.

A. Connect a syringe filled with warm water to the feeding tube and flush it out using gentle pressure.

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 nasogastric (NG) feedings in the comatose patient? A. Gastroesophageal sphincter is intact, lessening the possibility of regurgitation. B. Digestive process occurs more rapidly because 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 regurgitation.

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and would make a recommendation when noticing which circumstance? A. No land line; cell phone available and taken by family member during working hours B. Water of low pressure that can be obtained through all faucets C. Little food in the working refrigerator D. Electricity that loses power, usually for short duration, during storms

A. No land line; cell phone available and taken by family member during working hours

A client had surgery for a bowel obstruction 4 days ago. The nurse assesses that the client has not passed any flatus, and there are no bowel sounds. Even though the abdomen has become more distended, the client feels little discomfort. In considering the plan of care, what is the most appropriate first step for the nurse to take? A. Obtain an order for nasogastric tube insertion. B. Order a clear liquid diet. C. Place the client in a side-lying position. D. Apply a warm compress to the abdomen.

A. Obtain an order for nasogastric tube insertion.

The nurse conducts discharge education for a client who is to go home with parenteral nutrition (PN). The nurse determines the client understands the education when the client indicates a sign and/or symptom of metabolic complications is A. loose, watery stools. B. increased urination. C. elevated blood pressure. D. decreased pulse rate.

A. loose, watery stools.

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. What is the best action by the nurse? A. Reinsert the nasogastric tube to the stomach. B. Notify the surgeon about the tube's removal. C. Place the nasogastric tube to the level of the esophagus. D. Document the discontinuation of the nasogastric tube.

B. Notify the surgeon about the tube's removal.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? A. Ensure adequate hydration with additional water. B. Provide frequent mouth care. C. Keep the feeding formula refrigerated. D. Flush the tube with water before adding the feedings.

B. Provide frequent mouth care.

What observation should the nurse instruct the client with an ileostomy to report immediately? A. passage of liquid stool from the stoma B. occasional presence of undigested food in the effluent C. absence of drainage from the ileostomy for 6 or more hours D. temperature of 99.8° F (37.7° C)

C. absence of drainage from the ileostomy for 6 or more hours

Care of gastric residual

If residual is greater than or equal to 250mL and less than or equal to 400 mL, return the residual, hold the tube feeding for 2 hours, and recheck. If after 2 hours of holding, the residual is less than 250mL, return residual and restart the tube feeding previous rate. If after 2 hours holding the residual is greater than or equal to 250 mL and less than 400 mL return the residual, continue to hold tube feeding, and NOTIFY PROVIDER. If residual is greater than 400mL discard residual, hold tube feeding, and NOTFY PROVDIER

The patient is concerned about leakage of gastric contents out of the gastric sump tube the nurse has just inserted. What would the nurse do to prevent reflux gastric contents from coming through the blue vent of a gastric sump tube? A. Prime the tubing with 20 mL of normal saline. B. Keep the vent lumen above the patient's stomach level. C. Maintain the patient in a high Fowler's position. D. Have the patient pin the tube to the thigh.

B. Keep the vent lumen above the patient's stomach level.

Bolus feeding

a feeding given into the stomach in large amounts and at designated intervals AKA intermittent practical and inexpensive options for the patient receiving tube feedings who resides at home or in a long-term care facility; however, they may be poorly tolerated in patients who are acutely ill

Verify correct NG placement

a) Advance tube until you reach the marked unit b) Patient should not be coughing, choking, or cyanotic (all indications that the tube is in the lungs, not in the stomach). If this happens, pull the tube back and reinsert if patient tolerates c) Check back of the mouth to make sure tube is not curled in posterior pharynx. d) If placing a decompression tube (Salem Sump, Levin). Aspirate contents to check color and test pH (should be green/clear; pH <5); NOTE: return contents to stomach. e) If placing a feeding tube with a guidewire stylet: MUST get a Chest and abdominal Xray (KUB) to confirm placement (MD order required for Xray, MD must read Xray and give confirmation of placement order).

