Nutrition & Bowel Elimination

Question 1

What are special considerations when administering medications through a tube?

Answer 1

*Use liquid when possible
*Crush medications - CHECK with pharmacy
*Capsules - CHECK with pharmacy
*Warm/room temperature water
*Elevate HOB to prevent reflux
*CHECK tube placement prior to administration

Question 2

How to give medications via a tube?

Answer 2

*Flush w 15 ccs before/after each med
*Give each med separately
*If connected to suction, leave off for 20-30 mins after administering
*Tube feeding? Check compatibility (ex:Some meds cannot be given with food)

Question 3

What are you looking for in a Post-Op GI assessment?

Answer 3

*Assess bowel sounds (listen for a full minute in each of the 4 quadrants of the abdomen)
*Abdominal distension
*Passing flatus or stool?

Question 4

What nursing interventions are important for post-op GI patients?

Answer 4

*Privacy when in bathroom
*Laxatives/stool softeners (bowel regimen should be in place to prevent constipation - ex: docusate, miralax, senna)
*Increased food/fluids - increased fiber, fruit juices

Question 5

What are nursing actions to help with post-op rest and comfort?

Answer 5

ADD

Question 6

What’s included in measurement of I’s & O’s?

Answer 6

ADD

Question 7

The energy required to carry out involuntary activities; body at rest

Answer 7

Basal metabolism

Question 8

What laboratory values are used to evaluate nutrition status?

Answer 8

Albumin - more long-term (months back)
Prealbumin - more recent measure (days back)

Question 9

When assessing dietary intake, what do you include in a 24 hr recall?

Answer 9

-All food consumed
-Portion size

Question 10

How does dehydration affect H/H levels?

Answer 10

H/H will be high

Question 11

Nasogastric tube (NG)

Answer 11

Through nose into stomach
Risk of aspirating tube feeding into lungs
Decompression & healing

Question 12

What is a common adverse reaction to an Nasointestinal tube (NI)?

Answer 12

Dumping syndrome

Question 13

How do you check the placement of an NG tube/NI tube?

Answer 13

-X-ray
-Check gastric contents and pH (however pH may be altered due to medications and tube feedings)

Question 14

A condition that can occur after gastric surgery or tube feedings when food rapidly moves from the stomach into the small intestine. Symptoms may include nausea, vomiting, abdominal cramps, diarrhea, lightheadedness, and sweating

Answer 14

Dumping syndrome

Question 15

What are the options for a long-term feeding tube?

Answer 15

ADD

Question 16

What nursing interventions are important for patients receiving tube feedings?

Answer 16

Monitor tolerance
Keep HOB elevated

Question 17

What might make stool black?

Answer 17

-Iron
-Upper GI bleed

Question 18

Before giving immodium, what do you want to rule out?

Answer 18

C diff

Question 19

Paralytic Ileus

Answer 19

Temporary stoppage of peristalsis in the small intestine for 3-5 days

Question 20

What body system does low sodium affect most?

Answer 20

Neuro

Question 21

What are signs of low potassium?

Answer 21

Weakness

Fatigue

Muscle cramps or twitching

Constipation

Arrhythmia

Question 22

What are signs of low magnesium?

Answer 22

Nystagmus
Convulsions
Fatigue
Muscle spasms or cramps
Muscle weakness
Numbness

Question 23

Is incontinence a normal part of aging?

Answer 23

No, it’s a sign of underlying disease

Question 24

Surgically formed opening from inside to outside or organ

Answer 24

Ostomy

Question 25

What are the expected findings when assessing a stoma?

Answer 25

Pink or red in color, moist, shiny

Question 26

Ileostomy vs colostomy

Answer 26

Ileostomy is in the small intestine; colostomy is in the colon ileostomy has more liquid stool; colostomy more formed

Question 27

when would an NI tube be chosen over an NG tube?

Answer 27

-pt is at increased risk for aspiration due to impaired gag reflex or slow gastric motility -gastric tumor -pt cannot have HOB elevated -GERD

Question 28

symptoms of dumping syndrome

Answer 28

Distention of the small intestine, gas, bloating, nausea, diarrhea, cramping, and lightheadedness

Question 29

techniques to check tube placement

Answer 29

-x-ray -measurement of tube length and marking the tube -visual assessment and/or checking pH of aspirate -monitoring of CO2

Question 30

when checking for placement of an NI tube what is an indication the tube has moved into the stomach?

Answer 30

sudden increase in the volume of the aspirate

Question 31

the most common feeding schedule for gastric tubes

Answer 31

intermittent feeding

Question 32

the most common feeding schedule for intestinal tubes (NI tube, jejunostomy)

Answer 32

continuous (prevents dumping syndrome)

Question 33

This feeding tube schedule involves administering continuous feeding for a portion of the 24-hour period, most often 12 hours overnight. This allows the patient to attempt eating regular meals during the day, if this is possible, making ambulation and activity easier

Answer 33

cyclic feeding

Question 34

a muscular ring that regulates the size of the opening at the end of the stomach, controls the movement of chyme from the stomach into the small intestine.

Answer 34

pyloric sphincter

Question 35

the three parts of the small intestine

Answer 35

duodenum, jejunum, ileum

Question 36

The connection between the ileum of the small intestine and the large intestine

Answer 36

Ileocecal valve

Question 37

how long is the small intestine?

Answer 37

20 ft

Question 38

how long is the large intestine?

Answer 38

5 ft

Question 39

Just for review

Answer 39

youre doing great

Question 40

how much fiber and water should a person have in a day to promote bowel elimination?

Answer 40

25 -30 g of fiber 2 -3 L of fluids

Question 41

what are some ways to avoid aspiration for a pt receiving tube feedings?

