Seminar 5 Flashcards by Yaz Bassi

What are the top three quadrants of the abdomen called?

Right hypochondriac,
epigastric
left hypochondriac

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What are the middle three quadrants of the abdomen called?

right lumbar
umbillical
left lumbar

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What are the bottom three quadrants of the abdomen called?

Right illiac
Hypogastric
Left illiac

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What 6 structures are found in the right hypochondraic region?

Right lower lobe of liver
Gallbladder
Part of duodenum
Hepatic flexure of colon
Upper half of right kidney
Suprarenal gland

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What 6 structures are found in the epigastric region?

Pyloric end of stomach
Part of duodenum
Head of pancreas
Portion of liver
Aorta
Renal arteries

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What 6 structures are found in the left hydrochondriac region

Stomach
Spleen
Tail of pancreas
Splenic flexure
Upper portion of left kidney
Suprarenal gland

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what 5 structures are found in the right lumbar region

Lower half of right kidney
Hepatic flexure of colon
Ascending colon
Part of duodenum
Part of jejunum

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what 5 structures are found in the umbillical region

Lower duodenum
Jejunum
Ileum
Aorta
Femoral arteries

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What four structures are located in the left lumbar region

Descending colon
Lower half of kidney
Part of jejunum
Part of Ileum

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What 7 structures are found in the right illiac region

Cecum
Appendix
Lower end of ileum
Right femoral artery
Right ureter
Right spermatic cord
Right ovary

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what 5 structures are located in the hypogastric region

Ileum
Bladder (if distended)
Uterus (if enlarged)
Aorta
Femoral arteries

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What 5 structures are found in the left illiac region

Sigmoid colon
Left ureter
Left spermatic cord
Left femoral artery
Left ovary

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In addition to bowel sounds, what sounds are sometimes heard during abdomen auscultation

abdominal bruits

eg. aortic aneurysm

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what is enteral nutrition

The administration of nutrients directly into the gastrointestinal tract.

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In malnutrition, all lab values will be decreased, what value is typically increased?

Liver enzymes (liver damage)

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Parenteral feeding fails to stimulate the gut which results in what three complications?

villous atrophy
loss of gut mass
compromising the physical barrier (decreased surface area)

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PARENTERAL Feeding is feeding via

Feeding via an IV through a central vein

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ENTERAL Feeding is feeding via

Feeding via the stomach or intestine

With cause death if you give enteral food through a parental IV

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indications for parenteral feeding? and how is it delivered?

Indicated for patient’s with a non-functioning GI tract, delivered by a CVAD or PICC

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Short term enteral nutrition is through

nasogastric, nasoduodenal, nasojejunal

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Long term enteral nutrition is through

gastrostomy and Jejunostomy

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8 things

complications of enteral feeding

*Refeeding syndrome
*Aspiration
Metabolic problems (eg. deficiency or excess of electrolytes, vitamins, trace elements, and water)
Over-hydration
Hypo/hypernatremia
Tube dislodgement
Infection
GI side effects (nausea, abdominal bloating, cramps, regurgitation, diarrhea, constipation)

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when does refeeding syndrome occur

This occurs in previously malnourished patients who are then fed with high carbohydrate loads.

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Why does refeeding syndrome occur?

After long periods of not eating, insulin levels are low, when you suddenly feed someone fast, carb level (glucose) raises rapidly which also stimulates production of insulin. As insulin bings to our cells, it takes magnesium, potassium, phosphorus with it resulting in a decreased serum level of these electrolytes

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Refeeding syndrome can lead to

respiratory and cardiac failure :( | feed slowly

during enteral feeding, watch for signs of aspiration such as?

- Watch for increased SOB, productive cough, sputum, or difficulty swallowing - Assess gag reflex (if indicated), temperature, heart rate, and respiratory rate

in order to prevent aspiration, what should the nurse do

Ensure HOB elevated while a continuous tube feeding is running and for **1 hour** following intermittent feeds

# 8 things what contributes to a risk of aspiration with EN feeding?

Head of bed less than 30-degree angle Impaired level of consciousness (eg. sedation) Neurological deficits Poor oral health Mal-positioned feeding tube Gastroesophageal reflex Age over 60 years Delayed gastric emptying

if a patient is aspirating, how should the nurse position the patient?

Lower head of bed and put client on left side to prevent further seepage of formula into lungs

# types of feeding tubes What is considered Short-Term Feeding:

(less than 4 – 6 weeks)

NG tubes are Inserted a)...? The patient must have a b).. or c)..

a) into nostril down into the stomach b) gag reflex c) cough reflex

what does a anti-reflex valve prevent?

prevents gastric reflux or leakage through the vent lumen of a double-lumen nasogastric tube

what does a anti-reflex valve allow?

the valve allows the passage of air into the vent lumen when atmospheric pressure exceeds stomach pressure

can hard bore or large bore NG tubes be used for suction?

yes, can be used for suction as the smaller vent lumen allows for an inflow of air which prevents a vacuum if the tube adheres to the stomach wall

# HARD bore feeding tube is the salem sump double or single lumened

double

what size is a large/hard bore feeding tube

Usually 12 – 18 FR diameter

what size is a small bore feeding tube

Usually 6 -12 FR diameter

how often do soft/small bore NG tubes need to be changed?

monthly

When would a naso-enteric tube be used? | (Naso-Duodenal, Naso-Jejunal):

Used for clients at risk of aspiration

Indications for a long term feeding tube?

