Exam 4 prep U (Chapter 45) Digestive and GI Treatment Modalities

A. Dobbhoff

1. The Physician ordered an nasoenteric tube with a Tungsten weighted tip (do not facilitate migration of tube from stomach to intestine). The nurse knows to obtain what kind of tube? A. Dobbhoff B. Levin C. Salem D. Sengstaken Blakemore

X-ray confirmation- Radiologic identification of tube placement in the stomach is the most reliable method. Gastric fluid may be grassy green, brown, clear, or odorless, whereas an aspirate from the lungs may be off-white or tan. Hence, checking aspirate is not the best method of determining NG tube placement in the stomach. Gastric pH values are typically lower or more acidic than that of the intestinal or respiratory tract, but not always. Air auscultation is not a reliable method for determining NG tube placement in the stomach.

1.) A patient has just had a nasogastric (NG) tube inserted and the nurse is waiting for verification of placement of the tube prior to starting tube feedings. Which is the best method of verification the nurse should use for determining new NG tube placement? a. X-ray confirmation b. Observing gastric aspirate c. Air auscultation d. Gastric aspirate pH testing

A. Gastroesophageal sphincter is intact, lessening the possibility of regurgitation.

10. The nurse is caring for a comatose patient and administering Gastronomy feedings. What does the nurse understand is the reason that Gastronomy feedings are preferred to nasogastric feeding in the comatose patient? A. Gastroesophageal sphincter is intact, lessening the possibility of regurgitation. B. Digestive process occurs more rapidly because the feelings do not have to pass through the esophagus C. Feelings can be administered with the patient in the recumbent position D. The patient cannot experience the deprivational stress of not swallowing

Every shift- each nurse caring for the patient is responsible for verifying that the tube is located in the proper area for continuous feeding. Checking for placement each hour is unnecessary unless the patient is extremely restless or there is basis for rechecking the tube based on other patient activities. Checking for placement every 12 or 24 hours does not meet the standard of care due to the patient receiving continuous tube feedings.

10.) The patient is on a continuous tube feeding. How often should the tube placement be checked? a. Every hour b. Every 24 hours c. Every 12 hours d. Every shift

Acidic- the pH of gastric aspirate is acidic (1 to 5)

12.) The nurse is confirming placement of a patient's nasogastric (NG) tube using a combination of visual and pH assessment of the aspirate. The nurse determines that the NG tube remains properly placed when the pH of the aspirate is which of the following? a. Acidic b. Unmeasurable c. Neutral d. Alkaline

A. The tube is radiopaque

13. The nurse is inserting a sump tube in a patient with crohn's disease who is suspected of having a bowel obstruction. What does the nurse understand is the benefit of the gastric Salem sump tube in comparison to some of the other tubes? A. The tube is radiopaque B. The tube is shorter C. The tube is less expensive D. The tube can be connected to suction and others cannot

1 hour- The semi-Fowler's position is necessary for an NG feeding with the patient's head elevated at least 30 to 45 degrees to reduce the risk for reflux and pulmonary aspiration. This position is maintained for at least 1 hour after completion of an intermittent tube feeding and is maintained at all times for patients receiving continuous tube feedings.

13.) Semi-Fowler's position is maintained for at least which time frame following completion of an intermittent tube feeding? a. 30 minutes b. 90 minutes c. 1 hour d. 2 hours

Digestive enzymes and sodium bicarbonate- 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.

18.) 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? a. Cola mixed with cranberry juice b. Alka Seltzer mixed with water c. Meat tenderizer diluted with saline d. Digestive enzymes and sodium bicarbonate

A. In high Fowler's position

2. A nurse prepares a patient for insertion of a nasoenteric tube. What position should the nurse place the patient in? A. In high Fowler's position B. Flat in bed C. On his or her right side D. In semi Fowler's position with his or her head turned to the left

Place patient in semi-Fowler's position during, and 60 minutes after, an intermittent feeding- To minimize the risk of aspiration, it is important to place the patient in a semi-Fowler's position during, and 60 minutes after, an intermittent feeding because proper positioning prevents regurgitation. Checking tube placement and gastric residual prior to feedings is another important measure because it prevents improper infusion and vomiting. If aspiration is suspected, feeding should be stopped as cessation prevents further problems and allows for treatment of the immediate problem. Changing tube feeding container and tubing, monitoring weight daily, and administering 15 to 30 mL of water before and after medications and feedings are measures to maintain tube function.

