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120 Cards in this Set

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what 3 places do GI intubations go?
nose
mouth
a surgical incision
Most all tubes are plastic and come in 3 sizes, short, medium, and long. which one is seen most in hospitals?
the short one, the the shortest one, the nasogastric NG tubes. This tube is used to decompress the stomach, meaning empty the stomach.
There are 2 NG tubes the book describes, the Levin tube and the Gastric Sump (Salem). Whats the difference?
Levin is a 1 lumen tube, the Salem has 2 lumens. The 2nd lumen is a vent. Salem is used to keep stomach allways empty. The 2nd lumen can keeps suction at 25 mm, the level of capillary fragility. This small 2nd lumen is called the blue pigtail
The intermittent suctioning at around 30 to 40 mm Hg on the Levin tube. This tube will also get intermittent suctioning. Why?
intermittent suctioning helps avoid erosion or tearing on the stomach lining, a result from the tube's lumen adhering to mucosal lining of the stomach wall.
How is the blue pigtail designed to prevent gastric reflux?
There is a one way antiflux valve on the blue pigtail that prevents acid coming out the vent lumen.
Why do we see these NG short tubes the most in a hosptial?
this is the tube used in a patient before surgery, usually on the esophageal or stomach. They remove gastric fluids and gas from upper GI tract OR to get a specimen for lab work. They can also be used for short term (3-4 wk) use for meds or feeding.
What is the usual lengths and barrel sizes for NG tubes?
120 - 125 cm or 4 feet long.
barrel sizes are 14 - 18 french. The Salem is 12 - 18.
What is a Moss NG tube for?
it has both a gastric decompression lumen AND a duodenal lumen for postop feeding, so it pumps and feeds!
What does the Sengtaken-Blakemore NG tube do?
has 3 lumens! 2 lumens infliate, one for gastric and other for esophageal balloon.
What are medium length tubes used for?
feeding. These medium tubes are a foot longer than NG tubes, around 160 cm (60 in)
Feeding tubes are more pliable than decompress tubes. Which tube usually has the larger bore and why?
the decompress tube is larger so things don't get stuck. gastric contents are chunkier than masticated food. Go figure.
What is stomach pump? Why do we stomach pump?
when a patient tries to take too much drugs or medicines and comes to the emergency room and the pump the stomach and this means are large bore lumen to get all those pills back up.
Tubes can be used to treat a bowel obstruction. Tubes can be used to fix a bleeding sore, how?
inflating a balloon catherter to press against the bleeding area. The can also use tube to put ice into area to help stop bleeding. Tubes can be used to analyze stomach content, pH, bacteria analysis, etc.
Which is a larger diameter tube, the 18 or 12 French?
The 18 french is wider in diameter than the 12 french, duh.
Is the NG tube (in the nose or nares) intended use for short or long term? Why?
short term. This naso installation is hard on the nose, causes all kinds of problems, so NG is short term install.
Part of the nursing care is assessing the nares for what?
blisters, anything bleeding or sore. Also check the tube by looking in the mouth, see the tube going down, what does the mouth look like?
This is a painful procedure but the patient will feel better for doing it. So do what?
Educate them on why it has to be done. Teach the what it is and why its done, get them involved with their health. Teach that they will vomit puting it in, its part of it.
So, the 3 purposes of the NG tube are:
to decompress
to feed
to what ...?
to remove gas & fluid from upper GI tract.
Ok, the best method to verify tube placement is Xray, then tube bubbling, then what?
two on this, you have one nurse inject air into tube while the other nurse listens w/ stethoscope for air in upper left hand quadrant for a swoosh, which means your in the stomach. Another method is to pull stomach content and assess if it IS stomach content. Also check the pH of content. (between 1 - 5pH).
What is the pH of the intestines?
pH of intestines is 6 or greater than 6.
The respiratory pH is around what?
