ch 34 ng tube

The nurse is caring for a patient who is receiving continuous tube feedings. What must the nurse do to care for this patient? a. Verify tube position every 4 to 6 hours. b. Obtain a radiograph every 4 to 12 hours. c. Instill air into the stomach via the tube and listen for bubbles. d. Do not worry about tube placement because the tube has already been determined to be in the right place.

ANS: A After initial radio graphic verification that a tube is positioned in the desired site (either the stomach or the small intestine), the nurse is responsible for ensuring that the tube has remained in the intended position before administering formula or medications through the tube.

The nurse is checking gastric residual on a patient who has a continuously running tube feeding. She finds that the patient has a 600-mL residual volume. How should the nurse respond? a. Stop the tube feeding. b. Slow the tube feeding. c. Continue the tube feeding at the same rate. d. Increase the rate of the tube feeding.

ANS: A Tube feedings are stopped if the patient has high gastric residual (more than 500 mL).

What is an appropriate amount of nasogastric irrigant for an adult patient? a. 1 or 2 mL b. 30 mL c. 5 to 15 mL d. 250 mL

ANS: B Draw up 30 mL of normal saline or tap water in a syringe. This amount of solution will flush the length of the tube.

Which technique is appropriate for the nurse to implement during nasogastric (NG) tube insertion? a. Use sterile gloves. b. Have the patient mouth-breathe. c. Advance the tube quickly when the patient coughs. d. Bend the patient's head backward after the tube is through the nasopharynx.

ANS: B Emphasize the need to mouth-breathe and swallow during the procedure.

Which technique is appropriate for providing intermittent tube feeding once placement of the tube has been checked? a. Cooling the formula b. Lowering the head of the bed c. Allowing the bag to empty gradually over 30 to 45 minutes d. Adding food coloring to detect aspiration

ANS: C Allow the bag to empty gradually over 30 to 45 minutes.

Of the patients listed below, which would be a candidate for nasoenteric feeding tube placement? a. Post-motor vehicle accident victim with a broken nose and jaw b. Patient with a bleeding ulcer and possible esophageal varices c. Elderly patient with a diagnosis of failure to thrive and an inability to chew d. Patient with an esophageal tumor

ANS: C Enteral nutrition, commonly called tube feeding, is the administration of nutrients through the gastrointestinal tract when a patient cannot ingest, chew, or swallow, but can digest and absorb nutrients. Nasoenteric tubes are contraindicated in patients with facial trauma, prolonged bleeding, and upper gastrointestinal (GI) blockage (as is seen in cases of solid cancer).

The nurse is checking the residual volume on a patient who is getting intermittent tube feedings via his NG tube. Which of the following may indicate that the patient has started to bleed again? a. The nurse obtains brown aspirate. b. The nurse notices that the abdomen is distended. c. The nurse obtains red aspirate. d. The nurse notices severe respiratory distress.

ANS: C Red or brown coloring (coffee-grounds appearance) of fluid aspirated from a feeding tube indicates new blood or old blood, respectively, in the gastrointestinal tract

The nurse has inserted a nasogastric (NG) feeding tube. The feeding tube has a stylet in place to aid insertion. What should the nurse do once the tube is in place? a. Remove the stylet immediately. b. Reinsert the stylet if the radiograph determines incorrect placement. c. Fasten the end of the NG tube to the patient's gown using tape and a safety pin. d. Leave the stylet in place and obtain a chest/abdomen radiograph.

ANS: D Leave the stylet in place (if used) until correct position has been verified by x-ray film.

The nurse would anticipate the need for an enteral access device in which of the following patients? a. Patient whose bowel sounds have not yet returned after abdominal surgery b. Patient who recently suffered a cerebrovascular accident (CVA) c. Patient who dislikes the taste of facility meals d. Patient who suffers from severe acute dysphagia

ANS: D A patient who is unable to swallow because of severe acute dysphagia will require an enteral access device to provide adequate nutrition.

The home health nurse evaluates the provision of intermittent tube feedings by the patient's family member. The nurse notes that additional teaching is required when she notices that the family member: a. keeps the formula refrigerated between feedings. b. keeps the feeding tube capped between feedings. c. begins the feeding before checking tube placement. d. irrigates the tube with 30 to 60 mL of water before and after feedings.

ANS: C For intermittent tube-fed patients, test placement immediately before each feeding and before each administration of medication.

Which evaluation indicates that placement of a nasogastric or enteric tube is correct? a. Nasointestinal aspirate with a pH of less than 6 b. Pleural fluid pH of less than 6 c. Gastric aspirate with a pH of 5 or less after patient fasting d. Gastric aspirate with a pH of 4 and continuous tube feedings

ANS: C Gastric fluid from a patient who has fasted for at least 4 hours usually has a pH of 5 or less.

