Ch. 29 Fundies, Ch. 54 ATI
A nurse is inserting a tube through the mouth of a client into the stomach to remove toxic substances that have been ingested by the client accidentally. What kind of tube is the nurse using to remove the toxic substance?
Orogastric
When the client with the NG tube for decompression indicates that he is very thirsty, which nursing intervention is most appropriate to add to the plan of care?
Provide crushed ice in sparse amounts
The most definitive technique for determining whether the distal end of the tube for gastric decompression is in the stomach is to:
Request a portable x-ray of the stomach
Purpose of Orogastric tube
Used in an emergency to remove toxic substances Diameter big enough to remove pill fragments and debris (drug overdose) Charcoal may be instilled to absorb poison Ewald tube; Lavage (stomach pumping)
verifying placement of NG tube
bedside ultrasonography x-ray fluid aspiration inspection ph testing abdominal auscultation
positioning
cause as little discomfort as possible preserve integrity of nasal tissue locate tube within the stomach
lumen
channel
troubleshooting ng tubes- the suction is inadequate
check that the pressure is 40-60 mmHg
NG position
client in semi-high fowlers with hyperextended neck
dumping syndrome
cluster of symptoms resulting from the rapid deposition of calorie-dense nourishment into the small intestine
cyclic feeding
continuous instillation of liquid nourishment for 8 to 12 hours
feeding schedules
continuous, bolus, intermittent
tamponade
controlling gastric bleeding with internal pressure via a tube
complications of tube feedings
diarrhea, aspiration, hyperglycemia
removal of NG tube
disconnect suction, remove tape securing the tube, withdraw tube 6-8 inches at 10 minute intervals (or in one swift motion), when the last 18 inches remain the tube is pulled gently from nose, provide nasal and oral care
A nurse is obtaining the NEX measurement of a client before inserting a tube in the stomach. Which body part should the nurse measure to make the first mark on the tube?
distance from the nose to the earlobe
high protein
double protein than standard formula
troubleshooting ng tubes- the drainage container is filled beyond capacity
empty and record the amount of drainage in the suction container
medication administration through enteral tubes
enteral nutrition is provided via stomach or small intestine rather than oral route formula type based on clients nutritional needs risk of dumping syndrome, especially for intestinal feedings NEVER crush enteric coated meds to put through tube
insertion of NG tube
establish hand signals, position client in semi-fowlers, hyperextend neck, lubricate tube, insert tube into nostril pointing the tip backward and downward, once tube is past nasal area and at the pharynx have the client tilt head forward and sip water during the remainder of insertion (1-2 in per swallow), if signs of stress begin pull tube back to first mark and reattempt once the patient has recovered, tape tube to nose when you have reached the mark, ask client to speak, obtain x-ray verification
The nurse is caring for a client who has had excessive diarrhea and now requires tube feeding. Which type of formula does the nurse anticipate will be ordered?
fiber containing
A client with dysphagia has been experiencing weakness and nausea after the introduction of enteral feedings. The care team recognizes that the client is likely experiencing dumping syndrome. Dumping syndrome results from which physiological process?
fluid shifts from circulation to the intestines
The nurse is placing a nasogastric tube when the client becomes short of breath, coughs, and has difficulty breathing. What is the priority nursing action?
stop placement and assess for signs of respiratory distress
troubleshooting ng tubes- the tubing is kinked or disconnected
straighten tubing or reconnect to the suction machine
ostomy
surgically created opening
A nurse is checking the placement of a nasogastric tube in a client. Which is the most accurate technique for checking tube placement?
testing the pH of aspirated liquid
Damage from NG tubes
tissue breakdown nasal and pharyngeal damage
percutaneous endoscopic gastrostomy (PEG) tube
transabdominal tube inserted into the stomach under endoscopic guidance
gastrostomy tube (G-tube)
transabdominal tube located in the stomach
jejunostomy tube (J-tube)
transabdominal tube that leads to the jejunum of the small intestine
patient teaching for Ng tubes
tube is smaller than the food they swallow explain the process of placing the tube and what their responsibilities are make sure to establish a means of communication explain that you will not force the tube and if they need to rest or catch their breath then they can assess LOC, weight, bowel sounds, distention, nasal, oral, swallow, gag, cough ability, N/V present, nasal patency
orogastric tube
tube that is inserted from the mouth into the stomach...Ewall
percutaneous endoscopic jejunostomy (PEJ) tube
tube that is passed through a PEG tube into the jejunum
nasogastric tube
tube that is placed in the nose and advanced to the stomach
intestinal decompression tube
tubes have several openings on distal portion helps remove large amounts of air continuous suction- must have salem sump vented tubing protects stomach mucosa by neutralizing the pressure in the stomach through the use of the atmospheric air connect to low pressure-usually 40-60 mmHg If drainage stops or the clients abdomen becomes distended, reposition the client. Repositioning can change the location of the tip of the suction catheter
transabdominal tubes
tubes placed through the abdominal wall PEG or PEJ
sump tubes
tubes that contain a double lumen
Troubleshooting NG tubes-drainage holes are adhering to the gastric mucosal wall
turn suction off momentarily. Change the client's position
A nurse is caring for a client whose nasogastric tube drainage holes are adhering to the gastric mucosal wall. Which interventions can solve the problem?