Ostomy paste

aka paste barrier •Used to fill in uneven areas of skin to enable the ostomy wafer to be flush against Skin Ostomy paste is not an adhesive - it works like caulk Ostomy paste is actually not a paste at all. It is the consistency of paste but it is used more like a caulk than a glue or an adhesive. The caulk like paste is used to fill in uneven skin contours to help create a flatter surface. A flatter surface is important because the ostomy wafer will adhere better if it is completely flush against your abdomen. The ostomy wafer will not stay in place if there are gaps between the wafer and your skin. If there are gaps, the ostomy wafer can become dislodged completely or it can start to leak. Ostomy paste, like many ostomy supplies, is meant to increase the wear time of your ostomy system while protecting your skin from the stoma output. If your ostomy wafer is right against the skin it will adhere better which should improve wear time. Ostomy paste is not an adhesive but it does work like a caulk. The paste can be applied to the skin or to the wafer and you can place it where you need it. If you have dips or scars around your stoma that keep the wafer from being completely against the abdomen than ostomy paste is a great solution. Once applied, it helps to let the paste set up for a good minute or so to help cut down on the messiness of the paste

common complications and nursing implications of gastroenteral feedings

· Gastric residuals > 200 mL (hold feeding, notify MD, maintain semi-fowlers, and recheck in 1 hour) *EBP suggests that routinely checking residuals are contra indicated, only check residuals if patient is symptomatic (nausea, vomiting, distended abdomen) · Diarrhea > 3x in 24 hours (notify MD, confer with dietician, provide skin care) · Nausea or vomiting (hold feeding, notify MD, check tube patency, aspirate for residual, auscultate BS) · Aspiration of formula (hold, position on side, suction, O2, monitor VS, auscultate lungs, notify MD, chest x-ray) · Skin irritation around tube site (provide skin barrier, monitor tube placement) · Also: hypo and hyperglycemia

The nurse observes that the client's total parenteral nutrition (TPN) solution is infusing too slowly. The nurse calculates that the client has received 300 mL less than was prescribed for the day. The nurse should: A. increase the flow rate to infuse an additional 300 mL over the next hour. B. maintain the flow rate at the current rate and document any discrepancy in the chart. C. assess the infusion system, note the client's condition, and notify the health care provider. D. discontinue the solution and administer dextrose in 5% water until the infusion problem is resolved.

C. assess the infusion system, note the client's condition, and notify the health care provider.

The nurse is to discontinue a nasogastric tube that had been used for decompression. What is the first action the nurse should take? Remove the tape from the nose of the client. Withdraw the tube gently for 6 to 8 inches. Provide oral hygiene. Flush with 10 mL of water.

Flush with 10 mL of water.

A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate? "It is a vent that prevents backflow of the secretions." "It acts as a siphon, pulling secretions into the clear tubing." "It helps regulate the pressure on the suction machine." "It works as a marker to make sure that the tube stays in place."

"It is a vent that prevents backflow of the secretions."

Illeostomy Stomas

-Formed in the small intestine -They are high output ostomies (up to 1L a day) -the effluent is liquid to semi-liquid and has large amounts of digestive enzymes ---very irritating to peristomal skin -protruded well above the skin and are spout shaped.

Colostomy stomas

-formed in the large intestine. -They are low output ostomies (200-300 ml a day) - the effluent is semi-solid to solid. -usually only slightly protruded from the skin to even being flush with the Skin

The nurse administers a tube feeding to a client via the intermittent gravity drip method. The nurse should administer the feeding over at least which period of time? 15 minutes 30 minutes 60 minutes 80 minutes

30 minutes

A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use? 5-mL 10-mL 20-mL 30-mL

30-mL

A patient is receiving a continuous tube feeding. The nurse notes that the feeding tube was last irrigated at 2 p.m. The nurse would plan to irrigate the tube again at which time? 4 p.m. to 6 p.m. 6 p.m. to 8 p.m. 8 p.m. to 10 p.m. 10 p.m. to 12 a.m.

6 p.m. to 8 p.m.

A client with a feeding tube is to receive medication. The medication supplied is an enteric-coated tablet. Which of the following would be most appropriate? A. Check with the pharmacist to see of a liquid form is available. B. Dissolve the tablet in water after crushing it. C. Sprinkle the contents of the opened tablet into the tube. D. Give the tablet as is in its original state.