respiratory pH is at 7 or greater than 7.
What can confuse the nurse with tube placement and pH evaluation?
If the patient is on an H2 inhibitor like Prylosac or Previsen. These drugs alter pH of the stomach so you might have a pH of 6 and think the tube is in the intestines! So, is patient on H2 inhibitors OR did they just eat???
what is a H2 inhibitor and why?
H2 inhibitor is a Antiulcer med; Histamine H2-receptor antagonists competivitely inhibit action of histomines at the H2 receptor, located in gastric parietal cells, thus inhibiting gastric acid secretion.
A patient on H2 inhibitors will have altered pH in their stomach! This will throw off the unsupecting nurse!
What is the pH of Jevity and why?
pH of Jevity is around 6.6 so that can throw you off.
At every shift change we will assess the tube on patient how?
from the nose to the end of the tube (this length will be charted)see if it has moved.
We will do a visual check of aspirate
do a pH measurement of aspirate
What must be done prior to giving meds or fluids in a tube?
the tubes placement must be checked.
What if an order said LCS, what does that mean?
Low continous suction. LIS means low intermittent suction.
do you give an NPO patient fluids or ice because their miserable and throat hurts?
who knows. Whatever you give will just come right back up. You have to chart it if you do both in and out.
How do you decide which fluid to irrigate tube with? Saline, tap, sterile water?
Do what the doctor ordered then after that use your own critical thinking. Realize electrolyte imbalance cannot be affected with saline water, its isotonic and usually what most would use. What is their potassium like,
What is their choride at, what is their electrolytes doing?
what is patency?
is the tube clear, does it draw correctly, is it blocked. Irrigate tube every 4-6 hours (thus every shift) w/ sterile/saline water. If hooked to suction only irrigate if giving meds
How can you tell if a NPO patient is dehyrated? This is a big problem here, with NPO patients hooked to suction!!!
confusion
dry mouth
dizzyness
assess mucous membranes
lethagy
decreased output
confused
we need acurate I/O on these patients is the point here.
By the way, an NG tube hooked to a suction will not have what?
any food or medications going into it.
NOW ENTERAL TUBES. Enteral think Entrals Intestines are Entrals so Enteral tubes are for feeding. Enteral means feeding, need nutrition. Quick, if your going to use an NG tube for feeding, can you use a smaller or larger size?
smaller size NG tube for feeding because the stuff you put down it is very thin like liquid. This will help provide more comfort to patient.
Who would be using an Enteral feeding tube? What would be the patients situation most likely?
someone who needs nutrition:
a nursing home going down hill fast, can't swallow, etc
a patient in coma
a burn victim
anorexia
patient with a jaw wired shut
failure to thrive baby
mutliple reasons but they want the gut to continue working and to get nutrition.
How do gastroscopy differ from jejunoscopy?
ones in the tummy other in the bowel. Gastro is surgically installed
whats the difference between a PEG and PEJ?
Look at the G and the J
G = gastro meaning tummy
J = jejuno meaning bowel
P = percutaneou (thru skin)
E = endoscopic (light, see)
what would you look for in caring for PEG or PEJ?
infection so looking for red areas around stab wound.
We're giving skin care to wound daily w/ soag n water.
We're changing dressing.
Why would it be better to put a tube in the duodenum instead of the jejeno of small bowel?
the doudenum has the ducts for the pancreatic ducts and bile ducts enter here so more food digestion thus achieve your goals better here
How do you take care of a PEG/PEJ wound?
clean it
put antibiotic ointment on it
look for infectin
look to see if its leaking
You can feed a patient at night if they are concerned with body image. What would this do?
The patient wouldn't have to go around with a feed bag on during the day, important with hipsters.
What has a guide wire?
the Enteral tube has a guide wire to help place it. Its removed after its properly installed.
How much fluid does a patient need a day?
2 liters or half gallon a day!

