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NURS 112 - TEST 5 - UNITS F.5 & (I) > CHAPTER 54 - NASOGASTRIC INTUBATION AND ENTERAL FEEDINGS > Flashcards

CHAPTER 54 - NASOGASTRIC INTUBATION AND ENTERAL FEEDINGS Flashcards

1
Q

CHAPTER 54

A

Nasogastric Intubation and Enteral Feedings

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2
Q

Nasogastric intubation

A

insertion of a nasogastric (NG) tube
to manage gastrointestinal (GI) dysfunction /
provide enteral nutrition via NG tube

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3
Q

give enteral feedings through

A

NG / jejunal / gastric tubes

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4
Q

NG tube is a

A

hollow, flexible, cylindrical device
nurse inserts through nasopharynx into stomach.

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5
Q

INDICATIONS FOR NG TUBE

A

DECOMPRESSION
FEEDING
LAVAGE
COMPRESSION

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6
Q

Decompression

A

● Removal of gas / stomach contents
prevent / relieve distention, nausea, / vomiting

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7
Q

● Tube types: FOR DECOMPRESSION

A

Salem sump, Miller‑Abbott, Levin

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8
Q

Feeding

A

● Alternative to oral route
administering nutritional supplements

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9
Q

● Tube types: FOR FEEDING

A

● Tube types: Duo, Levin, Dobhoff

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10
Q

Lavage

A

● Washing out stomach
treat active bleeding, ingestion of poison, or for gastric dilation

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11
Q

● Tube types: FOR LAVAGE

A

● Tube types: Ewald, Levin, Salem sump

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12
Q

Compression

A

internal balloon to
apply pressure for
preventing GI /esophageal hemorrhage

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13
Q

● Tube types: FOR COMPRESSION

A

● Tube type: Sengstaken‑Blakemore

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14
Q

REVIEW CLIENT HISTORY PRIOR TO INSERTION INCLUDING

A

nasal problems, anticoagulants, previous trauma, past history of aspiration).

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15
Q

ESSENTIAL TO HAVE A MEANS OF COMMUNICATION TO SIGNAL______WHILE INSERTING

A

DISTRESS

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16
Q

NG INSERTION EQUIPMENT

A

NG tube:
◯ Tape
◯ Clean gloves
◯ Water‑soluble lubricant
◯ Topical anesthetic
◯ Cup of water / straw
◯ Catheter‑tipped syringe, usually 30 to 60 mL
◯ Basin - prepare gag‑induced nausea
◯ pH test strip / meter - gastric secretions for acidity
◯ Stethoscope
◯ Disposable towel - maintain clean environment
◯ Clamp / plug - close tubing after insertion
◯ Suction apparatus (continuous / intermittent suction
◯ Gauze square - cleanse outside tubing after insertion
◯ Safety pin / elastic band - secure TUBING / PREVENT ACCIDENTAL REMOVAL

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17
Q

INTRAPROCEDURE
NURSING ACTIONS

A

Auscultate - bowel sounds, / palpate abdomen - distention, pain, / rigidity.
● Raise bed - comfortable LEVEL for nurse.
● high‑Fowler’s position (if possible).
● Assess nares - to avoid septal deviation or other obstruction .
● If client vomits - clear airway, / provide comfort prior to continuing.
● Check placement. testing pH
● After placement verification, secure NG tube (nose), avoiding pressure on the nares.
◯ Confirm placement - x‑ray
● Clamp the NG tube, or connect it to the suction device.
●

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18
Q

● If client vomits -

A

clear airway, / provide comfort prior to continuing.

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19
Q

WHAT SHOULD THE PH LEVEL RANGE BE TO CONFIRM PALCEMENT

A

0-4

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20
Q

NOT AN ACCEPTABLE WAY TO CHECK FOR PLACEMENT

A

Injecting air into tube - listening over the abdomen is not an acceptable practice.

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21
Q

WHEN CHECKING PLACEMENT IF TUBE IS NOT IN STOMACH DO WHAT?

A

If the tube is not in the stomach, advance it 2.5 to 5 cm (1 to 2 in).

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22
Q

Salem sump tubing has a blue pigtail for

A

negative air release,

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23
Q

negative air release PREVENTS

A

preventing vacuum pressure if the tube adheres to the stomach lining and allowing secretions to drain continuously.

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24
Q

SHOULD YOU clamp Salem sump W/ blue pigtail when tube is attached to suction.

