Gastrointestinal - Malnutrition and NG Tubes

Question 1

Dyspepsia

Answer 1

Indegestion

Question 2

Diverticula

Answer 2

Abnormal pouchlike herniation of mucosa in colon

Question 3

Diverticulosis

Is Diverticulosis norma? What complication can come from diverticulosis?

Answer 3

Presence of many abnromal pouch like herniation

• usually harmless and normal but can become inflammed and cause SXS

Question 4

How can a decrease in appetite and a difficulty eating affect a patient?

Answer 4

• cause uninteional weight loss

Question 5

How does malnutrition affet a patients general health? How does that affect a patient’s healthcare visits?

Answer 5

• health decline progressively
  -> seek more healthcare services

Question 6

How does malnutrition affect a patients physical and cognitive status?

Answer 6

• reduction in physical and cognitive status

Question 7

How does malnutrition affect a patients living arrangements?

Answer 7

• premature moving into other living arrangements
  -> Convalscents home
  -> assisted living

Question 8

How does malnutritionn impact morbdity & mrtaltiy?

Answer 8

• increased morbidity & mortality

Question 9

How does malnurition affect a patients ADLs?

Answer 9

• difficulty with ADLs

Question 10

Describe how the following risk factors cotnribute to malnutrition:

• Tooth Loss
• ↓ Body Mass
• ↓ Activity Level
• ↓ GI enzymes
• ↓ Appetite
• ↓ Heptic Function

Answer 10

Tooth Loss:

• Gum Disease, Tooth Infection
  -> ↓ appetite

↓ Body Mass:

• low muscle stength

↓ Activity Level:

• low energy distribution

↓GI Enzymes:

• delay gastric emptying

↓ Appetite:

• dminished sene of smell & taste

↓ GI Motility:

• ↑ in GI fxn disorders
• Dysphagia, Dyspespsia, Anorexia

↓ Hepatic Function:

• ↓ liver volume, blood flow & drug metabolism

Question 11

Describe how the following risk factors contribute to malnutrition:

• Loneliness/Depression
• Limted Income
• Lack of Transportation
• Inability to Cook
• Patient Food Preferences
• Non-compliance

Answer 11

Loneliness/Depression:

• ↓ appetite for food

Limited Income:

• ↓ availability for food

Lack of Transportation:

• Inability to grocery shop

Inability to Cook:

• Functional decline
• inability to prepare meals

Paitent Food Preferences:

• Specific cultural/ethnic foods

Non-compliance to changes

• lifestyle changes
• experience chronic or acute pain

Question 12

What are common clinical manifestations of malnutrition?

Answer 12

• Indigestion
• Mastication, dysphagia
• Fluid restriction
• Constipation
• Weight loss
• Poor skin turgor
• Fatigue
• Confusion/irritability
• Dizziness

Question 13

What is Total Enteral Nutrition (TEN)?

Answer 13

delivering nutrients to the digestive tract when the person un unable to eat normally or cannot get enough nurtients through oral intake

Question 14

What are nasoenteric tubes? How long are they used for?

Answer 14

• tubes used for feedings that are inserted nasally into GI tract
• used for short term feeding, less than 4 weeks

Question 15

What are enterostomal feeding tubes? How long are they used for?

Answer 15

• direct access to GI tract using surgical, endoscopic and laproscopic techniques
• used for long term feeding

Question 16

What are the (3) types of nasoenteric tubes? How are they inserted? Where to they extend to?

Answer 16

• nasogastric tube: inserted nasally into the stomach
• nasoduodenal: inserted nasally through the stomach and into the duodenum
• nasojujenal tube: inserted nasally into the jejenum

Question 17

What are the (2) types of enterostomal feeding tubes?

Answer 17

• Gastrotomy (G-tube)
  -> Percutaneous Endoscopic Gastrostomy (PEG Tube)
• Jejunostomy tube (J-Tube)

Question 18

Describe how the following type of enterostomal tube is inserted:

Gastrostomy tube (G-Tube)

Answer 18

• stoma (opening) created from abdominal wall into stomach

Question 19

What are some possible complications of TEN?

