Digestive and Gastro intestinal treatment Pep U

A client has had a gastrostomy tube inserted. What does the nurse anticipate the initial fluid nourishment will be after the insertion of the gastrostomy tube? Distilled water at 60 mL/h Sterile water at 30 mL/h Formula feeding at 50 mL/h High-calorie liquids at 50 mL/h

Sterile water at 30 mL/h The first fluid nourishment is administered soon after tube insertion and can consist of a sterile water or normal saline flush of at least 30 mL. Distilled water is not used for initial start of feeding. Formula feeding and high-calorie liquids are not used initially.

A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate? "It is a vent that prevents backflow of the secretions." "It acts as a siphon, pulling secretions into the clear tubing." "It helps regulate the pressure on the suction machine." "It works as a marker to make sure that the tube stays in place."

"It is a vent that prevents backflow of the secretions."

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach? 4 6 8 10

4 Gastric secretions are acidic and have a pH ranging from 1 to 5. Intestinal aspirate is typically 6 or higher; respiratory aspirate is more alkaline, usually 7 or greater.

Which condition is caused by improper catheter placement and inadvertent puncture of the pleura?

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.

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? Spray the oropharynx with an anesthetic spray. Have the patient maintain a backward tilt head position. Allow the patient to sip water as the tube is being inserted. Have the patient eat a cracker as the tube is being inserted.

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

The nurse is to discontinue a nasogastric tube that had been used for decompression. What is the first action the nurse should take? 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.

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.

The nurse is caring for a group of clients. Which client(s) would be a candidate for total parenteral nutrition (TPN)? Select all that apply. Child with short bowel syndrome Young adult with gastroenteritis Middle-aged man with acute pancreatitis Woman with superficial burns Man with two-thirds of his colon removed

Child with short bowel syndrome Middle-aged man with acute pancreatitis Man with two-thirds of his colon removed

What type of feedings should be administered to a client who is at risk of diarrhea due to hypertonic feeding solutions? continuous feedings intermittent feeding bolus feeding cyclic feeding

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

To ensure patency of central venous line ports, diluted heparin flushes are used with continuous infusions. before drawing blood. when the line is discontinued. daily when not in use.

Daily instillation of dilute heparin flush when a port is not in use will maintain the port. Continuous infusion maintains the patency of each port. Heparin flushes are used after each intermittent infusion. Heparin flushes are used after blood drawing to prevent clotting of blood within the port. Heparin flush of ports is not necessary if a line is to be discontinued.

A client with a feeding tube is to receive medication. The medication supplied is an enteric-coated tablet. Which of the following would be most appropriate? Check with the pharmacist to see of a liquid form is available. Dissolve the tablet in water after crushing it. Sprinkle the contents of the opened tablet into the tube. Give the tablet as is in its original state.

Enteric-coated tablets due to their formulation cannot be crushed. Rather the nurse would need to contact the pharmacist to see if there is a liquid form available. Some time-released tablet forms can be opened but cannot be crushed because doing so may release too much of the drug too quickly Giving the tablet as is in its original form would be inappropriate because it would not pass through the tube, thus not reaching its intended site for absorption.

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 cardiac dysrhythmia Fluid volume deficit Mucous membrane irritation Pulmonary complications

Fluid volume deficit

Gastrostomy feedings are preferred to nasogastric feedings in the comatose patient, because the: Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration. Digestive process occurs more rapidly as a result of the feedings not having to pass through the esophagus. Feedings can be administered with the patient in the recumbent position. The patient cannot experience the deprivational stress of not swallowing.

Gastroesophageal sphincter is intact, lessening the possibility of regurgitation and aspiration.

The nurse cares for a client who receives continuous enteral tube feedings and who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. The nurse determines which action is correct? Monitoring the feeding closely. Increasing the feeding rate. Lowering the head of the bed. Flushing the feeding tube.

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

The patient is concerned about leakage of gastric contents out of the gastric sump tube the nurse has just inserted. What would the nurse do to prevent reflux gastric contents from coming through the blue vent of a gastric sump tube? Prime the tubing with 20 mL of normal saline. Keep the vent lumen above the patient's stomach level. Maintain the patient in a high Fowler's position. Have the patient pin the tube to the thigh.

Keep the vent lumen above the patient's stomach level.

Which venous access device can be used for less than 6 weeks in clients requiring parenteral nutrition? nontunneled catheters peripherally inserted central catheters tunneled catheters implanted ports

Nontunneled catheter The subclavian vein is the most common vessel used because the subclavian area provides a stable insertion site to which the catheter can be anchored, and it allows the client freedom of movement. It also provides easy access to the dressing site. Peripherally inserted central catheter (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 used for long-term home IV therapy (e.g., Port-A-Cath, Mediport, Hickman Port, P.A.S. Port).

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. What is the best action by the nurse? Reinsert the nasogastric tube to the stomach. Notify the surgeon about the tube's removal. Place the nasogastric tube to the level of the esophagus. Document the discontinuation of the nasogastric tube.

Notify the surgeon about the tube's removal.

The nurse observes dry mucous membranes in a client who is receiving tube feedings after an oral surgery. The client also reports unpleasant tastes and odors. Which measure should be included in the client's plan of care? Ensure adequate hydration with additional water. Provide frequent mouth care. Keep the feeding formula refrigerated. Flush the tube with water before adding the feedings.

Provide frequent mouth care.

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? A length of 50 cm (20 in) A point that equals the distance from the nose to the xiphoid process The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process The distance determined by measuring from the tragus of the ear to the xiphoid process

The distance measured from the tip of the nose to the earlobe and from the earlobe to the xiphoid process Before inserting the tube, the nurse determines the length that will be needed to reach the stomach or the small intestine. A mark is made on the tube to indicate the desired length. This length is traditionally determined by (1) measuring the distance from the tip of the nose to the earlobe and from the earlobe to the xiphoid process, and (2) adding up to 15 cm (6 in) for NG placement or at least 20 to 25 cm (8 to 10 in) or more for intestinal placement.

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

diaphoresis, vomiting, and diarrhea.

Rebound hypoglycemia is a complication of parenteral nutrition caused by glucose intolerance. fluid infusing rapidly. feedings stopped too abruptly. a cap missing from the port.

feedings stopped too abruptly.

The nurse conducts discharge education for a client who is to go home with parenteral nutrition (PN). The nurse determines the client understands the education when the client indicates a sign and/or symptom of metabolic complications is loose, watery stools. increased urination. elevated blood pressure. decreased pulse rate.

loose, watery stools.

The client is on a continuous tube feeding. The nurse determines the tube placement should be checked every shift. hour. 12 hours. 24 hours.

shift.

The most significant complication related to continuous tube feedings is the interruption of GI integrity. a disturbance of intestinal and hepatic metabolism. the increased potential for aspiration. an interruption in fat metabolism and lipoprotein synthesis.

the increased 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 client 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.