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39 Cards in this Set

  • Front
  • Back
Is a certified nursing assistant allowed to put in a feeding tube?
No, but RN nurses are able to
When would a patient be fed parenterally (through a central vein)?
1. When the patient is at risk for aspiration due to an non-functional protective airway
2. When the patient has a non-functional gut that cannot empty (peristalsis not working properly)
What are the risks of enteral feedings?
1. Gastric emptying impairments
2. Aspiration of gastric contents
3. Diarrhea
4. Sinusitis
5. Esophagitis/erosions
6. Displacement of feeding tube (can be placed in lungs accidentally)
Why are enteral feedings superior to parenteral feedings?
1. If the gut is not used, GI function declines: atrophic effects occur to the intestinal villus (hormones stop being produced)
2. Enteral feedings promote secretory IgA secretion and function (lymph tissue growth)
3. Enteral feedings protect the gut against harmful bacteria (reduces bacterial translocation)
4. Lower cost
When would a patient be fed via enteral nutrition?
1. Mechanical GI dysfunction/disorders
2. Facial/jaw injuries; head/neck cancer (oral-pharyngeal dismotility: 5 cranial nerves damaged by radiation therapy)
3. Pancreatitis; inflammatory bowel disease
4. Hypermetabolic conditions (increased protein requirements)
5. Major burns, trauma, sepsis
6. Person with cystic fibrosis (pancreas fails because person cannot breakdown mucous secretions: eventually person becomes diabetic)
What prevents enteral feeds from moving up the GI?
The lower esophageal sphincter (collar around esophagus)
What can cause the lower esophageal sphincter (LES) to relax?
1. Medications can cause LES to relax
2. Incompetent LES
A newborn with cystic fibrosis needs what type of feeding tube?
Nasojejunal or gastrostomy tube (enteral feedings)
What type of tube is used for a nasogastric tube?
Salem sump tube
What is a transpyloric feeding?
Feeding tube through the pyloric valve (at end of stomach) into the duodenum or jejunum.
Feeds must have had sugar breakdown if stomach is bypassed by feeding tube.
A person has a lower esophageal sphincter that is not closing tight enough. This problem increases pressure in his thoracic cavity. What surgery prevents gastrointestinal reflux (GERD) caused by an inefficient LES?
A Nissen fundoplication surgery
Why are transpyloric feeding tubes used?
1. Gastric atony (lack of normal tone or strength in the stomach)
2. Colonic ileus (slowing of the gastrointestinal tract. Movement of food, and digestive juices is slowed, leading to distension)
What techniques are used to position a transpyloric feeding tube? How is the positioned verified?
1. Prokinetic agents such as Reglan (enhance gastrointestinal motility)
2. Fluoroscopy (an imaging technique that uses X-rays to obtain real-time moving images)
3. pH test (to see if tube is in right place)
4. Endoscopic guidance
What does a transpyloric valve consist of?
Enters side through pyloric sphincter.
A weight is typically at the end of the tube to pull through the stomach to the jejunum (flexible, pulls through in 4 hours)
When would a jejunostomy be used?
1. Gastro esophageal Reflux (GERD)
2. Gastroparesis (nerve damage of the stomach that delays or stops stomach emptying)
3. Pancreatitis (inflammation of the pancreas)
What is a jejunostomy?
A jejunostomy refers to a fistula surgically created by opening of a loop of the jejunum onto the anterior abdominal skin either partially or completely bypassing the remainder of the intestine and colon.
When would a nasojejunal tube be used?
1. Nasojejunal used when gastric feedings have failed (upper GI intolerence, poor gastric emptying, vomiting, aspiration)
2. Cardiopulmonary or neurologic status prevents placement of nasogastric tube (lost function to protect airway)
What drug is used to increase adherance of the nasogastric tube tape to the patient's skin?
Benzoin
If a patient's gastrostomy tube falls out, how long will it take until the incision closes if the tube is not placed immediately back it?
Within 2 hours, open gastrostomy incision will close (lubricate before putting tube back in- not with vasoline)
How is a feeding tube placement checked?
X-ray check before feeding; measurements on the tube predict the location of the tube
What feeding types are intermittent drip feeds used for?
Jejunum and duodenal feedings
What should you do before giving a nasal jejunum feeding?
Nasal jejunum feedings should be diluted
Does a gastrostomy require surgery?
No, a gastrostomy can go in percutaneously through the skin without surgery while the patient is under conscious sedation with ultrasound.
Can be put in surgically though, with sutures.
When checking the pH for nasogastric tube positioning, what should the pH be?
1-4 pH
What would the pH be from respiratory secretions?
Alkalotic pH of 7
What would the pH be from small intestine aspirates?
pH = 6
What are the steps of feeding a patient by an enteral feeding tube?
1. Wear gloves
2. Place food in bag
3. Once food in bag, prime tubing (run the food all the way through, clamp, then put tubing on pump and open roller clamp
4. If giving meds, pulverize meds before administering into enteral tubes (flush with warm sterile water before and after meds, stop feeding pump when giving meds)
What are things that can go wrong with enteral feedings?
1. Tube can be occluded
2. Liquid preparations may contribute to diarrhea
3. Contamination of feeding formula
A number of medications are hyperosmolar and can cause osmotic diarrhea if given undiluted, especially in the small intestine. What is an example of a hyperosmolar med that can be given enterally?
Acetaminophen elixir (5400 mOsm/kg) can pull water out of cells and into stool
What is the gauge of a gastrostomy tube?
16 French
Is there gauze placed underneath the plug/barrier where a gastrostomy tube is exposed?
No, no gauze underneath tubing exposure
At what rate is an NG tube set at?
Level 80/low intermittent
How often should you give enteral feedings?
Every 4 hours (food and fluid)
What tests are done before enteral feedings?
1. Gastroccult testing
2. Chest X-ray
How much water should you flush before/after giving meds enterally?
30 mL flush of water
How much food/fluid should you not exceed giving every 3 hours?
Do not exceed 400cc every 3 hours
How much nutrition should you be giving each enteral feed?
150 mL
At how many milliliters must stomach residual be in order to give feedings/meds?
Under 100 mL
Which gastronomy tube port is the inflation port?
The white port