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Skills Lecture > Exam 6 > Flashcards

Exam 6 Flashcards

1
Q

What is digestion?

A

Mechanical breakdown of food to its simplest form.

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2
Q

What is absorption?

A

The body absorbs nutrients by means of passive diffusion, osmosis, active transport and pinocytosis

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3
Q

Metabolisms and storage of nutrients

A

All the biochemical reactions within the cells of the body

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4
Q

Elimination

A

Chyme moves by persistaltic action through the ileocecal valve into the large intestine where it becomes feces

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5
Q

What is dysphagia

A

Difficulty swallowing

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6
Q

What should not be confused with dysphagia?

A

Dysphasia which is the partial loss of language

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7
Q

What are the signs of dysphagia

A
  • Cough during eating
  • Change in voice tone or quality after swallowing
  • Abnormal movements of the mouth, tongue, or lips
  • Slow, weak, imprecise or uncoordinated speech
  • Inability to speak consistently
  • Abnormal gag, delayed swallowing
  • Incomplete oral clearance
  • Regurgitation
  • Delayed or absent trigger of swallow
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8
Q

How do you assess for dysphagia?

A

Asses for signs of dysphagia
Attempt to have pt take a small sips of water while sitting upright in high fowlers
IF DIFFICULTIES PRESENT NOTIFY DOCTOR

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9
Q

What are some complications of dysphagia

A
  • Aspiration pneumonia
  • Dehydration
  • Decreased nutritional status
  • Weight Loss
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10
Q

Patients with dysphagia become frustrated with eating and show changes in albumin levels. Increase or decrease?

A

Decrease in albumin

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11
Q

What do we want to keep in mind with pts with dysphagia and giving their meds?

A

We want to avoid PO so we give through IV

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12
Q

What is the nurses role with dysphagia patients

A
  • Review ordered diet
  • Advancing diets as tolerated by pt
  • Promoting appetite
  • Assisting with oral feedings and promote independence
  • Use of weighted silverware
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13
Q

For the most part what do you always want to assume about a pts diet in acute setting

A

NPO diet (nothing by mouth) unless diet order is different

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14
Q

What is NPO

A

Nothing by mouth

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15
Q

What do you need to ensure when pt is NPO for a long time?

A

Make sure they are receiving fluids intravenously to maintain hydrated

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16
Q

What is a clear liquid diet

A

Only clear liquids or clear solids that become clear liquids

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17
Q

What are some clear liquids?

A

Broth, coffee, tear, juice, jello, popsicles, etc.

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18
Q

What is a full liquid diet

A

Clear liquid with the addition of smooth textured dairy products such as pureed veggies, puddings, frozen yogurt, etc.

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19
Q

What is a low sodium diet?

A

1g, 2g, 4g, or 500 mg diet
From no added salt to severe sodium restriction
You would need to call cafeteria!

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20
Q

What is a low cholesterol diet

A

300 mg/day cholesterol

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21
Q

What is a gluten free diet

A

Eliminates wheat, oats, barley, and their derivatives

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22
Q

What is a regular ordered diet

A

No restrictions unless specified

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23
Q

What is the purpose of an NG tube

A
  • Enteral feeding and medication administration
  • Decompression
  • Lavage
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24
Q

What are the sizes of NG tube

A

Small bore: <12 French

Large bore: 12, 14, 16, 18 French (12 & above)

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25
Q

What is a small bore NG tube used for

A

For medication administration and enteral feedings

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26
Q

What is a large bore NG tube used for

A

For gastric decompression or removal of gastric contents

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27
Q

What tubes can deliver enteral nutrition to the pt who is unable to consume nutrients by mouth

A
  • Nasoenteric
  • Gastrotomy
  • Jejunostomy
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28
Q

When is an orogastric tube chosen

A

If the pt is intubated or has nasal trauma such as a broken nose

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29
Q

What does -ostomy refer to

A

To a surgical creation of an opening in an organ

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30
Q

What are the types of surgical tubes

A

Gastrostomy tubes

Jejunostomy tubes

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31
Q

What consideration should be made when choosing a tube

A

Aspiration risk

If pt is at high risk for aspiration, jejunal feeding is preferred

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32
Q

What are the types of gastric tubes

A 
Salem sump (Dual lumen
Levin (single lumen)
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33
Q

Which type of gastric tube is used more commonly

A

Salem Sump (Dual lumen)

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34
Q

What do you document when you insert NGT

A
  • Site of NGT
  • Which nare it was places in
  • Where it was secured (how many cm)
  • Placement verification
  • Gastric content residuals
  • Pt tolerated (without voiced complaints, reports pain?)
  • Current condition (Clamped, Suctions, Meds?)
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35
Q

What do you need to ensure when you’ve placed an NG tube

A
  • Verify the tube position hasn’t moved
  • keep tube secure to nostril or mouth
  • Ensure tube remains patent
  • Always flush tube with water before and after use
  • Ensure head of bed is elevated minimum of 30 degrees
  • Ensure tube stays above the stomach level
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36
Q

What is a PEG tube?