A. Check with the pharmacist to see of a liquid form is available.

A patient is receiving nasogastric tube feedings. The intake and output record for the past 24 hours reveals an intake of 3100 mL and an output of 2400 mL. The nurse identifies which nursing diagnosis as most likely? A. Excess fluid volume B. Risk for imbalanced nutrition, more than body requirements C. Deficient fluid volume D. Impaired urinary elimination

A. Excess fluid volume

The nurse collaborates with the physician and dietician to determine the best type of tube feeding for a client at risk for diarrhea due to hypertonic feeding solutions. Which type of feedings should the nurse suggest? A. continuous feedings B. intermittent feedings C. bolus feedings D. cyclic feedings

A. continuous feedings

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

Total parenteral nutrition (TPN) is prescribed for a client who has recently had a small and large bowel resection and who is currently not taking anything by mouth. What should the nurse do to safely administer the TPN? A. Administer TPN through a nasogastric or gastrostomy tube. B. Handle TPN using strict aseptic technique. C. Auscultate for bowel sounds prior to administering TPN. D. Designate a peripheral IV site for TPN administration.

B. Handle TPN using strict aseptic technique.

The primary source of microorganisms for catheter-related infections are the skin and the A. catheter tubing. B. catheter hub. C. IV fluid bag. D. IV tubing.

B. catheter hub.

The most significant complication related to continuous tube feedings is A. the interruption of GI integrity. B. a disturbance of intestinal and hepatic metabolism. C. the increased potential for aspiration. D. an interruption in fat metabolism and lipoprotein synthesis.

C. the increased potential for aspiration.

Types of drainage Bags

Closed Ended Bags •Replace when full •Typically used with Colostomies Drainable Bags •Faucet type •Chip clip type •Lock and Roll type

NG tubes confirmation of placement

Feeding tubes (Metal tip) •Xray (chest and abdomen KUB) •Ph Testing •Never Air "pseudoconfirmatory gurgling" Decompression Tubes •Xray if able (chest and abdomen KUB) •Ph Testing •Never Air "pseudoconfirmatory gurgling" Auscultation (NEVER EVER - here's why) Auscultation involves instilling air into the feeding tube with a syringe while using a stethoscope placed over the stomach to listen for rushing air. However, this method cannot differentiate between tube placement in the stomach or the lung/bronchial tree. For example, in one study, x-ray confirmation identified 16 instances where nasogastric tubes were not located in the stomach. However, in 15 of those instances, clinicians using the auscultation technique believed that those tubes were in the stomach. Also, the auscultation method cannot determine when a feeding tube ends in the esophagus (a condition that predisposes to aspiration). Misinterpretation of auscultation of air insufflation is known as pseudoconfirmatory gurgling. Radiographic Confirmation of Nasogastric Tube Placement (ALWAYS for feeding tubes, IF possible for decompression tubes) The gold standard for nasogastric feeding tube placement is radiographic confirmation with a chest x-ray. The gold standard for nasoenteric feeding tube placement is radiographic confirmation with chest and abdominal x-rays. While radiographs are the preferred method of confirmation for small bore feeding tubes (keofeeds, Dobhoffs) they are not always done when large, rigid nasogastric tubes are inserted (i.e Salem Sumps) pH Testing (ALWAYS! GOLD STANDARD) Another reliable method for ongoing tube placement verification is determining the pH of the fluid aspirated from feeding tubes. Gastric fluid is usually acidic, with a pH less than or equal to 5.5. Respiratory secretions are almost always alkaline, with a pH greater than or equal to 6. If the pH of the feeding tube aspirate is greater than or equal to 6, the tube may be inadvertently located in the respiratory tract pH testing be augmented by appearance of the aspirate to bring the accuracy closer to the gold standard, radiographic confirmation.

The health care provider orders the insertion of a single lumen nasogastric tube. When gathering the equipment for the insertion, what will the nurse select? Salem sump tube Miller-Abbott tube Sengsten-Blakemore tube Levin tube

Levin tube

Determining the proper length for an NG tube

N-E-X: Measure from the nose to the earlobe to the xiphoid process; note measurement with a piece of tape

A client is receiving continuous tube feedings at 75 mL/h. When the nurse checked the residual volume 4 hours ago, it was 250 mL, and now the residual volume is 325 mL. What is the priority action by the nurse? Discard the residual volume. Stop the continuous feeding. Decrease the rate to 40 mL/h. Notify the healthcare provider.