2.) Tube feedings are given to a patient after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which of the following measures should the nurse include in the care plan to reduce the risk of aspiration? a. Avoid cessation of feedings b. Change tube feeding container and tubing c. Administer 15 to 30 mL of water before and after medications and feedings d. Place patient in semi-Fowler's position during, and 60 minutes after, an intermittent feeding.

Urinary output 20 mL/hr- The nurse should notify the physician when the patient has a urinary output of 20 mL/hr as this is a decreased urinary rate. Decreased urinary output, lethargy, lightheadedness, hypotension, and increased heart rate are signs and symptoms of fluid volume deficit. A heart rate of 100, BP of 118/72, and moist mucous membranes are findings that are within acceptable ranges/limits and do not indicate a fluid volume deficit.

22.) The nurse is monitoring a patient with nasoenteric intubation. The nurse contacts the physician when which of the following is noted? a. Moist mucous membranes b. Heart rate of 100 c. Urinary output 20 mL/hr d. Blood pressure 118/72

Respiratory rate of 30- The nurse determines that the patient may be having pulmonary complications when the respiratory rate is 30, indicating tachypnea. Other signs/symptoms of pulmonary complications include coughing during food or medication administration, difficulty clearing the airway, and fever.

23.) The nurse caring for a patient who is receiving feedings through a nasogastric (NG) tube is assessing the patient for signs and symptoms of pulmonary complications. The nurse determines that the patient may be experiencing pulmonary complications when which of the following is noted? a. Respiratory rate of 30 b. Blood pressure of 110/72 c. Temperature of 97˚F d. Pulse 88

30 minutes- Tube feedings administered via intermittent gravity drip should be administered over 30 minutes or longer.

24.) The nurse is administering a tube feeding to a patient via intermittent gravity drip method. The nurse should administer the feeding over at least which period of time? a. 60 minutes b. 15 minutes c. 80 minutes d. 30 minutes

Monitor the feeding closely- High residual volumes (>200 mL) should alert the nurse to monitor the patient more closely. Increasing the feeding rate will increase the residual volume. Lowering the head of the bed increases the patient's risk for aspiration.

25.) The nurse is caring for a patient who is receiving continuous enteral tube feedings who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. Which of the following is the correct action by the nurse? a. Increase the feeding rate b. Flush the feeding tube c. Lower the head of the bed d. Monitor the feeding closely

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

3. The nurse is inserting a Levin tube for a patient for gastric decompression. The tube should be inserted to 6 to 10 centimeters beyond what length? A. A length of 50 centimeters (20 inches) B. 8.2 equals the distance from the nose to the xiphoid process C. The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process D. The distance measured by measuring from the tragus of the ear to the xiphoid process

Continuous feedings- Continuous feedings should be administered to a patient who is at risk of diarrhea due to hypertonic feeding solutions. Bolus or intermittent feedings cause sudden distention of the small intestine, while cyclic feedings are not advised.

3.) The nurse is collaborating with the physician and dietician to determine the best type of tube feeding for a patient at risk for diarrhea due to hypertonic feeding solutions. Which of the following feedings should the nurse suggest? a. Bolus feeding b. Intermittent feeding c. Continuous feedings d. Cyclic feeding

D. 6

4. The nurse inserts a nasogastric tube into the right nares of a patient. When testing the tube aspirate for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs? A. 1 B. 2 C. 4 D. 6

Nontunneled central catheter- Nontunneled central catheters are used for short-term (less than 6 weeks) IV therapy in acute care settings. The subclavian area provides a stable insertion site to which the catheter can be anchored; it allows the patient freedom of movement and provides easy access to the dressing site. PICC lines may be used for intermediate terms (3 to 12 months). Tunneled central catheters are for long-term use and may remain in place for many years. Implanted ports are devices also used for long-term home IV therapy (Port-A-Cath, Mediport, Hickman Port, P.A.S. Port).