Answer 19

DRAFT

• Diarrhea
• Refeeding syndrome
• Abdomnial Distention, N/V
• F/E Imbalance
• Tube Misplacement

Question 20

What condition/state must the body be in to be affected by Refeeding Syndrome? What effects does the condition/state of body have on the body?

Answer 20

• Starvation state (body not receiving enough nutrients, causing it to BD proteins and fats instead of carbohydrates)
  -> causes muscle and cell loss in heart, liver, and lungs

Question 21

Describe the following subcategory of Gastostomy Tube is inserted:

Percutaneous Endoscopic Gastrostomy (PEG) Tube

Answer 21

1. utilizes endoscope to guide where to create the stoma.
2. Stoma created and a short tube is placed from the stoma and into the stomach

Question 22

Describe how the following type of enterostomal tube is inserted:

Jejunostomy tube (J-Tube)

Answer 22

• Surgically Bypass stomach and advanced into jejunum site.

Question 23

Describe the physiology behind Refeeding Syndrome

Answer 23

1. Body is in Starvation State
   -> used fat & protein for energy instead of carbs
2. Feeding begins
3. The body, unaccustomed to food, release insulin to handle the new glucose in the body
4. Insulin pushes glucose and electrolytes into the cell
5. Electroylete levels drop suddenly
   -> causing hypophosphatemia, and hypokalemia

Question 24

What is tube misplacement? What complications can arise from tube misplacement?

Answer 24

• dilsodged tube into trache or peritoneal
  -> lead to aspiration pneumonia or infeciton

Question 25

In regards to TEN, what causes abdominal distention? what can abdominal distention lead to?

Answer 25

- Overfeeding -> lead to aspiration pneumonia or F/E imbalance

Question 26

In regards to TEN, how does diarrhea develop?

Answer 26

- diet intolerance - malabsoprtion of nutrients

Question 27

In regards to TEN, how can fluid/electrolyte imbalance develop?

Answer 27

- develop from isotonic & hypertoic products

Question 28

What are 3 different types of feeding?

Answer 28

* bolus feeding * continuous feeding * cyclic feeding

Question 29

Describe the following feeding type: **Bolus Feeding** (Description, Timing, Amdministration)

Answer 29

**Description:** - intermittent feeding of a specified amount of enteral product **Timing:** - administer at set intervals during 24hr period -> typically every 4-6 hours **Administration:** - Manually - Mechanical pump/controller device

Question 30

Describe the following feeding type: **Continuous Feeding** (Description, Timing, Amdministration)

Answer 30

**Description:** - set amoutns of enteral products are continuously infused 24hrs -> similar to IV therapy **Timing:** - infused continuously over a specified time **Administration:** - gravity drip - Mechanical pump/controller device

Question 31

Describe the following feeding type: **Cyclic Feeding** (Description, Timing, Amdministration)

Answer 31

**Description:** - Set amounts of feeding continuously infused, but stopped for a specified time each in 24hr period -> known as "down time" **Timing:** - continuous infusion for a portion of the day, with the infusion stoppped for a specified time -> down time is ually 6 hours or longer **Administration:** - gravity drip - Mechanical pump/controller device

Question 32

In regards to Cyclic Feedings, when does down time typically occur?

Answer 32

In the morning to allow for: - bathing - treatments - other activites

Question 33

What are methods used to verify tube placement?

Answer 33

**X-Ray** * **Chest X-Ray - BEST** * **KUB**: routine abdomnial x-ray used to verify tube aplcement **Other**: * **pH paper**

Question 34

What is considered the GOLD standard and best/perferred method to verify the placement of a tube feeding?

Answer 34

* Chest X-Ray

Question 35

What does pH paper examine? Where is pH paper typically utilized?

