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46 Cards in this Set
- Front
- Back
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purposes of gastric intubation |
- gavage (gastric or intestinal) - to give nourishment. -decompression - to empty (post-op or n/v) -compression - to prevent bleeding (balloon) -lavage - to wash -obtain gastric analysis (biopsy) |
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single lumen |
"levin" ; multi purpose (12-18 fr) , rarely used causes ulcers from suction. |
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Double lumen |
"Salem sump" ; air vent to decrease suction to gastric mucosa, used for decompression. |
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Small-bore |
Weighted ; gavage only, use of stylet for insertion, need x-ray to verify placement, dislodged easily. |
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Percutaneous endoscopic gastrostomy (PEG) or Percutaneous endoscopic jenostomy (PEJ) |
endoscopically placed longer term tube |
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G button or mickey |
short tube access to stomach or intestine. |
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enteral nutrition |
passing of tube into GI tract for feeding (NG) , 4 wks or less , small bore most common (smaller tube = less discomfort). |
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What type of tube is used for feeding has the least risk for aspiration ? |
PEG tube or mickey because they go directly into the stomach. |
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What tube is used for short term? |
NG - 4 wks or less |
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What tube is used for long term? |
G - 4 wks or more |
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Dumping syndrome |
diarrhea, bloating, aspiration |
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What area is best for feeding? |
Gastric , stomach is best for any formula |
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Can you use intestinal for feeding? |
Yes , if stomach is unable to use, need to use elemental formulas (broken down proteins). Don't do too fast bc it can cause dumping syndrome. |
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Nursing responsibilities with tube feeding |
-elevate head of bed 30 degrees or higher -after feeding bed elevated 30-60 min -directly in sm bowel - if pt not using G-tube for feeding ok to put bed at any level. |
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nutritional assessment |
BMI chart ; larger the pt = less kcals |
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What are you checking for when verifying placement ? |
The tube is in the right place and not in the airway. |
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Why are you verifying the placement of a tube? |
To prevent aspiratin |
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How do you verify the placement of tube? |
1. x-ray (most accurate) 2. pH testing 3. instill 10-30 ml or air (UNRELIABLE) 4. color 5. g-tube length 6. bili 7. food dye - not used bc causes death -co2 detection |
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pH testing levels |
gastric - below 5 intestine - above 6 resp - above 6 |
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colors and testing |
gastric - grassy, green or clear intestine - yellow or greenish brown resp - clear and frothy (bubbly) |
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When should you verify placement of tube? |
Before instilling anything or irrigation , every 4 hrs for continuous infusions, and before intermittent feedings. |
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How can you identify delayed gastric emptying? |
If gastric residual volume (GRV) is 250mL or more on 2 consecutive checks 1 hour apart OR if since check of GRV is 500mL or more this means pt is not digesting food (NOT GOOD). You should check residual, check placement, elevate head of bed. |
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Recommendations on aspiration |
1. stop feedings immediately if aspiration occurs 2. withhold feedings and reassess pt tolerance if GRV is over 500mL. 3. routinely evaluate the pt for aspiration 4. use nursing measures t reduce risk of aspiration if GRV is 250-500mL (check residual , placement, and head of bed). |
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What can be done to increase gastric motility? |
-Ambulation -Avoid or limit medication that decrease motility (narcotics) -Meds that increase motility |
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Meds that increase motility |
-Metoclopramide - only works on proximal gut -Erythomycin - stimulates receptors in GI tract / contactions -Cisapride - contractions of lower esphogas and sphincter (helps with aspiration). |
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Polymeric formula |
(1-2kcals/ml) ; blenderized whole nutrient foods home or dietary prepared or commercially made . ex) ensure or boost. Cannot have milk allergy. |
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Modular formula |
(3.8-4kcal/ml) single macronutrients such as proteins, glucose, or lipids. Not complete nutrition and used with other food to supplement. |
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Element formula |
(1-3 k/cal) predigested nutrients that are easier for the GI tract to absorb (required for intestinal feedings). |
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specialty formulas |
(1-2kcal/mL) for specific diseases or conditions ; nephro -kidney disease , diabetes |
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what is the normal osmolality in a formula? |
350-400 m0sm/L - iso -osmolar |
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serum osmolality |
280-300 |
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hyper-osmolar |
increased amounts of particles in formula (protein, glucose, eletrolytes |
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prevention of contamination in an open system |
-change every 24 hours -rinse after each feeding -8 hr max time for feeding ; if you add more than decrease to 4 hrs -gravity or pump |
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prevention of contamination in a closed system |
-spike container and inside is sterile -use a pump to set -no flexibility with adding extra nutrients -hang time 24-48 hrs |
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prevention of nasal erosion/altered mucous membranes |
-assess nares Q 4 hrs -oral care Q 2 hrs -put ointment if skin breakdown occurs |
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What water to use?? |
tap water is fine , only need sterile water or saline if dr orders. |
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what to monitor for with decompression of salem sumo NG tube |
-c/o nausea , nose or mouth discomfort -drainage -air vent ; above stomach / pin to shirt -abd assessment -oral cavities -need order for ice chips -turn off suction , disconnect before ambulation -irrigate with normal saline and tap for meds |
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troubleshooting for no suction / drainage |
reposition , check connections, is it turned on, tube clogged |
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troubleshooting for nausea |
stomach not emptying , check connections, turned on , reposition |
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troubleshooting for second lumen leaking |
means main lumen is clogged or vent lower than stomach and no suction out. |
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troubleshooting for tube blockage |
irrigate well with saline to prevent this; if clogged use warm water and a gentle push pull method , commercial prducts used , do not use coke bc it can cause death |
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what happens when GI tract has normal functioning? |
-return of bowel sounds -flatus -decline in amt of drainage - approx 250ml/shift -color change dark green to clear -clamping trial (need order) |
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how to check for residual? |
Aspirate and when you feel resistance that is residual. |
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enteral tubes in children |
-5 fr for infant / other children measure -play -parent hold child -use paci or straw if old enough -water based lube -child sit at dinner table with fam |
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irrigation for children |
1-3mL neonate 3-5mL peds |
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check placement for children |
-resp distress -change in length -color of aspirate (clear and frothy in lung) -pH |