Notify the healthcare provider.

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

Place the client in a semi-Fowler's position with the head of the bed at 45 degrees.

A nurse is caring for a client who needs a nasogastric (NG) tube for a tube feeding. What is the safe method for the nurse to use to measure the appropriate length of the NG tube? A length of 50 cm (20 in) The distance measured from the nose to the xiphoid process The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process The distance measured from the tragus of the ear to the xiphoid process

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

Ostomy device types

Two piece: Wafer and Drainage bag separate ** Make sure bag attaches to flange securely! One piece: Wafer and Drainage bag is one piece **Be careful when cutting!

Sengstaken-Blakemore

Type of gastric tube that has 3 rubber lumens Two lumens are used to inflate the gastric and esophageal balloons, and one tube is reserved for suction or drainage.

Levin tube

Type of gastric tube that has a single lumen and is made of plastic or rubber Connected to low intermittent suction (LIM)(30-40mmHg) to avoid erosion or tearing of the stomach lining If accidentilly removed, it is replaced by the surgeon

Salem Sump

Type of gastric tube that is radiopaque, clear plastic, double-lumen the inner smaller lumen (blue port) vents the larger suction-drainage tube to the atmosphere -should be kept above the patients waist to prevent reflux of gastric contents through it -has a one-way antireflux valve in the blue pigtail can protect fragile gastric mucosa by maintaining a low (25mmHg) continuous force of suction at the drainage opening

Ways to create a better seal for ostomies

Use convex flange/wafer to enable the stoma to protrude more Consider abdominal support belts or girdles to keep the appliance in place Avoid heavy lifting and heavy work to prevent herniation (older people have weaker rectus abdominal muscles = high risk for herniation) Recommend exercise to strengthen abdominal muscles. Educate the patient about weight reduction to achieve a body mass index of 20-25. Re-Evaluate the ostomy appliance system for the size and fit to the stoma - to minimize skin exposure to effluent and irritant dermatitis Trial a two-piece system so the pouch can be changed without removing the skin barrier Use skin barrier paste (Adapt) or wax strips to fill, or level skin creases and folds or at the areas that are concave under the appliance Consider skin barrier paste to caulk the edge of the skin around the stoma as a barrier to slow the process of erosion Consider liquid skin protectant to form a protective layer over the damaged skin. Sprinkle skin barrier powder onto the denuded (excoriated) area and apply a liquid to seal the powder. DIET in terms of electrolyte imbalances, not only BMI reduction.

Ostomy wafers

aka Skin Barriers, Faceplates or Flanges, moldable barrier when combined with a bag, the system is called an ostomy device or appliance Made of pliable adhesive material that can be cut or molded around the stoma •The ostomy wafer contains the round ring/coupling device (flange) that connects the ostomy bag to the wafer can be flat or convex -Convex wafers are for retracted stomas or stomas flush with belly

Barrier wipes, liquid, or spray

aka skin protectant Forms a breathable, transparent, non sting coating on the skin Protects intact, damaged or 'at-risk' skin from stomal output, + adhesive removal trauma •Can be used on excoriated or broken skin. Cavilon no sting barrier film is an alcohol-free liquid barrier film that forms a breathable, transparent, non sting coating on the skin. It is designed to protect intact, damaged or 'at-risk' skin from urine, feces, other body fluids, adhesive trauma and friction. Cavilon durable barrier cream provides unique, long-lasting protection from body fluids whilst moisturizing the skin and is recommended to prevent skin breakdown when used on intact skin. Cavilon skin care products have been updated with new, innovative packaging to help easily identify the right product for a specific need. The new packaging better promotes the recognition of the purple and blue themes; Purple for Protection of intact skin and Blue for use on sore, Broken skin.

