NUR 3010: CH 44 DIGESTIVE AND GASTROINTESTINAL TREATMENT MODALITIES

A client is recovering from percutaneous endoscopic gastrostomy (PEG) tube placement. The nurse

Administers an initial bolus of 50 mL water

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to

Auscultate lung sounds every 4 hours.

Which tube is a nasoenteric feeding tube?

Dobbhoff

The nurse is to administer a cyclic feeding through a gastric tube. It is most important for the nurse to

Elevate the head of the bed to 45 degrees.

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. What is the best action by the nurse?

Notify the surgeon about the tube's removal.

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate?

Hang a solution of dextrose 10% and water until the new solution is available.

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?

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

When a central venous catheter dressing becomes moist or loose, what should a nurse do first?

Remove the dressing, clean the site, and apply a new dressing.

The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 cm beyond what length?

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

What is a central venous access device? (CVAD)

a device designed and use for administration of sterile fluids, nutritional formula, and medications into central veins

What is bolus feeding?

a feeding given into the stomach in large amounts and at designated intervals

What is percutaneous endoscopic gastrostomy? (PEG)

a feeding tube inserted endoscopically into the stomach

What is a stylet?

a stiff wire place in a catheter or other tube that allows the tube to maintain its shape during insertion

To maintain patency when is the tube irrigated during enteral feedings?

after every feeding and medication delivery, and every 4-6 hours during continuous feedings

What is lavage?

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

What is a total nutrient admixture? (TNA)

an admixture of lipid emulsions, proteins, carbs, electrolytes, vitamins, minerals, and water

What is intravenous fat emulsion?

an oil-in-water emulsion of oils, egg phospholipids, and glycerin

The primary source of microorganisms for catheter-related infections are the skin and the

catheter hub

Why do pulmonary complications sometimes occur from gastric intubation?

coughing and clearing of the pharynx are impaired

The nurse on an evidence-based practice council makes recommendations to ensure patency of nontunneled central venous lines. The nurse recommends that daily saline and diluted heparin flushes be used in which situation?

daily when not in use

To ensure patency of central venous line ports, diluted heparin flushes are used

daily when not in use

What are some reasons for GI intubation?

decompression, lavage to remove toxins or other materials, diagnostics, administer feedings, fluids or medications, to compress a bleeding site, or to aspirate GI contents for analysis

What are some possible causes of constipation?

dehydration, fiber free formula, opioids

What occurs as a result of dumping syndrome?

dehydration, hypotension, and tachycardia

What is a peripherally inserted central catheter? (PICC)

device inserted into a peripheral vein and designed and used for administration of sterile fluids, nutritional formulas, and medication into central veins

What are symptoms of fluid volume deficit?

dry skin and mucous membranes, decreased urinary output, lethargy, lightheadedness, hypotension, and tachycardia

What measures can be used to decrease the frequency of feeding regurgitation and aspiration?

feeding patients through tubes placed beyond the pylorus or using prokinetic agents like erythromycin or metoclopramide

Rebound hypoglycemia is a complication of parenteral nutrition caused by

feeding stopped too abruptly

What are the signs and symptoms of dumping syndrome?

feelings of fullness, nausea, cramping, dizziness, diaphoresis, and osmotic diarrhea

What can cause dumping syndrome?

if a concentrated solution of high osmolality enters the intestines is taken in quickly or in large amounts, water moves rapidly into the intestinal lumen from fluid surrounding the organs and the vascular compartment

When can the small intestines sometimes tolerate a high osmolality formula?

if it is started at a low hourly rate and advanced slowly

What is osmolality?

ionic concentration of fluid

Why is enteral feeding preferred over parenteral?

it maintains gut function and mucosal integrity, is associated with improved immune function and fewer complications

What are some possible causes of diarrhea?

malnutrition d/t decrease in absorption, medications, c diff, zinc deficiency, lactose intolerance, hypothyroidism, dumping syndrome, contamination of formula

What is parenteral nutrition?

nutritional feeding through the vein

What is enteral nutrition?

nutritional formula feedings infused through a tube directly into the GI tract

What is gastroparesis?

partial paralysis of the stomach that results in decreased gastric motility and emptying

What can cause malposition or dislodgement of the tube during enteral feedings?

patient movement, coughing, suctioning, or airway intubation

What is cyclic feeding?

periodic infusion of feedings given over 8-18 hours

What is dumping syndrome?

physiologic response to rapid emptying of gastric contents into the small intestine, manifested by nausea, weakness, sweating, palpitations, syncope, and possibly diarrhea

What is a Salem Sump?

radiopaque, double lumen gastric tube, the inner smaller lumen vents the larger suction-drainage tube to the atmosphere by means of opening at the distal end of the tube, connected to low continuous suction; blue vent lumen should be kept above the patient's waist or it will act as a siphon

What is decompression? (GI)

removal of gastric or intestinal contents to prevent gas and fluid distention

What is aspiration?

removal of substance by suction or inhalation of fluid or foods into the trachea and bronchial tree

What position should the patient be in during feedings?

semi- fowlers, HOB at least 30-45 degrees

What is a Levin tube?

single lumen, connected to low intermittent suction to avoid erosion or tearing of the stomach lining, if this tube becomes dislodged or removed too quickly typically the surgeon replaces it

What is radiopaque?

something that can be localized easily on an xray

What is the preferred site for parenteral nutrition?

superior vena cava bc it is a large high-flow vein that can rapidly dilute incoming nutrients when given a concentrated solution

What is a gastrostomy?

surgical creation of an opening into the stomach for the purpose of administering fluids, nutritional formulas, and medications OR for decompression and drainage of stomach contents

What is a lumen?

the channel within a tube or catheter

What is the overall goal of a nutritional formula?

to achieve positive nitrogen balance and weight maintenance or gain without producing discomfort or diarrhea