4.) The nurse is caring for a patient receiving parenteral (PN) nutrition. The nurse notes on the care plan that the catheter will need to be removed 6 weeks after insertion and notes that the patient's venous access device is which of the following? a. Tunneled central catheter b. Implanted port c. Peripherally inserted central catheter (PICC) d. Nontunneled central catheter

B. Keep the vent lumen above the patients waist to prevent gastric content reflux

5. The nurse is managing a gastric (Salem) sump tube for a patient who has intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly? A. Maintain intermittent or continuous suction at a rate greater than 120 mm Hg. B. Keep the vent lumen above the patients waist to prevent gastric content reflux C. Irrigate only through the vent lumen D. Tape the tube to the head of the bed to avoid dislodgement

Daily when not in use- Daily installation of normal saline and dilute heparin flush when a nontunneled central catheter is not in use will maintain the patency of the line. Normal saline and heparin flushes should be used after each time blood is drawn in order to prevent clotting of blood within the line.

5.) The nurse on an evidence-based practice council is making recommendations to ensure patency of nontunneled central venous lines. The nurse recommends that daily saline and diluted heparin flushes be used in which of the following situations? a. Daily when not in use b. When the line is discontinued c. With continuous infusions d. Before drawing blood

A. Until bowel sound is present B. Until flatulence is passed C. Until peristalsis is resumed

6. 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) A. Until bowel sound is present B. Until flatulence is passed C. Until peristalsis is resumed D. Until the patient stops vomiting E. Until the tube comes out on its own

Feeding- Placement of the tube must be verified prior to any feeding. A gastric sump and nasoenteric tube are used for gastrointestinal decompression. Nasoenteric tubes are used for feeding. Gastric sump tubes are used to decompress the stomach and keep it empty.

7.) For what are medium-length nasoenteric tubes used? a. Emptying b. Decompression c. Feeding d. Aspiration

D. When the residual is greater than 200 mL

8. The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed? A. When the residual is about 50 mL B. When the residual is between 50 and 80 mL C. when the residual is about 100 mL D. When the residual is greater than 200 mL

The potential for aspiration- Because the normal swallowing mechanism is bypassed, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the patient receiving continuous tube feedings. Tube feedings preserve GI integrity by intraluminal delivery of nutrients. Tube feedings preserve the normal sequence of intestinal and hepatic metabolism. Tube feedings maintain fat metabolism and lipoprotein synthesis.

8.) The nurse is teaching an unlicensed caregiver about bathing patients who are receiving tube feedings. Which of the following is the most significant complication related to continuous tube feedings? a. An interruption in fat metabolism and lipoprotein synthesis b. The interruption of GI integrity c. The potential for aspiration d. A disturbance in the sequence of intestinal and hepatic metabolism

D. Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity

9. 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 a 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

Dobbhoff or EnteraFlo

Single Lumen plastic, or rubber nasogastric tube about 4 foot in length

Moss

Triple Lumen nasogastric tube that also has a duodenal Lumen for post-operative feedings

Sengstaken- Blakemore

Triple Lumen, rubber nasogastric tube (2 lumens are used to inflate the gastric an esophageal balloons)

Hypoglycemia (He is tired)

headache is sweating tachy irritable restless excessive hunger dizziness

hyperglycemia

polyuria, polyphagia, polydespia (lead to dry skin, dec vision, drowsy, poor healing)

Dobbhoff- The Dobbhoff tube is a nasoenteric feeding tube. Nasogastric tubes include Levin, a gastric sump (Salem), and Sengstaken-Blakemore tubes.

11.) Which of the following is a nasoenteric feeding tube? a. Sengstaken-Blakemore b. Salem c. Levin d. Dobbhoff

B. Place the patient in a Fowler's position with the head of the bed at 45 degrees

12. The nurse is caring for a patient who has a Gastronomy tube feeding. Upon initiating her care, the nurses aspirates the Gastronomy tube for gastric residual volume (GRV) and obtains 200 mL of gastric contents. What is the priority action by the nurse? A. Discontinue the infusion B. Place the patient in a Fowler's position with the head of the bed at 45 degrees C. Remove the aspirated fluid and do not reinstall D. Dilute the gastric tube feeding solution with water and continue the feeding

C. Allow the patient to sip water as the tube is being inserted

14. The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? A. Spray the oropharynx with an anesthetic spray B. Have the patient maintain a backward tilt head position C. Allow the patient to sip water as the tube is being inserted D. Have the patient eat a cracker as the tube is being inserted

Tunneled central catheters- 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 the hospital, long-term care, or the home setting.

14.) Hickman and Groshong are examples of which type of central venous access device? a. Tunneled central catheters b. Peripherally inserted central catheters (PICC) c. Implanted ports d. Nontunneled central catheter

Catheter hub- The primary sources of microorganisms for catheter-related infections are the skin and the catheter hub. The catheter site is covered with an occlusive gauze dressing that is usually changed every other day.