A

NO

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25
Q

POSTPROCEDURE
NURSING ACTIONS

A

insertion / maintenance - NG tube - nursing responsibility,
◯ Measure / record any drainage, (color, consistency, / odor.
◯ Document all relevant information.

26
Q

nurses may delegate WHAT PART OF NG TUBE JOB

A

measuring output, providing comfort, and giving oral care.

27
Q

WHAT RELEVANT INFO WOULD YOU DOCUMENT AFTER NG TUBE REMOVAL

A

■ Tubing removal / condition of tube
■ Volume / description of drainage
■ Abdominal assessment, (inspection, auscultation, percussion, / palpation
■ Last/ next bowel movement / urine output

28
Q

NG TUBE COMPLICATIONS

A

EXORIATION OF NARES AND STOMACH
DISCOMFORT
OCCLUSION OF NG TUBE LEADING TO DISTENSION

29
Q

EXORIATION

A

ermatillomania or excoriation disorder, skin picking disorder is where you cannot stop picking at your skin. There are things you can try to help yourself, but some people may need professional treatment.

30
Q

REMEDY FOR EXORIATION OF NARES AND STOMACH

A

water‑soluble lubricant to nares as necessary.
● Assess color of drainage. (Report dark, coffee‑ground, or blood‑streaked drainage immediately.
● Consider switching tube to other naris.

31
Q

REMEDY FOR DISCOMFORT

A

Rinse mouth w/ water - dryness.
● Throat lozenges / swabs moistened w/ water
● Rx for local anesthetic - gargling / relieve irritation.
● oral hygiene frequently.
● Replace soiled tape / loose fixation devices.

32
Q

REMEDY FOR OCCLUSION

A

Irrigate tube per facility’s protocol to unclog blockages.
Use water w/ enteral feedings.
Have client change position in case tip of tube is against stomach wall.
● Verify suction equipment functions properly.

33
Q

Enteral feeding is a method of

A

providing nutrients to clients who cannot consume foods orally but whose GI tract is functioning.

34
Q

ENTERAL FORMULAS

A

STANDARD (POLYMERIC)
MODULAR FORMULAS
ELEMENTAL FORMULAS
SPECIALTY FORMULAS

35
Q

STANDARD (POLYMERIC)

A

1 to 2 kcal/mL
● Milk‑based, blenderized foods
● Whole‑nutrient formulas, (commercial or dietary department)
● Only for - GI tract can absorb whole nutrients

36
Q

MODULAR FORMULAS

A

3.8 to 4 kcal/mL
● Single‑macronutrient preparation
● Not nutritionally complete
● Supplement to other foods

37
Q

ELEMENTAL FORMULAS

A

1 to 3 kcal/mL
● Predigested nutrients
● Not nutritionally complete
● Easier for a partially dysfunctional GI tract to absorb

38
Q

SPECIALTY FORMULAS

A

1 to 2 kcal/mL
● specific nutritional needs
● Not nutritionally complete
● for hepatic failure, respiratory disease,/ HIV infection

39
Q

ENTERAL ACCESS TUBES

A

Nasogastric or nasointestinal
Gastrostomy or jejunostomy
Percutaneous endoscopic gastrostomy or jejunostomy

40
Q

Nasogastric or nasointestinal

A

For short-term therapy
● Inserted via the nose

41
Q

Gastrostomy or jejunostomy

A

Therapy duration longer than 6 weeks
● Inserted surgically

42
Q

Percutaneous endoscopic gastrostomy or jejunostomy

A

Therapy duration longer than 6 weeks
● Inserted endoscopically

43
Q

Gastroparesis, esophageal reflux, or a history of aspiration pneumonia generally requires ___________placement.

A

INTESTINAL

44
Q

INDICATIONS FOR ENTERAL ACCESS TUBES

A

Critical illness/trauma
● Neurologic / muscular disorders: brain neoplasm, stroke, dementia, myopathy, Parkinson’s disease
● Cancer that affects head / neck, upper GI tract
● GI disorders: enterocutaneous fistula, inflammatory bowel disease, mild pancreatitis
● Respiratory failure w/ prolonged intubation
● Inadequate oral intake

45
Q

CONSIDERATIONS / NURSING ACTIONS FOR ENTERAL ACCESS TUBES

A

Infusion pump (if not a gravity drip)
◯ Appropriate enteral formula
◯ Irrigant solution: sterile or tap water

46
Q

ONGOING CARE/ NURSING ACTIONS FOR ENTERAL ACCESS TUBES

A

Check expiration dates, and note the content of the formula.
◯ Ensure that the formula is at room temperature.
semi-Fowler’s position, or elevate head of bed - minimum 30°.
● Auscultate bowel sounds.
● Monitor tube placement.
◯ Check gastric contents for pH. (0 and 4).
◯ Aspirate - residual volume.
◯ Note appearance of aspirate.
◯ Return aspirated contents, or follow the facility’s protocol.
● Flush W/ at least 30 mL water.
● Administer formula.