Answer 35

* Examine: color and consistencey of sotmach content * LTAC or Nursing Homes

Question 36

What should be checked before the administration of medications of food through tube feeding?

Answer 36

* check placement before each administration * asses insertion site for infection or excoriation

Question 37

How should the head of the bed be positioned during Bolus feeding?

Answer 37

* HOB 30 degrees during feeding and 1 hour after

Question 38

How should the head of the bed be positioned during Continuous/Cyclic feeding? Why is the HOB positioned in this manner?

Answer 38

* HOB maintained continuously at 30 degrees -> prevent aspiration

Question 39

In regard to tube feeding, How often should residuals be checked?

Answer 39

* Residuals should be checked Q4h or before each feeding

Question 40

In regards to tube feeding, why is checking residuals important? What happens if you do not check residuals?

Answer 40

- helps prevent overfeeding and ensure the patient is abosrbing and digesting tube feeding properly - if you dont check tube feeding, the feed can build up and cause vomitting or aspiration

Question 41

Describe the process of checking residuals. What are high residuals and indication of? Low residuals?

Answer 41

1. Insert/Lay the syringe to the end 2. Suction out sotmach content * Higher residuals = slow digestion * Low residuals = faster/more digestion

Question 42

How often should a feeding bag/tube be changed? Why are feeding bags/tubes changed?

Answer 42

- Changed every 24 hours -> prevent bacterial growth

Question 43

Josh is preparing to chnage a feeding bag, how would Josh go about labeling this new bag?

Answer 43

- Label the bag with patients name, amount, and type of feeding

Question 44

In regards to tube feeding, it is imporant to monitor the patients albumin level. What is the reasoning behind this?

Answer 44

- a ↓ in albumin = possible malabsorption or inflammatory bowel disease

Question 45

Abby's is preapring to turn her paitent who is currently recieving tube feeding. What should abby do before turning the patient? Why is abby doing this? What should abby do after successfully turning the patient?

Answer 45

**Before:** - pause the pump before/when turning patient -> prevent aspiration **After:** - start the pump

Question 46

When are OG/NGT tubes used? What do Og/NGT allow for?

Answer 46

- used for major trumas or need to acess stomach - allow for irrgation, suctioning and/or feeding

Question 47

What are the **indications** in whhich a **OG/NGT tube** may be required?

Answer 47

**B SNIPER** - Bowel obstruction - Short term nutiron/feeding - N/V - Inability to eat/digest food - Prolonged ileus (paralytic ileus) - Empty gastric content - Relieve distention

Question 48

What is the **Salem Sump Tube** ? Include Lumen, Function, and MISC

Answer 48

**Lumen** - Double lumen -> one lumen for suction, feeding, med adminsitration (large, white) -> Other lumen for ventilation (blue) **Function** - relieve negative pressure - aspirate gastrice juice **MISC** - most common in hospitals

Question 49

What is the **Small Bore Tube**? Include Lumen, Function, and MISC

Answer 49

**Lumen** - single lumen **Function** - short term feeding **MISC** - general term

Question 50

What is a **Dobhoff tube**? Include: Lumen, Function

Answer 50

**Lumen** - single **Function** - specialized small-bore feeding tube with weighted tip to hold in place

Question 51

The small bore tube is similar to the Dobhoff tube, but how is the Dobhoff tube different?

Answer 51

- the Dobhoff tube has a weighted tip to hold the tube in place

Question 52

What is the **Levin Tube**? Include: Lumen, Function

Answer 52

**Lumen** - single **Function** - Feeding - Medication administration

Question 53

What is the most common nasogastric tube seen in hospitals?

Answer 53

- Salem Sump Tube

Question 54

What does continuous suctioning entail?

Answer 54

- cosntant suction pressure

Question 55

What does **intermittent suctioning** entail? Why would this type of suctioning be more beneficial compared to continuous suctioning?

Answer 55

- pressure that comes on and off at intervals -> prevents damage to mucosal lining | More common in hospitals