**BOTH of these** Inability to meet nutritional needs orally Death in not imminent **ONE of these** Longer than 4-6 weeks on NG or OG feed Low probability of nutritional needs being met orally over the next 4-6 weeks NG tube is contraindicated

# Long term feeding Gastrostomy Tube or Jejunostomy Tube (G-Tube/J-Tube) are inserted

Inserted through the abdominal wall into the stomach or the jejunem

long term feeding is usually more than a).. weeks

Usually used for more then 6 – 8 weeks

Gastrostomy Tube or Jejunostomy Tube (G-Tube/J-Tube) have a a).. incision

Larger abdominal incision

Percutaneous Endoscopic Gastrostomy (PEG) Tube, and Percutaneous Endoscopic Jejunostomy (PEJ) Tube: have a a).. incision

smaller abdominal incision

With a PEG or PEJ tube, feeding can usually start when?

shorter NPO time (often start feeds by 24 hours). | G-tube/J-tube have longer NPO times

is a PEG tube or G-tube less expensive and timely

A PEG tube is less expensive and saves time

When should long term feeding balloons be checked?

DO NOT check balloon volume for the first four weeks after insertion ***After four weeks, check balloon volume weekly or per facility policy **

What type of syringe should be used when checking the balloon on a long term feed

Use a slip tip syringe

IF a long term feeding tube becomes dislodged, the nurse should re-insert it! **TRUE OR FALSE**

FALSE

Closed System/Continuous Drip can be hung for how long?

Hang-time up to 48 hours (if sterile technique used)

Closed System/Continuous Drip tubing and bag should be changed how often

Tubing change with bag change; up to q48 hours

Open System/Bolus or Intermittent Feed are used when patient is able to

tolerate bolus feeds

how many ml are typically given with open System/Bolus or Intermittent Feed, and over how long are they administered

Usually 300 – 500 mL given several times per day, usually over 30 min time frame

How should the nurse care for open system feeding bags and tubing after intermittent feeds?

Open system feeding bags and tubing need to be rinsed with tap water, drained, and hung to dry following intermittent feeds

All feeding systems need to be labelled with:

Client Information Date/time Preparer’s initials Enteral feeding formula type, rate, strength, and amount

If there is mutiple bags or different access sites, the nurse should label where?

Label the tubing close to the client and at the site close to the source

How often should the moat or cap on the ENfit feeding tube be cleaned

once every 24 hours, and as needed if debris is present.

Tetra pack (ready to use) formula hang time?

8 hours

Reconstituted powder formula hang time?

4 hours

Closed system formula bottles hang time

– 48 hours

How often should a **open system** bag be changed?

change every 24 hours

How often should a **closed system** bag be changed

every 48 hours (or when bag empties, whichever comes first)

how often should any **attachments** (stopcocks or valves) for tube feeding be changed?

weekly

how often should tube feeding **accessory equipment** be changed

every 24 hours (syringes, bowls, cups, etc.)

What is the most accurate way to check if a feeding tube is in the correct spot

Chest x-ray

what is total free water requirement

Amount of fluid client needs in a 24-hour period to sustain life

what % of free water is in enteral feeds

60 – 85% free water

when on a enteral tube feed, what lab values should be taken daily for 3 days

Lytes, urea, creatinine, random glucose, phosphorus, magnesium

When on enteral feeding, what lab values should be check weekly (every monday) for 3 weeks

CBC, Lytes 4, urea, creatinine, random glucose, ionized calcium, phosphorus, magnesium, albumin

a standard feed should be initated at what rate

Initiate Isosource® 1.2 at 25 mL / H. If tolerated increase at 8H to 50 mL / H.

if at risk for refeeding syndrome, what rate should a enteral feed be initated at?

Isosource® 1.2 at 25 mL / H for minimum of 24H. increased to 40ml/ H ones lytes are corrected

How often should weight be taken for a client on enteral feed

(usually 2X/week)

external feeding tube length should be documented how often?

once a shift

a nurse should visually monitor tube position a)... during continuous enteral feeding and prior to each use.

q4h

Ensure the HOB is elevated a)... during all feeds

30 - 45 degrees

How often, and how many mL should be flushed with a continous feed

50 mL q4h

how many mls should be flushed before, between and after medications

15-30 before 15 between 30 after

If feeding tube is not in use, how often should the tube be flushed

Flush 50 mL BID if feeding tube not in use

J-tubes are rotated (true or false)

false, J-tubes are not rotated because it may cause it to become twisted and blocked

how often should gastrostomy tubes be rotated

once a day

If feeding is interrupted (eg. test, surgery)

, resume feeding at same rate unless ordered otherwise

Gastric Residual:

the volume of fluid remaining in the stomach before/during a gastric feed. Increased residuals may indicate delayed gastric emptying

in order to prevent blockage of thick medications (syrups)

Add 5 - 10 mL tap water

Seminar 5 Flashcards

(83 cards)