47
Q

Intermittent feeding

A

Hold tubing above instillation site.
■ Open stopcock on tubing, / insert barrel of syringe w/ end up.
■ Fill syringe w/ 40 to 50 mL formula.
■ IF feeding bag, fill bag w/ total amount of formula for one feeding, -hang to drain via gravity until empty (about 30 to 45 min).
■ If syringe, - hold high enough for formula empty gradually via gravity. (Continue to refill syringe until amount for feeding is instilled. Follow with at least 30 mL water to flush the tube and prevent clogging.

48
Q

Continuous‑drip feeding

A

Connect feeding bag system to feeding tube.
■ If pump, - program instillation rate, / set total volume to instill.
■ Start pump.
■ Flush enteral tubing w/ at least 30 mL water every 4 to 6 hr, / check tube placement again.
■ Monitor intake / output, / include 24‑hr totals.
■ Monitor capillary blood glucose - every 6 hr until client tolerates maximum administration rate for 24 hr.
■ Use infusion pump for intestinal tube feedings.
■ Follow manufacturer’s recommendations for formula hang time. Refrigerate unused formula, and discard after 24 hr.
gastric residual volume checks, typically every 4 to 6 hr. Check facility protocol .
■ Do not delegate this skill to assistive personnel.

49
Q

COMPLICATIONS ENTERAL TUBE ACCESS

A

Diarrhea three times or more in a 24‑hr period
Nausea or vomiting
Aspiration of formula
Skin irritation around the tubing site

50
Q

Diarrhea three times or more in a 24‑hr period - NURSING ACTIONS

A

● Slow instillation rate.
● Notify provider.
● Confer w/ dietitian.
● Provide skin care / protection.
● Consult w/ provider if client ALSO receiving antibiotics, possibly for Rx - different antibiotic.

51
Q

Nausea or vomiting - NURSING ACTIONS

A

Slow instillation rate.
● Keep HOB @ 30°.
● formula at room temperature.
● Turn client to side.
● Notify provider.
● Check tube’s patency.
● Aspirate gastric residual volume.
● Auscultate bowel sounds.
● Obtain a chest x‑ray.

52
Q

Aspiration of formula - NURSING ACTIONS

A

Withhold feeding.
● Turn client to side.
● Suction airway.
● Provide oxygen if indicated.
● Monitor vital signs - looking for elevated temperature.
● Monitor for decreased oxygen saturation or increased respiratory rate.
● Auscultate breath sounds for increased congestion.
● Notifyprovider.
● Obtain a chest x‑ray.

53
Q

Skin irritation around the tubing site - NURISNG ACTIONS

A

● Provide a skin barrier for any drainage at site.
● Monitortube’s placement.

54
Q

A nurse is delivering an enteral feeding to a client who has an NG tube in place for intermittent feedings. When the nurse pours water into the syringe after the formula drains from the syringe, the client asks the nurse why the water is necessary. Which of the following responses should the nurse make?
A. “Water helps clear the tube so it doesn’t get clogged.”
B. “Flushing helps make sure the tube stays in place.”
C. “This will help you get enough fluids.”
D. “Adding water makes the formula less concentrated.”

A

A. CORRECT: Flush the tube after instilling the feeding to help keep the NG tube patent by clearing any excess formula from the tube so that it doesn’t clump and clog the tube.
B. Tape a securing device, not flush the tube with water, to help maintain the position of the NG tube.
C. Administer additional fluids. The small amount used for flushing the NG tube will not be adequate.
D. Contact the dietary staff to prepare formula according to the prescription before the nurse instills it.

55
Q

A nurse is caring for a client who is receiving continuous enteral feedings. Which of the following nursing interventions is the highest priority when the nurse suspects aspiration of the feeding?
A. Auscultate breath sounds.
B. Stop the feeding.
C. Obtain a chest x‑ray.
D. Initiate oxygen therapy.