17.) The primary source of microorganisms for catheter-related infections include the skin and which of the following? a. IV tubing b. Catheter hub c. Catheter tubing d. IV fluid bag

Every 48 hours- The nurse should include changing the central line dressing every 48 hours in the plan of care.

19.) The nurse is creating the care plan of a patient with a central line receiving parenteral nutrition (PN). How often should the nurse include changing the catheter (gauze-using sterile tech. )dressing in her plan? a. Every 48 hours b. Every 96 hours c. Every 72 hours d. Every 24 hours

Hang 10% dextrose and water- If the PN solution runs out and no PN is available, the nurse should hang 10% dextrose and water until the PN becomes available

20.) The nurse caring for a patient receiving continuous parenteral nutrition (PN) through a Hickman catheter notices that the patient's solution has run out. No PN solution is currently available from the pharmacy. What should the nurse do? a. Hang normal saline with potassium b. Hang 5% dextrose and water c. Hang 10% dextrose and water d. Stop the infusion and flush the line

B. The nurse has inadvertently inserted the tube into the trachea

15. The nurse is inserting a nasogastric tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred? A. The nurse has inserted a tube that is too large for the patient B. The nurse has inadvertently inserted the tube into the trachea C. This is a normal occurrence and the tube should be left in place D. The tube is most likely defective and should be immediately removed

Feedings stopped too abruptly- 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. An air embolism can occur from a cap missing on a port.

15.) Rebound hypoglycemia is a complication of parenteral nutrition caused by which of the following? a. Fluid infusing rapidly b. Feedings stopped too abruptly c. Cap missing from the port d. Glucose intolerance

Pneumothorax- A pneumothorax is caused by improper catheter placement and inadvertent puncture of the pleura. Air embolism can occur from a missing cap on a port. Sepsis can be caused by the separation of dressings. Fluid overload is caused by fluids infusing too rapidly.

16.) Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura? a. Fluid overload b. Sepsis c. Pneumothorax d. Air embolism

B. 10% glucose and tap water

11. A patient has had a Gastronomy tube inserted. What does the nurs e anticipate the initial fluid nourishment will be after the insertion of the Gastronomy tube? A. Distilled water B. 10% glucose and tap water C. Milk D. High-calorie liquids

Loose, watery stools- When the patient indicates that loose watery stools are a sign/symptom of metabolic complications, the nurse evaluates that the patient understands the teaching of metabolic complications. Signs and symptoms of metabolic complications from PN include neuropathies, mentation changes, diarrhea, nausea, skin changes, and decreased urine output.

21.) The nurse is conducting discharge education for a patient who is to go home with parenteral nutrition (PN). The nurses sees that the patient understands the education when the patient indicates which of the following is a sign and/or symptom of metabolic complications? a. Loose, watery stools b. Decreased pulse rate c. Elevated blood pressure d. Increased urination

Enteric-coated tablets- Enteric-coated tablets are meant to be digested in the intestinal tract and may be destroyed by stomach acids. A change in the form of medication is necessary for patients with tube feedings. Simple compressed tablets may be crushed and dissolved in water for patients receiving oral medications by feeding tube. Buccal or sublingual tablets are absorbed by mucous membranes and may be given as intended to the patient undergoing tube feedings. The nurse may make an opening in the capsule and squeeze out contents for administration.

6.) The nurse is preparing to administer all of a patient's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes on the patient's medication administration record which of the following types of oral medication? a. Simple compressed tablets b. Buccal or sublingual tablets c. Soft gelatin capsules filled with liquid d. Enteric-coated tablets

B. Fluid volume

7. 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 C. Mucous membrane irritation D. Pulmonary complications

Reassess the residual gastric content in 1 hour- If the gastric residual exceeds 100 mL for 2 hours in a row, the physician should be notified. One observation of a residual gastric content over 100 mL does not have to be reported to the physician. If the observation occurs two times in succession, the physician should be notified. If the amount of gastric residual exceeds 100 mL, the tube feeding should be withheld at the time, but not indefinitely.

9.) The nurse prepares to give a bolus tube feeding to the patient and determines that the residual gastric content is 150 mL. The priority nursing action is to do which of the following? a. Give the tube feeding b. Reassess the residual gastric content in 1 hour c. Withhold the tube feeding indefinitely d. Notify the physician