or 30-40 mL per Kilogram but this is for a healthy patient. This will change if they are a trauma patient! Caloric and hydratin needs will increase
A pulled out PEG / PEJ needs to be reinserted in ______hrs. Why?
the wound hole will start to close in 4-6 hours so cover it with sterile dressing and get a doctor. Doctor!!! Report immediately! Doctor!!!
How do you unclog a clogged PEG/PEJ tube? Use Coka Cola or Cranberry juice? You redneck. What do you do?
use normal saline to irrigate or sterile water. You could use Clot buster but you need a doctor's order to use it.
What are some cool things with tube feeding using Nares?
cost effective
preserve GI integrity
preserve normal intestinal/hepatic metabolism
maintain nrmal insulin/glucogon ratios
This install is for pts with aspiration issus and short term use
What shuts down the gut faster than a Texas tornado?
having a patient on NPO AND on an IV. This combo will shut the gut down. Sometimes thats what the doc wants. But this causes all kinds of other issues doing this. Bigger complications
What is PEG/PEJ for anyway?
long term feeding...like more than 3-4 weeks.
there are different feeding types:
Intermittant
Continous by pump
gravity
1/2 strength
what is intermittant feeding?
200-250 mL in 10-15 minutes
Continous is preferred and has varying rates but 100-150 mL hour but start slow and work up to it.
Gravity is used only when tube is above the stab wound
1/2 strength is 50-50 mix with water.
What are some examples of complications from tube feedings?
diarrhea
nausea/vomiting
gas/bloating
dumping syndrome
constipation
aspiration pneumonia
tube coming out or clogged
nasopharyengel irritation
hyperglycemia
dehydration is a BIGGY
What is dumping?
a rapid distinction of the doudenum ... the small bowel gets filled too fast and you get lots of dirrhea. A hi carb or hi fat food feeding
What is azotemia?
increase of nitrogenous wastes in the blood, probably from dehydration
Ittigation of tubes...
why and when do you do this?
before and after medications
after checking gastric pH, anything to do with it
every 4-6 hrs w/ cont. feeding
if tube is disconnected
How much water do you use to irrigate a tube?
20-30 mL of water, normal saline, tap OR
60 mL from a catheture tip syringe (less pressure here)
What about discontinuing a feeding tube, you have to remember to the patient hold their breath after doing all the other stuff, like irrigate it. Why do we irrigate a tube your getting ready to remove?
to make sure its not stuck to the stomach wall first of all
Second, the gastric stuff on the tube will get on the nose on the way up and burn it.
So irritate with 30 mL of solution
Do you irrigate before or after turning off the suction?
after dummy.
Because you would only be sucking back up what you irrigated it with.
How do you give meds when they are on a suction tube?
turn it off for 15-30 minutes, or per policy, then:
ck placement
aspirate content, put it back
flush w/ 30 mL water
meds 5 mL b/t meds
flush w/ 30-50 mL water
wear gloves
Any kind of tube you do this EXCEPT enteric pills
Try to get meds in a syrup and don't give crushed pills.
Try to give meds in a liquid form here.
What is parenteral PN nutrition?
I think she said this can also be called TPN for total parental nutrition
Nutrition in IV form!
Usually in 2-3 liter bags
to improve nutritional status
This is for a person whose gut isn't working, remember.
So this is a supplement to oral nutrition
what is PPN ?
peripheral parental nutrition
not completely nutritionally complete like PN is. PPN has less protein and dextrose and should be limited to 5-7 days
What is a picc line?
its peripherally placed (in the arm) but leads into the superior vena cava
What is a Colonoscopy?
****************************
An internal examination of the entire large intestine, terminating at Ileum, able to view anus to Cecum.
glucogon (sugar) is used to do what and how much?
****************************
1mL of glucogon to relax smooth muscle ie bowels.
WHAT DOES LAVAGE MEAN
REMOVE TOXIC SUBSTANCES