A

A. Listen to breath sounds whenever there is suspicion of the client aspirating. However, another assessment is the priority.
B. CORRECT: The greatest risk to the client is aspiration pneumonia. The first action to take is to stop the feeding so that no more formula can enter the lungs.
C. Obtain a chest x‑ray whenever there is suspicion of the client aspirating. However, another assessment is the priority.
D. Initiate oxygen therapy whenever there is suspicion of the client aspirating. However, another assessment is the priority.

56
Q

A nurse is preparing to instill an enteral feeding for a client who has an NG tube in place. Which of the following actions is the nurse’s highest assessment priority before performing this procedure?
A. Check how long the feeding container has been open.
B. Verify the placement of the NG tube.
C. Confirm that the client does not have diarrhea.
D. Make sure the client is alert and oriented.

A

A. Checking that the container has not exceeded its expiration date, either for having it open or for opening it, is important. However, there is a higher assessment priority among these options.
B. CORRECT: The greatest risk to the client receiving enteral feedings is injury from aspiration. The priority nursing assessment before initiating an enteral feeding is to verify proper placement of the NG tube.
C. Assess the client for any possible complications of enteral feedings (diarrhea). However, there is another assessment that is the priority.
D. Determine the client’s level of consciousness as an assessment parameter that is ongoing and should precede any procedure. However, another assessment is the priority

57
Q

A nurse is caring for a client in a long‑term care facility who is receiving enteral feedings via an NG tube. Which of the following actions should the nurse complete prior to administering the tube feeding? (Select all that apply.)
A. Auscultate bowel sounds.
B. Assist the client to an upright position.
C. Test the pH of gastric aspirate.
D. Warm the formula to body temperature.
E. Discard any residual gastric contents.

A

A. CORRECT: Auscultate for bowel sounds, because the client’s gastrointestinal tract might not be able to absorb nutrients. Then withhold feedings and notify the provider.
B. CORRECT: Place the client in an upright position, with at least a 30° elevation of the head of the bed. Upright positioning helps prevent aspiration.
C. CORRECT: Before administering enteral feedings, verify the placement of the NG tube. The only reliable method is x‑ray confirmation, which is impractical prior to every feeding. Testing the pH of gastric aspirate is an acceptable method between x‑ray confirmations.
D. Have the enteral formula at room temperature before administering the enteral feeding.
E. Return the residual to the client’s stomach, unless the volume of gastric contents is more than 250 mL or the facility has other guidelines in place

58
Q

A nurse is preparing to insert an NG tube for a client who requires gastric decompression. Which of the following actions should the nurse perform before beginning the procedure? (Select all that apply.)
A. Review a signal the client can use if feeling any distress.
B. Lay a towel across the client’s chest.
C. Administer oral pain medication.
D. Obtain a Dobhoff tube for insertion.
E. Have a petroleum‑based lubricant available.

A

A. CORRECT: Establish a means for the client to communicate that they want to stop the procedure before inserting an NG tube.
B. CORRECT: Place a disposable towel across the client’s chest to provide for a clean environment and protect the client’s gown from becoming soiled.
C. Because the purpose of the procedure is to remove stomach contents, the procedure would also remove the oral pain medication.
D. Plan to use the prescribed type of tube for gastric decompression, which is a Salem sump, Miller‑Abbott, or Levin. A Dobhoff tube is for feeding.
E. Plan to use a water‑based lubricant to reduce complications from aspiration.

59
Q

List at least four indications for enteral feedings.

A

Critical illness, trauma
● Neurologic / muscular disorders: brain neoplasm, cerebrovascular accident, dementia, myopathy, Parkinson’s disease
● GI disorders: enterocutaneous fistula, inflammatory bowel disease, mild pancreatitis
● Respiratory failure w/ prolonged intubation
● Inadequate oral intake

60
Q

List the steps of administering an enteral feeding.

A

Prepare formula and 60 mL syringe.
● Remove plunger from syringe.
● Hold tubing above instillation site.
● Open stopcock / or pinch tubing, / insert barrel of syringe w/ end up.
● Fill syringe w/ 40 to 50 mL formula.
● If feeding bag, fill bag w/ total amount of formula for one feeding, / hang to drain via gravity until empty (about 30 to 45 min).
● If syringe, hold high enough for formula to empty gradually via gravity.
● Continue refill syringe until amount for feeding is instilled.
● Follow w/ at least 30 mL water to flush tube / prevent clogging.

NURS 112 - TEST 5 - UNITS F.5 & (I) (9 decks)

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