A

A flexible feeding tube that is placed through the abdominal wall into the stomach and requires surgical procedure for placement

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37
Q

Who can benefit from a PEG tube?

A

Patients who have difficulty swallowing, problems with their appetite or an inability to take adequate nutrition through the mouth

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38
Q

How should you care for the PEG tube

A

Clean the site once a day with diluted soap and water or normal saline
Keep site dry between cleanings
Initial dressing is needed but after 2 days no dressing is needed

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39
Q

What are some of the complications of a PEG tube

A
  • Pain a the PEG site
  • Infection at the PEG site
  • Leakage of stomach contents around the tube site
  • Dislodgement or malfunction of the tube
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40
Q

What does a PEG stand for

A

Percutaneous Endoscopic Gastrostomy

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41
Q

How does a PEG work

A

It allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus

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42
Q

How long do PEG tubes last and can they be removed?

A
  • Peg tubes can last for months or years

- B/c they can break down or become clogged or dislodged they may need to be replaced

43
Q

What steps do you need to follow when administering meds through an NGT & PEG tube

A
  • Prepare meds
  • GI assessment (Inspect, auscultate, palpate) & make sure bowels are working correctly
  • Confirm placement (Flush 30 ml of water and listen for air swoosh with steth.)
  • Check residual before each feeding/med administration by connecting syringe to port and pulling back contents
44
Q

What are residuals

A

The liquids currently in the stomach

45
Q

What do you need to do when checking residuals of NGT & PEG tube before feeding/med administrAation

A
  • Return residuals to stomach once you’ve checked for them
  • IF they are >500ml you hold the feeding and meds for 2 hrs and recheck
  • ALWAYS CHECK ORDERS TO VERIFY RESIDUAL CONTENT AMOUNT
46
Q

After assessing residuals what do you do

A

Flush tube with 30 ml of water

47
Q

What are the ways you can administer meds with NGT and PEG tube

A

-Draw liquid up into syringe, connect syringe to tubing, deliver contents. You repeat this with all meds
OR
-Disconnect plunger from syringe. Connect open syringe to port. Pour med contents in and deliver by flow of gravity until all meds have been given

48
Q

What do you need to do after you’ve administered meds through NGT and PEG tube

A
  • Flush tube with 30 ml of water

- Document meds given and how much fluid was delivered to pt

49
Q

What do you need to keep in mind when administering meds through NGT and PEG tube

A
  • Each time you disconnect the syringe from port of the NGT tube DON’T FORGET TO CLAMP!
  • Keep pt in semi to high fowlers for at least an hour after meds have been given
50
Q

When is enteral tube feeding used

A

When pts are unable to ingest food by mouth but are still able to digest and absorb nutrients

51
Q

What are some complications of enteral tube feedings

A

-Aspiration of contents leading to pneumonia and respiratory distress

52
Q

What do you need to ensure when providing tube feedings

A

Be sure pt is appropriate position throughout feeding and for at least 1 hr after feeding

53
Q

What are continuous feedings

A

They are delivered over the course of hours with a small amount given each hour

54
Q

What are bolus feedings

A

Given by syringe to the flow of gravity.

Administered similar to med administration

55
Q

What is nurses role during NGT & PEG tube feedings

A
  • Assess pt during feedings
  • Check residuals
  • Increase feedings per orders or as tolerated by pt
56
Q

The NGT was placed a few hours ago. You receive order to begin enteral tube feedings. The first step is to:
A. place the pt in prone position
B. irrigate the tube with normal saline
C. check to see that the tube is properly placed via x-ray
D. introduce a small amount of fluid into the tube before feeding

A

D. introduce a small amount of fluid into the tube before feeding

57
Q

Why would you remove a gastric tube

A
  • Temporary tube is being removed to place a permanent tube
  • Bowel obstruction resolved
  • Out of coma
  • Lavage completed
58
Q

What do you need to ensure when removing gastric tube

A
  • Flush tube with 30 ml of air (clears contents from tube)
  • Educate the pt to hold their breath during removal
  • Detach all tape while holding tube securely
  • Swiftly remove tube while pt holds breath and coil it in hand
59
Q

What is peristalsis

A

Series of involuntary wave-like muscle contractions which move food along the digestive tract

60
Q

What are the parts of the large intestine (colon) in order

A

Ascending
Transverse
Descending
Sigmoid

61
Q

What is digestion

A

Begins in the mouth and ends in the small and large intestine

62
Q

Where does absorption occur

A

Small intestine is the primary area of absorption

63
Q

How does bowel elimination happen

A

Chyme is moved through peristalsis and is changed into feces

64
Q

What is metabolism

A

All biochemical reactions within the cells of the body
Anabolic=synthesis of molecules
Catabolic=breakdown of molecules

65
Q

What parts of the body are involved in the digestive and elimination process

A

Mouth, esophagus, stomach, small intestine, large intestine, and anus

66
Q

What happens in the mouth during digestion

A

Digestion begins here with mastication

67
Q

What happens in the esophagus during digestion

A

Peristalsis moves food into the stomach

68
Q

What happens in the stomach during digestion

A

The stomach stores food, mixes food, liquid, and digestive juices; moves food into small intestines