Answer 41

*check tube placement *Elevate HOB at least 30 degrees during feeding and 1 hour after *Give small, frequent feedings *Avoid oversedation of patient *Check residual volume per policy

Question 42

when do you flush the tube for tube feedings?

Answer 42

before and and after feeding every 4 hours during continuous feeding after withdrawing aspirate

Question 43

how much water do you use to flush a feeding tube initially?

Answer 43

30 mL water with a 50 or 60 mL syringe

Question 44

a potentially life-threatening condition that can occur when a malnourished individual is reintroduced to nutrition too quickly, particularly with high-calorie or high-carbohydrate intake

Answer 44

refeeding syndrome

Question 45

what are some questions to ask a pharmacist about regarding enteral medications?

Answer 45

-risk of drug clogging the tube -drug-nutrient interactions -drug-drug interactions -whether the location of the feeding tube's distal end allows safe and adequate drug delivery

Question 46

what do you use to dilute medications given through an enteral tube and flush tubing?

Answer 46

water only

Question 47

what forms of medication can be given through an enteral tube?

Answer 47

Crushed immediate release solid or oral liquid dosage forms

Question 48

what patients are at high risk for dysphagia?

Answer 48

-Acute stroke -Parkinson's disease -dementia -history of prolonged or multiple endotracheal intubations or tracheostomy

Question 49

What should you do before proceeding with a swallow screen?

Answer 49

Make sure the patient can voluntarily cough, clear his throat, and swallow saliva

Question 50

How do you do a swallow screen?

Answer 50

Offer pt sips of water and observe carefully for cough, drooling, or voice change (especially wet or gurgling quality). If any of these occur, notify the provider immediately

Question 51

What should you NOT offer to a patient who can't swallow saliva or voluntarily cough and clear his throat?

Answer 51

-Solids, liquids, or semisolids (including oral medications) -Sedatives or hypnotics (if possible) because they can impair the cough reflex and swallowing

Question 52

what is the hang time for a closed EN system?

Answer 52

24-48 hours

Question 53

What is included in intake for strict I/O's?

Answer 53

-All foods liquid at room temp -Sips of water -Flushes -Liquid medications

Question 54

What is included in ouput in strict I/O's?

Answer 54

Voiding, diarrhea, vomiting, drainage, heavy perspiration

Question 55

O2 carrying protein of RBC

Answer 55

Hemoglobin

Question 56

A measurement of the volume of red blood cells in relation to the total blood volume

Answer 56

Hematocrit

Question 57

Protein found in red blood cells that binds to oxygen and carries it from the lungs to the tissues throughout the body. Reflect the blood's capacity to carry oxygen

Answer 57

Hemoglobin

Question 58

how can dehydration mask malnutrition?

Answer 58

Dehydration may falsely inflate albumin levels because albumin will be at higher concentration

Question 59

In situations where there is muscle wasting or significant muscle loss, such as in malnutrition or certain illnesses, decreased _______ production may be observed.

Answer 59

creatinine

Question 60

what are the options for long-term feeding tubes (>4 weeks)?

Answer 60

-PEG Tube -J-tube (jejunostomy) -LPGD (low-profile gastrostomy device)

Question 61

A type of feeding tube that sits flush against the skin after placement. It is similar to a PEG tube in terms of being inserted into the stomach, but it has a low-profile design that is less prone to catching on clothing or being dislodged

Answer 61

Low profile gastrostomy device (LPGD)

Question 62

a tube that is inserted directly into the stomach through a small incision in the abdominal wall; typically used for long-term enteral feeding when a patient cannot consume adequate nutrition orally

Answer 62

PEG tube

Question 63

a tube that is inserted directly into the jejunum (the second part of the small intestine) through either a surgical procedure or endoscopy. Used when there is a need to bypass the stomach entirely, such as in cases of gastric motility disorders, gastroparesis, or significant gastric dysfunction

Answer 63

J-Tube (Jejunostomy Tube):

Question 64

What is the starting rate for tube feedings?

Answer 64

10-40mL

Question 65

How do you monitor patients for tolerance to tube feedings?

Answer 65

-No nausea/vomiting -Gastric residual minimal to none -No diarrhea/constipation -No ABD pain/distension -Presence of bowel sounds

Question 66

How many mL do you use to flush before and after tube feedings?

Answer 66

30-50mL

Question 67

How do you position patients for tube feedings?

Answer 67

HOB 30-45 degrees during & 1 hour post

Question 68

this part of the brain stem plays a significant role in the control and regulation of defecation

Answer 68

medulla

Question 69

what are the options for long-term feeding tubes (>4 weeks)?

Answer 69

-PEG Tube -J-tube (jejunostomy) -LPGD (low-profile gastrostomy device)

Question 70

Antibiotics tend to have a ____ effect

Answer 70

laxative

Question 71

How is paralytic ileus generally managed?

Answer 71

-NPO / IV fluids -Early ambulation -NG decompression to relieve distension

Question 72

what are some causes of occult blood?

Answer 72

-ulcer disease -inflammatory bowel disease -colon cancer

Question 73

Guaiac Fecal Occult Blood Test (FOBT)

Answer 73

a type of screening test used to detect the presence of hidden (occult) blood in the stool

Question 73

what are the options for long-term feeding tubes (>4 weeks)?

Answer 73

-PEG Tube -J-tube (jejunostomy) -LPGD (low-profile gastrostomy device)

Question 74

what are the options for long-term feeding tubes (>4 weeks)?

Answer 74

-PEG Tube -J-tube (jejunostomy) -LPGD (low-profile gastrostomy device)

Question 75

what are the options for long-term feeding tubes (>4 weeks)?

Answer 75

-PEG Tube -J-tube (jejunostomy) -LPGD (low-profile gastrostomy device)