turn the suction off momentarily
gastric residual
volume of liquid remaining in the stomach
lavage
wash out; remove poisonous substances
NG tube measurement
NEX- Nose-earlobe-xyphoid process
The nurse is caring for a client with impaired swallowing who requires tube feeding. Which type of formula does the nurse anticipate will be ordered?
standard isotonic
The nurse is providing discharge teaching for a client who will continue to administer tube feedings at home. The client states, "I don't think I can do this." What is the appropriate nursing response?
"Perhaps we can contact a home health nurse to assist."
The nurse is flushing a client's feeding tube with 50 mL of water after giving medications through it. When the client asks, "Why are you doing that?" what is the appropriate nursing response?
"Water helps keep the feeding tube free from obstruction."
When a practical nurse assists with the insertion of a single lumen NG tube, which of the following instructions is correct when the tube is in the client's oropharynx?
"press your chin to your upper chest."
A nurse is caring for a client with a nasogastric tube. Which intervention should the nurse perform to reduce the risk for aspirating gastric fluid?
Ask the client to take a deep breath and hold it
A client has been receiving feeds for the past two weeks during recovery from a severe stroke. The care team has discussed the client's nutritional needs with the family and they have collectively decided to replace the client's nasogastric (NG) tube with a percutaneous endoscopic gastrostomy (PEG) tube. What advantage does a PEG tube hold over an NG tube?
A PEG tube can be used for longer-term feeding but an NG tube can only be used for shorter-term feeding
The nurse has assessed that a client's nasogastric tube is obstructed. What is the appropriate nursing action?
Contact the healthcare provider.
The nurse has assessed 100 mL of gastric residual after completing a tube feeding. What is the appropriate nursing action?
Document the assessment finding
gastric residuals
Done before each bolus/intermittent feeding and at specified intervals when receiving continuous feedings Gastric contents are aspirated into the large 60 mL syringe REINSTILL GASTRIC CONTENTS
After receiving a tube feeding, the patient becomes sweaty and has abdominal distention with diarrhea. The nurse assesses that this is because of:
Dumping syndrome
To determine the length for inserting an NG sump tube, the nurse is most correct in placing the distal tip of the tube at the client's nose and measuring the distance from there to the
Ear and then to the xiphoid process
A nurse is caring for a client with a gastrostomy tube. Which activity should the nurse perform?
Ensure that sutures holding the tube are intact
Purpose of transabdominal tube
GTube (PEG), JTube (PEJ) more than one month doesn't get messed up by gastric acid
Immediately after insertion of a transabdominal gastrostomy tube, which finding should the nurse consider normal when assessing the gastrostomy site?
Serosanguineous drainage
Tubal obstructions
flush with 30-60 mL of water before and after feeding, giving meds or re-administering residual (policy may vary) flush every 4 hours if receiving continuous feeding cranberry juice or carbonated beverages can be used as flush solutions if tube becomes obstructed, consult the physician - dr may give an order to flush with solution of meat tenderizer or pancreatic enzymes
standard (ionic) formula
for normal digestion and absorption
intermittent feeding
gradual instillation of liquid nourishment four to six times a day
Which of the following are expected normal characteristics of gastric contents?
