GI - NG Tubes Flashcards Preview

Nursing Fundamentals II > GI - NG Tubes > Flashcards

Flashcards in GI - NG Tubes Deck (106):
1

Aspirate

to remove fluids or gases by suction

2

Bolus

- a one time large dose
- meds, food

3

Carina

point at which trachea divides into right and left bronchi

4

What do you do if someone starts to cough and turn blue while you are inserting NG tube?

pull out and start over

5

What precaution do you take for someone that is in coma?

- check placement of tube
- make sure it is not in lungs

6

Cachexia

- a state of ill health, malnutrition and protein wasting
- eating own muscle

7

Decompression

- to decrease pressure
- remove contents in stomach

8

Dumping syndrome

- symptoms due to rapid entry of undigested food into jejunum
- diabetes or ng tube too long

9

How long can you leave a NG tube in?

7 to 10 days

10

Dysphagia

difficulty swallowing

11

Emesis

vomiting

12

Enterostomy

opening into stomach or jejunum through which a feeding tube is inserted

13

Why do stroke patients have an NG tube?

dysphagia, aspiration issues

14

Enteral

- within the intestines-gastro intestinal tract
- something into GI tract

15

Eructation

producing gas from the stomach, belching

16

Flatus

gas from the intestine

17

Gastrostomy

surgical creation of a gastric fistula

18

Gavage

introduction of nourishment into the GI tract by mechanical means

19

Intermittent

coming and going, suspending activity at intervals

20

Ileus

obstruction of intestine caused by paralysis of intestinal muscles

21

Nasogastric

tube that is passed through the nose into the stomach

22

Lumen

inner open space of a tube

23

Jejunostomy

surgical creating of an opening into the jejunum

24

Kwashiorkor

extreme malnutrition from severe protein insufficiency

25

Lavage

- washing out of a cavity, irrigate
- stomach - taken overdose of medicine and need to get it out

26

Parenteral

outside of the intestines

27

Patent

wide open, accessible

28

PEG

percutaneous endoscopic gastrostomy, type of NG tube

29

Regurgitation

return to the mouth from the stomach

30

Residual

what is left over

31

Salem Sump

- double lumen radiopaque gastric tube with blue pigtail
- one lumen for meds
- second lumen - safety valve

32

Reasons for NG intubation

- decompress
- instill medicine
- irrigate
- feed

33

Why would you use gravity drainage?

- sometimes for people who have fragile suture line
- suction would create bleeding
- below the bed on a hanger

34

Why would you use a NG tube to decompress?

- major GI surgery, no collection of acids, secretions in stomach
- vomit blood - need to get blood out of stomach

35

intermittent suction

on and off

36

continuous suction

on all the time

37

Why would you use a NG tube to instill medicine?

- run out of veins, rectal
- must always flush with water both before and after giving a medication

38

Why would you use a NG tube to irrigate?

- to maintain patency
- to wash out (lavage)
- GI bleed, suction out, put in ice saline to try to create vasoconstriction, last ditch approach

39

Why would you use a NG tube to feed?

- Only 7 to 10 days
- Stroke, neuromuscular disorder
- Gavage
- Bolus
- Continuous/intermittent feeding

40

What size does an NG tube come in?

- 12 to 18 French
- average is 14 french

41

How do you decide where to place NG tube?

- check nostrils for patency
- do they breathe better in one over the other
- polyps, trauma, etc...

42

When not to insert a NG tube...

- The patient is recovering from gastric, nasal, craniofacial or hypophysectomy (removal of the pituitary gland) surgery or brain/facial injuries
- If it gets pulled out do not put back in until you speak with the surgeon
- The patient may return from the OR with a NG tube in place but always check with the MD before inserting a new tube on a new GI surgical.

43

What should you elevate head of bed to when inserting NG tube?

at least 45 degrees

44

What type of lubrication do you use for NG tube insertions?

water based

45

How do you measure the length of NG tube?

- Measure from the tip of the nose to the earlobe, to the xyphoid process.
- Mark the tube before insertion.

46

Why do you set up a signal for the patient?

so they can let you know if they are having a bad time

47

How much of the NG tube do you lubricate?

first 4 inches

48

What position is the patient's head in when you first start the NG tube insertion?

the patient's head is slightly up

49

What position is the patient's head in when you pass the gag reflex?

chin toward chest

50

What can a patient do to help you advance the NG tube?

take sips of water

51

How do you check for placement of NG tube?

- use pen light to look at back of throat
- aspirate stomach contents
- hear air at end of tube
- x-ray

52

What is the pH of stomach?

- 1 to 4 but as high as 5.5
- question under 1 and over 5.5

53

What do you expect if patient is coughing after insertion of NG tube?

tube could be in trachea

54

How often should the NG tube be repositioned?

- at least once a shift
- inspected for skin or mucous membrane irritation
- loosen tape, rotate tube, look for skin irritation

55

What should you do with end of tube after insertion?

attach tube for suction or plug it

56

What do you do with tube when not feeding?

plug it

57

How do you test position of NG tube with air?

insert 10-15 mL of air and listen for it come through the tube in the stomach

58

NG tube - single lumen

must be attached to low (30-40 mm Hg) intermittent suction

59

NG tube - double lumen

- May be attached to intermittent high (120 mm Hg) suction or continuous low suction
- Stabilize blue tube above level of stomach and insert blue to blue anti-reflux valve

60

NG tube - triple lumen

- Usually used for irrigation and suction simultaneously, such as a GI bleed

61

Why provide oral care for patient with NG tube?