Kangaroo Pump

continuous mechanical feeding infusion pump

Types of ostomy wafers

cut-to-fit moldable pre cut

The nurse recognizes that medium-length nasoenteric tubes are used for decompression. feeding. aspiration. emptying.

feeding

Lavage

flushing of the stomach with water or other fluids with a gastric tube to clear it

The nurse cares for a client who receives continuous parenteral nutrition (PN) through a Hickman catheter and notices that the client's solution has run out. No PN solution is currently available from the pharmacy. What should the nurse do? stop the infusion and flush the line hang normal saline with potassium hang 10% dextrose and water hang 5% dextrose and water

hang 10% dextrose and water

Stoma

has no sensory nerve endings and is insensitive to pain Appears red, moist, and shiny immediatly after surgery if healthy. A matured healthy stoma beefy red or pink, edematous, moist, and shiny. The skin around the stoma (peristomal skin) should be healthy Expected edema for first 6-8 weeks, the it usually shrinks down to about 1/3 of its inital size warrants close observation as pouching types and sizes may need to be changed during this time as the stoma shrinks

At the beginning of the shift, the nurse is assigned a client with an ascending colostomy. Which picture identifies the correct placement where the nurse will assess the stoma?

large intestine on the patients right side (ascending segment)

Excessive residual volume

more than 200mL when this occurs twice in a row, notify provider

Stomal stenosis

narrowing or constriction of the stoma or its lumen. This condition may occur at the skin or fascial level of the stoma. Causes include hyperplasia, adhesions, sepsis, radiation of the intestine before stoma surgery, local inflammation, hyperkeratosis, and surgical technique. Stoma stenosis frequently is associated with Crohn's disease. You may notice a reduction or other change in effluent output with both urinary and GI ostomies. With GI stoma stenosis, bowel obstruction frequently occurs; signs and symptoms are abdominal cramps, diarrhea, increased flatus, explosive stool, and narrow-caliber stool. The initial sign is increased flatus. Partial or complete bowel obstruction and stoma stenosis at the fascial level require surgical intervention.

High protein tube feeding

nutritionally complete, high protein, fiber containing tube feeding designed to help support surgical wounds, trauma, burns or pressure sores. Added vitamin A, C and zinc help aid in wound healing

Mucocutaneous seperation

occurs when the stoma separates from the skin at the junction between the skin and the intestine used to form the stoma. Causes are related to poor wound-healing capacity, such as malnutrition, steroid therapy, diabetes, infection, or radiation of the abdominal area. Tension or tautness of the suture line also can cause mucocutaneous separation. This complication usually arises early and can lead to other serious conditions, such as infection, peritonitis, and stomal stenosis. The area of the separation may completely surround the stoma (known as a circumferential separation), or the separation may affect only certain areas of the stoma/skin junction. The separation may be superficial or deep The first sign of mucocutaneous separation may be induration. Treat the separation as a wound, and apply wound-healing principles: Absorb drainage, reduce dead space, use the proper dressing, and promote wound healing. The proper dressing depends on wound depth and amount of wound drainage. Be sure to assess the wound, using the "clock method" to describe location; measure the wound area in centimeters; and describe the type of tissue in the wound bed. Be aware that slough may be present Treatment of the wound dictates how often the pouch is changed. A two-piece pouching system commonly is used to reduce the number of pouch changes. Cover the wound dressing with the pouching system unless the wound is infected. If infection is present, let the wound drain into the pouch and heal by secondary intention. Don't use a convex pouching system, because this may cause additional injury to the mucocutaneous junction.

Cyclic feeding

periodic infusion of feedings given over 8 to 18 hours

Continuous feeding

the delivery of feedings incrementally by a slow infusion over long periods. Slow drip feedings may reduce aspiration rates, distention, nausea, vomiting, and diarrhea in patients with poor gastric emptying or who are receiving hypertonic feeding solutions, as well as patients with severe reflux or altered mental status. This method may also be used to administer tube feedings into the small intestine. Enteral feeding pumps control the delivery rate of the formula. They allow for a constant flow rate and can infuse a viscous formula through a small-diameter feeding tube. However, they do not allow the patient as much flexibility as intermittent feedings. Portable lightweight enteral pumps are available for home use. In addition, feeding pumps have built-in alarms that signal when the bag is empty, the battery is low, or the tube is occluded. The patient and caregiver need to be aware of these alarms and know how to "troubleshoot" the pump.