green in color, clear in color, ph of 0-4
pseudoconfirmatory gurgling
gurgling sound made when air enters the esophagus or small intestine causing a misinterpretation of a gastric location of a tube's tip
troubleshooting ng tubes- tube is displaced above the esophageal sphincter
if the measured mark is not at the tip of the nose, remove the tape, advance the tube, check placement, and resecure
troubleshooting ng tubes- a solid particle or thick mucus obstructs the lumen
increase suction pressure momentarily, obtain and implement a medical order for an irrigation
nasointestinal tubes
inserted through the nose for distal placement below the stomach Dobb Hoff, keofeed (feeding), maxter (decompression)
orogastric intubation
insertion of a tube through the mouth into the stomach
nasogastric intubation
insertion of a tube through the nose into the stomach...lumen, salem sump
nasointestinal intubation
insertion of a tube through the nose to the intestine
troubleshooting ng tubes- the vent is acting as a siphon
instill a bolus of air into the vent to restore patency
bolus feeding
instillation of liquid nourishment four to six times a day in lesss than 30 minutes
continuous feeding
instillation of liquid nutrition without interruption
A client is receiving enteral nutrition via an unvented nasogastric tube. Which suction setting will most likely prevent the tube from adhering to the wall of the client's stomach?
intermittent suction at 40-60 mm Hg
Troubleshooting NG tubes
irrigate per physician order, use 0.9 NS (doesn't cause electrolyte shift), instill 30-60 mL of fluid per dr order and then aspirate
A client who is being tube-fed through a nasogastric tube has diarrhea. Which is the most likely reason for tube feeding to cause diarrhea?
lactose intolerance
Purpose of Nasointestinal tube
longer than nasogastric, NEX measurement +9 inches used with enteral feedings
risk for aspiration guidelines
measure residual auscultate bowel sounds palpate abdomen and measure ask if feeling full, nauseas, or vomiting check restrictions for positioning
stylet
metal guidewire
Nose-to-Earlobe-to-the-Xiphoid (NEX) measurement
method to determine the projected depth of a tube to reac the oropharynx and stomach
fluid imbalance risks
monitor older adults for agitation, confusion resulting in pulling tubes change in mental status can signal electrolyte imbalance too much water can cause electrolytes to be drawn into the gastric fluid causing an electrolyte imbalance don't add water to formulas to help feed through the tube, it will dilute the formula and therefore decrease nutritional value
enteral nutrition
nourishment provided via the stomach or small intestine rather than via the oral route
A client who overdosed by taking a bottle of acetaminophen has been brought to the emergency department. The nurse gathers which tube that will be used to remove the toxic substance that has been ingested?
orogastric
intubation
placement of a tube into a structure of the body
A 71-year-old woman has presented to the emergency department with intense abdominal pain accompanied by nausea and vomiting. Diagnostic imaging results indicate that the client has a bowel obstruction and the emergency physician has ordered the insertion of a nasogastric tube. What is the most likely rationale for the client's gastrointestinal intubation?
promoting decompression
fiber containing
provide fiber to normalize bowel function will usually see a result within 30 minutes
Skin irritation at tubing site
provide skin barrier for any drainage at the site and monitor the tubes placement
high calorie formula
provide up to double amount of calories than standard formula
partially hydrolyzed
provides nutrients that require little or no digestion
gavage
provision of nourishment
Dumping Syndrome symptoms and treatments
rapid gastric dumping diarrhea, nauseas, sweaty, bloating, cramping, fatigue, vomiting hypoglycemia, weakness, sweating, and dizziness happens when intestine fills too quickly happens 1-3 hours after eating
A client has been prescribed a nasointestinal tube. Which is the key advantage of a nasointestinal tube over a nasogastric tube?
reduces danger of aspiration
intestinal decompression
removal of gas and intestinal contents
decompression
removal of gas and secretions from the stomach or bowel
troubleshooting ng tubes- the vent is capped or plugged
remove the cap and restore the prt to atmospheric pressure
gastric residuals-if amount is less than 100cc
replace gastric contents into the patient continue with next feeding
gastric residuals-if amount is more than 100cc
replace gastric contents into the patient do not feed next feeding per policy protocol recheck after 30 minutes and if less than 100cc continue with next feeding
troubleshooting ng tubes- the portable suction machine is disconnected or turned off
replace the plug into the electrical outlet or turn on power
troubleshooting ng tubes-the cover on the suction container is loose
resecure the lid to the container
gastric reflux
reverse flow of gastric contents
Purpose of Nasogastric tube
smaller than orogastric, larger and shorter than nasointestinal some with more than one lumen remains for several days or more discomfort can lead to break down, stretched opening of the esophageal sphincter sengstaken-Blakemore tube provides esophogastric tamponade Salem Sump- double lumen (white suction/blue vent)
types of formulas
standard (isotonic), high calorie, high protein, fiber containing, partially hydrolyzed
replacing tube
when conditions improve, when tube is hopelessly obstructed, or according to agency policy for maintaining integrity of nasal mucosa large diameter- 2-4 weeks for adults small diameter- 4 weeks-3 months peds- more frequent because of tissue breakdown and infection risk
