Chapter 45: Digestive and Gastrointestinal Treatment Modalities

A patient is receiving a continuous tube feeding via an open delivery system. The patient is to receive 480 mL in 24 hours. The maximum amount of formula in the bag should not exceed which amount? 50 mL 80 mL 120 mL 240 mL

Correct response: 80 mL Explanation: When using an open delivery system, bacterial contamination is possible. Therefore, the amount of feeding formula in the bag should never exceed what should be infused in a 4-hour period. In this case that amount would be 80 mL. (480 mL divided by 24 hours equals 20 mL per hour. 20 mL times 4 hours equals 80 mL.)

The nurse is caring for a patient who has dumping syndrome from high carbohydrate foods being administered over a period of less than 20 minutes. 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 about 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.

Correct response: Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity. Explanation: The following strategies may help prevent some of the uncomfortable signs and symptoms of dumping syndrome related to tube feeding: Slow the formula instillation rate to provide time for carbohydrates and electrolytes to be diluted. Administer feedings at room temperature, because temperature extremes stimulate peristalsis. Administer feeding by continuous drip (if tolerated) rather than by bolus, to prevent sudden distention of the intestine. Advise the patient to remain in semi-Fowler's position for 1 hour after the feeding; this position prolongs intestinal transit time by decreasing the effect of gravity. Instill the minimal amount of water needed to flush the tubing before and after a feeding, because fluid given with a feeding increases intestinal transit time.

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.

Correct response: Assess patency of the NG tube. Explanation: When an NG tube is no longer patent, stomach contents collect in the stomach, giving the client a sensation of fullness. The nurse should begin by assessing patency of the NG tube. The nurse can measure abdominal girth, auscultate bowels, and assess vital signs, but she should check NG tube patency first to help relieve the client's discomfort.

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome? Dry skin Slowed heart beat Diarrhea Hyperglycemia

Correct response: Diarrhea Explanation: Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when they begin to take solid food. This syndrome produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea, which result from the rapid emptying (dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food) into the jejunum. This concentrated solution in the gut draws fluid from the circulating blood into the intestine, causing hypovolemia. The drop in blood pressure can produce syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn causes hypoglycemia.

The nurse is attempting to unclog a patient's feeding tube. Attempts with warm water agitation and milking the tube have been unsuccessful. The nurse uses evidence-based practice principles when she then uses which of the following to unclog the tube? Digestive enzymes and sodium bicarbonate Cola mixed with cranberry juice Alka Seltzer mixed with water Meat tenderizer diluted with saline

Correct response: Digestive enzymes and sodium bicarbonate Explanation: The nurse should attempt to unclog the tube with digestive enzymes activated with sodium bicarbonate. Although historically both cranberry juice and cola have sometimes been used to unclog feeding tubes, evidence has shown that their acidic nature worsens the clog by causing precipitation of proteins. Meat tenderize diluted with saline is not applicable.

Rebound hypoglycemia is a complication of parental nutrition caused by which of the following? Glucose intolerance Fluid infusing rapidly Feedings stopped too abruptly Cap missing from the port

Correct response: Feedings stopped too abruptly Explanation: Rebound hypoglycemia occurs when the feedings are stopped too abruptly. Hyperglycemia is caused by glucose intolerance. Fluid overload is caused by fluids infusing too rapidly. Air embolism can occur from a missing cap on a port.

The nurse is to discontinue a nasogastric tube that had been used for decompression. The first thing the nurse does is 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.

Correct response: Flush with 10 mL of water. Explanation: Before a nasogastric tube is removed, the nurse flushes the tube with 10 mL of water or normal saline to ensure that the tube is free of debris and away from the gastric tissue. The tape keeps the tube in the correct position while flushing is occurring and is then removed from the nose. The nurse then withdraws the tube gently for 6 to 8 inches until the tip reaches the esophagus, and then the remainder of the tube is withdrawn rapidly from the nostril. After the tube is removed, the nurse provides oral hygiene.

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.

Correct response: Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration. Explanation: Gastrostomy is preferred over NG feedings in the patient who is comatose because the gastroesophageal sphincter remains intact. Regurgitation and aspiration are less likely to occur with a gastrostomy than with NG feedings.

Hickman and Groshong are examples of which type of central venous access devices? Implanted ports Tunneled central catheters Peripherally inserted central catheters (PICC) Nontunneled central catheter

Correct response: Tunneled central catheters Explanation: Hickman and Groshong catheters are examples of tunneled central catheters. MediPort is an implanted port. A percutaneous subclavian Arrow is an example of a nontunneled central catheter. A PICC line is used for intermediate-term IV therapy for hospital, long-term care, or the home setting.

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

Correct response: diaphoresis, vomiting, and diarrhea. Explanation: The nurse must monitor for diaphoresis, vomiting, and diarrhea because these signs suggest an intolerance to the ordered enteral feeding solution. Other signs and symptoms of feeding intolerance include abdominal cramps, nausea, aspiration, and glycosuria. Electrolyte disturbances, constipation, dehydration, and hypercapnia are complications of enteral feedings, not signs of intolerance. Hyperglycemia, not hypoglycemia, is a potential complication of enteral feedings