69
Q

What happens in the small intestine during digestion

A

Absorption of nutrients

70
Q

What are the parts of the small intestine

A

Duodenum, jejunum, and ileum

71
Q

What is the large intestine responsible for

A

Its the primary organ of bowel elimination

72
Q

What is the anus responsible for

A

Expels feces and flatus from the rectum

73
Q

What factors influence bowel elimination

A
  • Age
  • Diet
  • Fluid intake
  • Physical activity
  • Psychological factors
  • Personal habits
  • Position during defecation
  • Pain
  • Surgery and anesthesia
  • Meds
74
Q

What are some common bowel elimination problems

A
  • Constipation
  • Impaction
  • Diarrhea
  • Incontinence
  • Flatulence
  • Hemorrhoids
75
Q

What is constipation

A

A symptom not a disease

Infrequent stool and/or hard, dry, small stools that are difficult to eliminate

76
Q

What is impaction

A

Results from unrelieved constipation

A collection of hardened feces wedged in the rectum that a person can’t expel

77
Q

What is diarrhea

A

An increase in the number of stools and the passage of liquid unformed feces

78
Q

What is incontinence

A

Inability to control passage of feces and has to the anus

79
Q

What is flatulence

A

Accumulation of gas in the intestines causing the walls to stretch

80
Q

What is hemorrhoids

A

Dilated, engorged veins in the lining of the rectum

81
Q

What is a bowel diversion

A

A temporary or permanent artificial opening in the abdominal wall (stoma)

82
Q

Bowel diversions are surgical openings in where?

A

The ileum of the small intestine or the colon off the large intestine

83
Q

The location of the ostomy determine what

A

Stool consistency

84
Q

What is the stool consistency with an ileostomy

A

Thin to thick liquid

85
Q

What is the stool consistency with a sigmoid colostomy

A

More formed stool

86
Q

What is the stool consistency with a transvers colostomy

A

Thich liquid to soft consistency

87
Q

What should the stoma look like

A
  • Red beefy color

- Wet, squishy, moist which indicated blood flow

88
Q

How often should you assess stoma

A

At least 1 per shift

89
Q

What are the colostomy types

A

Ascending
Transverse
Descending
Sigmoid

90
Q

What are the nutritional considerations with ostomies

A
  • Consume low fiber for the first weeks
  • Eat slowly and chew food completely
  • Drink 10-12 glasses of water daily
  • Pt may choose to avoid gassy foods
91
Q

What are the psychological considerations with ostomies

A
  • Serious body changes/self-image
  • Intimacy needs
  • Odor
92
Q

What do you want to make sure to do when collection a stool sample

A

Make sure no water or urine contaminate your stool sample

93
Q

How do you promote normal defecation

A

Sitting position
Positioning on bedpan
Develop and promote routine

94
Q

What do you want to ensure when positioning bedpan

A

That patient is sitting up either in semi or high fowlers instead of laying down. This position encourages normal defecation

95
Q

What to cathartics and laxatives do

A

Meds that initiate and facilitate stool passage

Empty the bowel

96
Q

How are cathartics and laxatives different

A

Cathartics are stronger and have a rapid effect

Laxatives can be given via oral or suppository route

97
Q

What are antidiarrheal agents

A

Decrease intestinal muscle tone to slow passage of feces

98
Q

What are enemas

A
  • Instillation of a liquid solution into the rectum and sigmoid colon
  • Promote defecation by stimulating peristalsis
  • Fluid breaks up fecal mass, stretches rectal wall and initiate the defecation reflex
99
Q

How do you administer a suppository

A
  • Wear gloves
  • Explain procedure
  • Position the patient laying on the left side (left lateral sims position)
  • Lubricate finger and med
  • insert about one inch or once you feel the med bypass the sphincter
  • Med will melt when it reaches body temp and will be absorbed
  • Can give acetaminophen through this route
100
Q

How do you administer an enema

A
  • Wear gloves
  • Explain the procedure, positioning, precautions to avoid discomfort, and length of time necessary to retain the solution before defecation
  • Administer slowly
  • Cramping most likely will occur
  • Position patient in lateral sims position
101
Q

When is digital removal of stool performed

A
  • When the fecal mass is too difficult for the patient to pass voluntarily
  • Last resort in managing severe constipation due to the discomfort and risks involved
  • AN ORDER IS NEEDED FOR THIS TO BE DONE
102
Q

What is the purpose of digital removal of stool

A

-To break up fecal mass and remove it so pt is able to voluntarily pass stool on their own

103
Q

What are the steps to digitally remove stool

A
  • Assess HR for baseline
  • Position pt to side, educate, hand hygiene, don gloves
  • Lubricate finger, insert into rectum slowly
  • Gently loosen fecal mass by massaging around it and remove small pieces slowly
  • Patient should be able to have a bowel movement voluntarily after
104
Q

What are the complications of digital removal of stool

A

-Irritation to mucosa, bleeding, possible stimulation of vagus nerve causing bradycardia

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