WASHING OUT A CAVITY

GETTING YOUR STOMACH PUMPED!
WHICH BORE DO YOU USE FOR DECOMPRESSION
LARGER THAN THE FEEDING TUBES

FEEDING TUBES ARE MORE PLIABLE
WHAT IS A NASO GASTRIC TUBE
GOES DOWN THE NOSE
WHAT SIZE TUBE DO YOU USE TO INTUBATE
14 - 16 FRENCH ANY SMALLER AND THEY CLOG UP
why shouldn't you force the tube
you could be running it into their brain
tubes come in 3 lengths
long tube for releiving bowel obstructions
medium tubes for feeding
short tubes for ...
fluid & gas from upper GI
what do we do if the pt starts gagging? stop take a breath and go on
before we do anything w/ the tube after installing what do we do
x ray
water to the brain is bad
x ray it and chart its results
also look at the policies and procedures in the facility
if you don't have an x ray machine, what do you do?
put the tube into glass of water if it bubbles, your in the lungs
whats another method if you can't x ray or use the water method?
inject 20-30 mL air into tube and you should hear a wooosh UPPER Lh QUAD... then aspirate ...if its green, tan, off white your in the tummy
if its golden yellow or clear its in the s intestine
another ck is the pH of the the contents from the tube
the pH of the stomach is ...
NOT ACCURATE BUT 1-5
INSTESTINE IS > 6
LUNGS IS >7
BUT H2 INHIBITOR ALTERS pH AND WILL SHOW A TUMMY AT 6 AND YOU'D THINK YOUR IN THE SMALL INTESTINE OR THEY JUST ATE OR JUST TOOK JEVITY ETC
SO EVERY SHIFT WE WILL MEASURE THE TUBE LENGTH AND CHART IT HOW
FROM NOSE TO END OF TUBE, ITS LENGTH and chart it.
make a visual assessment of the tube
what is nursing mangement?
watching the tube, managing it.
confirm its placement
what must be done b/f giving anything done the tube?
assess its placement prior to administerting meds or fluids
what would NG LCS mean?
Nasal Gastric

Low Continous Suction

a continous flow
what does NG LIS mean
low intermittent suction
when would irrigation with sand line be more appropiate than water?
************************
when the electrolytes could be affected, use saline because its isotonic and won't affect the pt's balance
should placement of the tube be confirmed b/f administering meds
yes and fluids too

also remember to provide oral hygiene every shift
regarding complications to NG therapy, whats the biggy?
fluid volume deficit
esp if hooked to suction
look for dry mucous membranes
lethary
look at i/o
look at pulmonary coughing,
can't clear airway fever, tachypnea (fast breathing)
why is suction and meds admin an issue.
you can't shallow with a tube down your throat so irrigate and administer meds and hook it back up
you do or don't irrigate a suction tube unless giving meds?
you only irrigate for meds administration
enteral tubes are for ...
feedings

enteral means nutrition
enteral tubes can be a smaller size tube b/c food is ...
not as thick and chunky as stomach gastric stuff

also short term use
how do enteric tubes differ in apperance from NG tubes
they look opague or white w/ an orange end
what is the kind of patient that would have an enteral tube
someone in real trouble
burn
anorexia
jaws wired shut
going down fast
failure to thrive baby
what is PEG/PEJ tubes
surgically placed tubes
whats a better place for PEJ tube, the duodnum or jejunum
the duodnum b/c the pancratic duck is there and also bile duct
whats the deal with PEG/PEJ tubes when they come out
infection to the stab wound

keep them washed w/ soap/water
dressing change and antibiotic
people put these tubes here to hide it instead of the nose
body image...feed at night so they don't have to run around during the day w/ feed bag
whats difference w/ enteral tubes and NG
enteral tubes have a guide wire
PEG/PEJ tubes is surgically placed so they have to have a doctor consent
we got to check out the pt b/f we put the tube in, assess what
gag reflex
breathing
Hx of risk of aspirations
nares
Hx of nutritional status
Kidneys/GI tract functioning
meds
someone w/ a tube of course cannot take oral meds BUT
there might not be an order to give meds via tube so ck w/ doc and get that corrected w/ the paperwork/order
fluid req pts need about
***************************
2 liters a day
or 30-40 mL per kgram
***************************
but this is healthy pt!
a burn pt etc will need MORE
If surgically tube is pulled out, what
get another one in b/c it will close up 4-6 hours
if a PEG or NG tube gets clogged what
no cranberry juice or coka cola