The nurse is preparing to administer an enteral feeding for the patient. The patient has been on enteral feedings for 2 days. The nurse knows that the most appropriate technique for implementing enteral feeding is: a. weighing the patient weekly. b. measuring the gastric residual every hour. c. changing the formula every 12 hours in an open system. d. leaving the formula in place in an open system for up to 24 hours.

ANS: C Maximum hang time for formula is 12 hours in an open system, and 24 to 48 hours in a closed, ready-to-hang system (if it remains closed).

The nurse is caring for a patient with an enteral feeding tube in place. She assesses for pulmonary aspiration as the main complication related to feeding tubes. She is aware of other complications, including which of the following? (Select all that apply.) a. Infection b. Diarrhea c. Tube clogging d. Tube dislodgment

a. Infection b. Diarrhea c. Tube clogging d. Tube dislodgment

Conditions that increase the risk for spontaneous tube dislocation include which of the following? (Select all that apply.) a. Retching/vomiting b. Nasotracheal suction c. Coughing d. Cyanosis

a. Retching/vomiting b. Nasotracheal suction c. Coughing

A tube passed through the nose or mouth with the end terminating in the stomach or the small bowel, and used in feeding the patient for short periods is known as a _____________.

nasogastric feeding tube

Before insertion of a nasogastric (NG) tube, of which finding should the physician be notified? a. Patent nares b. Absent bowel sounds c. Evident gag reflex d. Impaired swallowing

ANS: B Absent bowel sounds may indicate decreased or absent peristalsis and increased risk for aspiration.

The nurse is initiating a continuous tube feeding for a patient who has a gastrostomy tube. Which of the following procedures indicates proper practice? a. Allow the container to empty gradually over 60 minutes. b. Change the bag every 24 hours. c. Do not use water to flush the tube. d. Quickly increase the rate of administration.

ANS: B Rinse the bag and tubing with warm water whenever feedings are interrupted. Use a new administration set every 24 hours. Allowing the container to empty over 30 to 45 minutes is the method used for intermittent administration of tube feedings.

An appropriate technique for nasogastric (NG) tube insertion is for the nurse to: a. position the patient supine. b. apply oil-based lubricant to the plastic tube. c. advance the tube while the patient swallows. d. measure the tube length from the nose to the sternum.

ANS: C Encourage the patient to swallow by giving small sips of water or ice chips.

The nurse has just inserted a nasogastric (NG) feeding tube into a patient. What should the nurse do to definitely ascertain that the tube is in the stomach or in the intestine? a. Test the pH of the contents. b. Use a carbon dioxide sensor. c. Lower the head of the bed to 15 degrees. d. Obtain an order for a chest radiograph.

ANS: D The most reliable method of feeding tube verification is a chest radiograph (chest x-ray). Gastric and intestinal pH measurements have been shown to differentiate tube placement, with the stomach having a lower pH than the intestines. This helps to ensure that the tube is beyond the pylorus, theoretically reducing the risk for aspiration. This method is helpful before and after radiological confirmation. Carbon dioxide sensors are helpful in determining tube placement between the stomach and the lung. A small plastic piece with an embedded yellow sensor is attached to the end of the feeding tube; the sensor changes color when carbon dioxide is present. Investigators have shown that this reduces the incidence of inadvertent pulmonary placement. This method is helpful before and after radiological confirmation. Elevation of the head of the bed to a minimum of 30 degrees is a simple method used to keep the risk for aspiration at a minimum. The nurse is instrumental in achieving this goal. This method does not ascertain placement but may be useful in preventing aspiration.

The nurse determines that a nasogastric (NG) tube needs irrigation when she: a. obtains more than 200 mL of residual volume. b. obtains a small amount of thin watery residual. c. does not encounter resistance when aspirating the residual. d. obtains a unusually thick secretions.

ANS: D Thick secretions indicate the need to irrigate the tube.

The nurse is caring for a patient with a nasogastric tube in place. What interventions would the nurse perform to reduce the risk of clogging the feeding tube? (Select all that apply.) a. Use the smallest barrel syringe possible to reduce the pressure in the tube. b. Mix medication with feedings to thoroughly dilute the medication. c. Flush the tube liberally with water before, between, and after each medication instillation. d. Use the largest barrel syringe possible to reduce the pressure in the tube. e. Crush solid medications thoroughly and mix them in water before administration.

C. Flush the tube liberally with water before, between, and after each medication instillation. D. Use the largest barrel syringe possible to reduce the pressure in the tube. E. Crush solid medications thoroughly and mix them in water before administration.

The nurse, physician, and dietitian collaborate to select an enteral feeding formula for the patient. Their decision should be based on which of the following? (Select all that apply.) a. Protein requirements of the patient b. Digestive ability of the patient c. Amount of lactose required d. The patient's disease process

a. Protein requirements of the patient b. Digestive ability of the patient

The nurse is caring for a patient in a chronic vegetative state with inadequate gastric emptying. The nurse would anticipate finding in a ________ tube placed to assist with this patient's nutritional needs.

jejunostomy