- Patient only has to mouth breathe
- NG tube will decrease peristalsis, oral care will stimulate this

62

How often should you offer oral care?

every two hours

63

What do you document about NG tube insertion?

- How it went
- Return - color and amount
- Toleration - patient is resting, no complaints, watching tv - state of patient when you left the room
- How did procedure go
- Chart - clean and concise, if chart went to trial what would they look for

64

What solution do you use for irrigation?

- what the dr orders
- can be water or NS

65

Why would you use NS to irrigate?

prevent electrolyte imbalance

66

How much solution do you use to irrigate?

30-40 mL

67

When would you irrigate?

- Lot of return from suction but no longer getting suction
- Patient is nauseous and want to vomit - tube is clogged

68

How do you put in solution when irrigating?

- Gently
- If fluid doesn't go in, draw back out, and try again
- If fluid still doesn't go in may need to replace the NG tube because it is more than likely clogged

69

What type of patient do you never irrigate a NG tube on?

surgical

70

What is a gastrostomy tube?

- Usually placed for long term feeding
- Stomach
- Measured in French

71

When is a jejunostomy tube used?

- May be placed if the stomach needs to be bypassed or if the stomach has been removed, etc.
- Have had gastric bypass
- Tends to be smaller, hard to get meds down
- Measured in French

72

How is a “G” or “J” tube held in place?

a balloon is often used

73

How often is site care done for "G" or "J" tubes done?

twice a day

74

How do you clean a "G" or "J" tube sight?

clean only with water, may need something more, see facility policy

75

What is proud flesh?

skin that grows around the tube may use nitrate to burn it off

76

When would you use a dressing for a "G" or "J" tube?

when drainage is present

77

Do you cut the dressing to fit the site?

- never cut, always fold
- fiber/strings can get into site and cause infection
- fold 2 four by fours and can be taped together

78

How long should the tube be for a small bore feeding tube?

NEX + 10 inches

79

What are the checks for small bore feeding?

- Air-30-60 ml then aspirate
- pH>5
- Turn patient to right side
- OBTAIN XRAY Before Starting Feeding

80

What should you do prior to starting an enteral feeding for the first time?

- xray
- air
- aspirate

81

What do you do after the first feeding?

aspirate

82

How much residual should there be prior to enteral feeding?

- no more than 50 mL
- wait and hour and recheck

83

Do you want to elevate the bed prior to feeding?

yes

84

Why do you want to check dr orders prior to feeding?

- nephro, diabetics, lactose intolerant, etc...

85

How long is a closed bag good for?

24 hours

86

How long is an open bag good for?

4 to 6 hours

87

intermittent feedings

- Usually delivered via an infusion pump
- Prime tubing so patient doesn't get a lot of air
- Check expiration date on formula

88

How long does an intermittent feeding last?

usually given over 60 minutes

89

How much formula do you give at an intermittent feeding?

not more than 200 - 400 cc’s at one feeding

90

Continuous feedings

- delivered around the clock
- water flushes given (approx. 50ml) q shift

91

How much formula is given each hour for continuous feedings?

usually 50 - 100 cc’s per hour

92

Bolus feeding

- Large volume given at one time
- Delivered via gravity flow
- More for people who don't want to be tied to a system

93

How much formula do you give at a bolus feeding?

Usually 250 - 400 ml

94

What do you do prior to starting a bolus feeding?

- Aspirate - more than 50 ml wait one hour, no gastric contents listen for air

95

How much water do you flush into a patient prior to/after a bolus feeding?

30 mL

96

Do you use a luer lock syringe to administer bolus feedings?

no, too much pressure

97

Do you push fluids with a syringe?

- no because it causes too much pressure
- use gravity flow

98

How often should the oral cavity be inspected?

once a shift with a flashlight

99

How often should oral cares be done?

every 2 hours

100

Medications via enteral tube

- Use liquid form of medication whenever possible
- Never crush medications unless approved by your institution (check policy)
- Always flush tube with H20 before and after giving medications
- Always include the H20 on the intake sheet
- Never mix medications together unless facility policy supports this practice.

101

Feeding Pump

- Feeding should not hang more than 4-6 hours with an open system
- Use feeding ordered by physician and amount to be administered
- Keep HOB elevated 30-45 degrees
- Flush using side port with 30 ml water every 4-6 hours using a new sterile syringe
- Rinse open system before adding more formula

102

What do you need to take out a NG tube?

dr orders

103

What do you do prior to with drawing the NG tube?

Flush with 10-20 ml normal saline or air-to clear tube

104

What should patient do as you take NG tube out?

hold breath

105

What should you do with NG tube as you pull it out?

rotate it to loosen tissue that may have grown on it

106

Can you give a patient something to drink after taking out a NG tube?

If they have orders - give them something to drink, not hot or icy cold, not acidic, encourage them to start with something soft