use water or saline only
what is azotemia
a complication ... the effects of urea in blood increased nitrogen in the blood BUN rises CReatin rises, kidney issue
when do you irrigate a tube
b/f & after giving meds
after checking residuals
after checking pH
every 4-6 hrs w/ cont. feeding
whenever the tube is removed
whenever you start a intmittm feeding
what size syringe do you use to irrigate
60mL cath tip syringe! big but low pressure
20-30 mL water saline tap min.
some times irrigate after every feeding! you want to go twice the amount to the tube, meaning it will take 1-15 mL just to fill up the tube
do you irrigate a tube b/f removing it
yes if the tube was used for decompression, you irrigate to make sure it isn't stuck to the side of the stomach wall.
gastric shit on tube can irritate on the way out including a sugically installed one. irrigate AFTER turning off machine OR you'll suck it back up again
MEDICATION ADMINISTRATION
****************************
IF TUBE IS ON SUCK, AND YOU ARE TOLD TO GIVE MEDS IN TUBE, WHAT DO YOU DO, TURN SUCTION OFF?
15-30 MIN TURNED OFF B/F PUTTING IN MEDICINE. B/T MEDS GIVE 5mL AND AFTER ALL MEDS GIVE ANOTHER 30-60 mL WATER
CRUSH MEDS B/F GOING DOWN TUBES BUT LIQUID MEDS ARE BEST WHY?
MED STICKS TO TUBES
WHAT IS PARENTERAL NUTRITION?
IV NUTRITION
IV NUTRITION HERE...

COMES IN BIG BAGS 2-3 LITERS FOR 24 HOUR USE PROVIDE30-35 KILO CALORIES TO THE BODY. AND 1-1.5GRAMS PROTEINS/Kgam BODY WEIGHT
***************************
WE NEED TO KNOW WHAT THE NUTRITIONISTS LOOK AT AND WHAT THE DOCTORS LOOK AT
WHATS THE DIFF B/T PN PPN AND TPN
PN=PARENTAL NUTRITION(COMPLETE
PPN=PERIPHERAL PARENTAL(PARTAL NUTRITION, NOT COMPLETE 5-7 DAYS CLEAR STUFF
TPN=TOTAL PN=
PN CAN CAUSE TROUBLE
AIR EMBOLISM
PNEUMOTHORAX
HARD ON THE VEINS B/C ITS SO HYPERTONIC
B/C OF THIS THEY PUT IN A CENTRAL LINE IN PLACE
CLOTTED IVs
WHAT ELSE
SEPSIS
HYPERGLYCEMIA
FLUID OVERLOAD
ETC
what is the purpose of a NG tube to break an obstruction
suck it out or go up and get it out like either way
cleared w/ the endoscopy tube but the NG tube would feed etc but not do the actual blockage prodcedure
which tube is bigger 14 or 18
18 is bigger
purpose of NG tube =
decompression
remove fluid gas
long tubes are for
decompression and bowel obstruction
signs of pulmonary stress
tachnpenia
fever
pulse
a dislodged tube into airways
enteral tubes are:
8-12 french
use guide wire (to pull the weight back up)
nasal tube means
short term
assess for a feeding tube?
NARES
gag reflex
are kidneys working(if they get dehydrated easily)
breathing
history of aspirations
monitor for a PEG
infecton
drainage
blood
redness
any post op complicatons
why do we like entral tubes thru the nares
cost effective
no surgical hassels
insulin/glucogon levels
used for short term
PEGs are for long term
long term
less risk for aspiration
what is half strenth?
a can of food and same amount of water. 200 of food and 200 water = 400 total. OR order 1/2 strenth food.
atzomea
increased urhea in the blood
would you chart irrigation fluid
yes
PN nutrition formula
****************************
30-35 Kcal per (kcal=1 calorie) per Kilogram

Ex 205 lbs. / 2.2 = 193 X 30 = 2950 calories.
205/2.2 X 1 = 93 grams of protein
so 93 of it should be protein
are an Central line and a PICC the same thing
yes