Sengstaken Blakemore Tube

tubes for bleeding •For esophageal varices •Placed by GI docs •Tube is attached to traction or a football helmet •Patients must be in the ICU •Not used much anymore, cauterizing bleeding varices replaced the use of these tubes. •Patients also get a NG tube in addition to the Blake!

stoma necrosis

usually occurs within the first 5 postoperative days. The stoma appears discolored rather than red, moist, and shiny. Discoloration may be cyanotic, black, dark red, dusky bluish purple, or brown. The stoma mucosa may be hard and dry or flaccid. Also, the stoma has a foul odor. Associated complications may include stoma retraction, mucocutaneous separation, stoma stenosis, and peritonitis.

Indications for enteral nutrition

· Critical illness/ trauma · Neurological and muscular disorders (brain neoplasm, CVA, dementia, myopathy, Parkinson's disease) · GI disorders (enterocutaneous fistula, inflammatory bowel disease, mild pancreatitis) · Respiratory failure with prolonged intubation · Inadequate oral intake

recommended guidelines for administering medications via enteral feeding tube

· Establish drug and dose form suitability · Crush solid dosage forms · Open capsules · Dilute the medication · Flush the tube with 30 cc h2O · Don't mix medications (compatibility within the tube issue) · Don't push medications, administer via gravity · Administer separately (compatibility within the tube issue) · Flush 10-15 cc between medications · Final flush of 30 cc's. (Add flushes to I&O flowsheets) · Restart the feeding

Decompression and feeding tubes

•Gastrostomy (G-tube) •Gastrostomy Jejunostomy (G-J tube) •Naso Gastric (NG tube) •Naso Jejunal (NJ tube) •Jejunostomy (J tube) •Oro Gastric (OG tube) •PEG tubes •Gastric •Jejunal •Gastric Jejunal

Decompressing tubes

•Larger (12 - 18 Fr) •Placed as NG's ONLY •Used for decompression (hooked up to suction) •Lavage •Can be used for Feeding/Medications •Does not have a metal tip or stylet •Salem Sump (Double lumen) gastric Tube (Always Clear) •Levin is a single Lumen Gastric tube(Usually Red) • Salem sump gastric tubes are mostly used for decompression but can also be used for lavage. Their key feature is the double lumen. The blue port is open to atmospheric air so that it equalizes the pressure so when the tube is connected to suction, the distal end in the stomach does not get sucked up against the gastric mucosa. Therefore, the Salem sump can be connected to continuous suction, if desired. Levin Levin tube is a single lumen tube used mostly for decompression but can also is used for medication administration and possibly lavage. If it is used for decompression, only use intermittent suction otherwise the catheter tip adheres against the gastric wall and can cause problems (such as mucosal irritation). The Levin tubes in lab are clear plastic with a green end cap. Anti Reflux Valve •Prevents stomach contents from exiting the vent lumen when attached and maintained properly, preventing unnecessary patient gown and bedding changes and reducing the risk of exposure to potentially infections materials •Allows the vent lumen to neutralize the vacuum pressure in the stomach when the contents are fully evacuated

PEG tubes

•PERCUTANEOUS Tube •Surgically placed •Feeding and medications •Can use for decompression (usually to gravity) •Examples •G-Tubes (Gastric only) One port •GJ tubes (Gastric Jejunal) Two ports

feeding tubes

•Smaller •Can be placed as NG's or NJ's •Feeding and medications •NEVER to Suction •Has a metal tip and guide wire stylet •Examples: Keofeed's, Corflo's, Dobhoff's The feeding tubes, as the name implies, are used for feeding patients!! You only put things into feeding tubes- meaning feeding formula or medications. You can aspirate to check residual and/ or stomach contents but you would not use a feeding tube for any other indication (it would not be used for decompressions!!!!!). Feeding tubes are unique in that they have a radio-opaque distal tip; this means that the end inside the patient shows up clearly on x-ray. Feeding tubes have a stylet which is a rigid metal wire in the middle that helps to advance to tube easier. The stylet is removed after the tube is placed (and confirmed by Xray) and before you start using it.