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26 Cards in this Set
- Front
- Back
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Medical Ethics committees are hospital based
T/F |
True
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Rational analysis may be based on the following:
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-How the patient came to establish his or her health care preference
-The medical risks and benefits of a proposed intervention -The burdens that medical intervention might bear on patient and family -The effect on the patient/family quality of life -Any legal constraints, such patient being incapable of making informed decision |
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Advanced Directive
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-Statement made by person with decision making capacity indicating preference for receiving/not receiving medical Tx
-Specific to end-of-life decisions or to circumstances when medical condition is futile |
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Living will
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-a request to forego some type of medical TX in a terminal or irreversible medical condition
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should the patient not be able to make informed decisions, Durable Power of Attorney for Health Care appoints a ...
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person to act on the patients behalf regarding end of life or irreversible conditions
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Tube Feeding
Enteral |
Nasogastric- tube
Gastrostomy and Jejunostomy Tubes- G- tube Parenternal (TPN) Peripheral Parenternal Nutrition (PPN) |
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Nasogastric- tube
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goes from nose to stomach, 8-18 Fr., larger for medication and puree foods, smaller with weighted end called Dobhoff,"", usually placed in acute setting to sustain nutrition, used when medical status is thought to improve in a short time usually 3-4 weeks
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when is the nasogastric tube used?
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used when medical status is thought to improve in a short time usually 3-4 weeks
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which setting is the nasogastric tue normally used?
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usually placed in acute setting to sustain nutrition
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Gastrostomy and Jejunostomy Tubes- G- tube
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placed in stomach when digestive processes are intact, fed with formulae; J-tube into intestine (predigested formulae), patient remains at risk for aspiration
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risk for aspiration is reduced when using a gastrostomy and jejunostomy tube - G- tube T/F
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False, patient remains at risk for aspiration
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Parenternal (TPN)
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used when GI tract cannot, TPN commonly delivered to a vein like subclavian or internal jugular, can be used 4-6 weeks
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Peripheral Parenternal Nutrition (PPN)
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is through a peripheral vein and can be used 7-10 days
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when should you use Tube Feeding?
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-The patient has been unable to sustain nutrition orally, although swallow response is safe, may be quality of life issue
-The patient requires sufficient calories on a short term basis to overcome an acute medical problem -The patient is at risk for trachael aspiration if he/she is allowed to eat orally -Generally wishes of patient/family guide decision as in erosion of quality of life |
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The patient is at risk for trachael aspiration if he/she is allowed to eat orally
T/F? |
True
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Nasogastric Risks
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-uncomfortable
-poor cosmeis -distends PES and UES; may promote reflux -nasal ulceration -sinusitis -delays swallow -may trigger vagal bradycardia |
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Nasogastric Benefits
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-easy insertion
-no anesthesia -can be small bore; well tolerated -good short-term nutrition -patient can eat with tube in |
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Gastrostomy Risks
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-requires surgical placement
-infection and care at tube site -tube may full out -reflux if stomach fills too fast -diarrhea |
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Gastrostomy Benefits
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-good long-term option
-out of visual sight -easy tube replacement -easily removed -patient can eat with tube in |
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Jejunostomy Risks
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-requires surgical placement
-needs continuous drip feeding -requires hospital visit if dislodged -intolerance of special formula |
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Jejunostomy Benefits
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-may reduce reflux
-out of visual sight -good nutrition if stomach not available |
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Percutaneous Endoscopic Gastrostomy or Jejunostomy Risks
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-aspiration during procedure
-infection at tube site -potential for reflux |
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Percutaneous Endoscopic Gastrostomy or Jejunostomy Benefits
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-inserted under docal anetheis
-generally well tolerated OR time not needed |
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Aspiration Pneumonia
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Lung infection from aspiration during swallowing including saliva, retention of swallowed contents that are eventually aspirated, aspiration of gastroesophageal contents
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physical signs of aspiration pneumonia
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include shortness of breath with rapid heart rate, acute mental confusion, incontinence and infection, sometimes fever and an increase in sputum with cough, some elderly may not be symtomatic yet have infiltrates in posterior and (R) segment of lung
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Risk Factors of Aspiration Pneumonia
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Not all people who aspirate develop pneumonia, healthy people physiologically handle it, Some are at risk:
-Advanced age, compromised immune system -Patients with oral bacteria colonization who aspirate -Bedfast -Cannot self feed -Multiple medical Dx, taking many medications especially sedatives -Prior Hx of aspiration pneumonia -Respiratory impairment such as COPD |
