Tubes Flashcards Preview

NCLEX-RN (1) Fundamentals > Tubes > Flashcards

Flashcards in Tubes Deck (52)
Loading flashcards...
1

What is a lumen in relationship to the different types of tubes?

A lumen is a tube:

  • some lumens can have multiple tubes 
  • each tube has a separate function

 

2

What is the difference between a single, double, and triple lumen?

  • a single lumen has 1 tube
  • a double lumen has 2 tubes
  • triple lumen has 3 tubes

 

3

What is a (nasogastric) NG tube and what is its function?

A nasogastric tube is inserted in the nose and placed in the stomach.

The function of an NG tube is:

  1. to remove fluids or gas (called decompression)
  2. to give meds and nutrition (called tube feedings)

4

What is the difference between NG tube feedings and total parenteral nutrition (TPN)?

NG tube feedings and TPN both give nutrients to the client but in completely different ways:

  • NG tube feedings put liquid food into a tube that goes directly into the stomach
  • TPN are nutrients that go directly into an IV

5

Is the insertion of an NG tube a sterile or non-sterile procedure?

NG tube insertion is a non-sterile procedure and clean gloves are used.

The nose, mouth, stomach, and colon are not sterile.

6

How is an NG tube measured before insertion?

NG tube measurement: NEX (Nose, Earlobe, Xiphoid process):

Measure the length of the tube from:

  1. the bridge of the nose 
  2. to the earlobe
  3. to the xiphoid process

That is the length of tubing that will be inserted. 

7

What are the steps of an NG tube insertion?

Steps for NG tube insertion:

  1. place client in high-Fowler's position
  2. measure tubing (NEX)
  3. lubricate tip
  4. insert tube and have client swallow water while head is bent forward
  5. secure tube to nose with tape

Click HERE to view an example of the NG tube insertion procedure.

8

What test is done to confirm placement of an NG tube before being used for the first time?

NG tube placement is confirmed by x-ray.

This is to make sure the tube didn't accidentally go in the lungs, brain or get coiled in the back of the throat.

9

How is NG tube placement confirmed before meds or a feeding?

Before meds or starting a feeding, check the pH of gastric secretions by aspirating a small amount:

  • pH < 3.5 indicates the tube is in the stomach

10

What is assessed before starting tube feedings?

Before starting tube feedings assess:

  1. residual amount of fluid in the stomach by using a syringe to aspirate
  2. bowel sounds to make sure they are not hyperactive

11

When should a tube feeding be held?

Hold tube feedings if:

  • the residual is > 100 mL
  • there are no bowel sounds

Healthcare providers have different preferences on when it is appropriate to hold an NG tube feeding.

12

Why should residual fluid from an NG tube always be replaced back into the stomach?

Residual fluid from an NG tube is replaced in order to prevent fluid and electrolyte imbalances.

13

What is the difference between a bolus feeding and continuous tube feeding?

  • Bolus feeding: NG tube feedings are given quickly at once and several times throughout the day
  • Continuous feeding: NG tube feedings are continuously given throughout the day

 

14

What position is a client placed in for bolus and continuous NG tube feedings?

  • Bolus feedings: high-Fowlers for 30 minutes afterward
  • Continuous feedings: semi-Fowler's at all times

These positions are to prevent aspiration.

15

What is used to flush before and after NG tube med administration and NG tube feedings?

Flush NG tubing with water or normal saline before and after meds and feedings.

Flushing is to assure that the client received all the meds or feeding and to prevent blockage in the tube.

16

How should meds be given through an NG tube?

When giving meds through an NG tube, crush meds one at a time and give one med at a time.

This prevents interactions between crushed meds.

17

Which types of meds should NOT be crushed?

Do NOT crush extended-release or enteric-coated meds.

These meds are designed to be released over a longer time. Crushing the meds causes the client to receive too much of the med too quickly.

18

What are the steps to remove an NG tube?

Steps to remove an NG tube:

  1. tell the client to take a deep breath and hold it
  2. gently pull the NG tube out while coiling it around the hand

19

What is a G-tube and J-tube?

They are both long term feeding tubes:

  • G-tube: gastrostomy tube - placed in the stomach
  • J-tube: jejunostomy tube - placed in the small intestine

20

Does placement need to be checked with a G-tube or J-tube?

No. The tube is permanently placed and comes out through the abdominal wall.

 

21

How often is a bolus tube feeding and water bolus done?

Both tube feeding and water boluses are administered about every 4 hours during the day.

22

Why do water boluses also need to be given for tube feedings?

To prevent dehydration.

23

How often does the tubing that connects to the NG tube need replacement?

Replace the tubing that is connected to the bag every 24 hours.

This is to prevent bacterial growth.

24

What is a lavage tube?

A lavage tube is used to pump out stomach contents very quickly.

It is usually used when a client has ingested poisons.

25

What is an esophageal Minnesota tube?

An esophageal Minnesota tube is used to place pressure against esophageal veins in order to control bleeding.

It is used for those with complications of cirrhosis. 

26

What should be kept at the side of the bed for a client with an esophageal Minnesota tube?

Keep scissors at the bedside.

This is in case of respiratory distress. The tube is cut to relieve the pressure.

27

What is a Foley urinary catheter?

A foley urinary catheter is inserted through the urethra to continuously drain the bladder when the client is unable to urinate.

 

28

Is the insertion of a urinary catheter a sterile or non-sterile procedure?

Sterile: the tube is entering the sterile cavity of the bladder. 

29

What are the steps to insert a Foley urinary catheter?

Steps to insert a Foley urinary catheter:

  1. wash hands
  2. clean perineal area with soap and water
  3. open catheter kit (it's sterile inside)
  4. apply sterile gloves
  5. lubricate catheter
  6. attach syringe to ballon port
  7. clean perineal area with cotton balls or swab sticks
  8. insert catheter until urine drains into bag
  9. inflate ballon and secure tubing

Click HERE to view the Foley urinary catheter insertion procedure.

30

What is a straight cath?

A straight cath is a urinary catheter that has one lumen. It is only used once to either:

  • empty the bladder
  • obtain a sterile urine specimen
  • drain residual urine after a client voids

31

What are the steps to remove a Foley urinary catheter?

Steps to remove a Foley urinary catheter:

  1. insert 10mL syringe onto ballon injection port and remove all the fluid (about 10 mL)
  2. pull catheter out slowly and smoothly

32

What is a nephrostomy tube or ileal conduit tube?

Nephrostomy tube / ileal conduit tube is a stoma that is made through the skin to drain urine from the ureters or urethra.

33

What is an endotracheal tube (ET) tube?

An endotracheal tube (ET tube) is used to maintain a patent airway.

It is used with a ventilator or Ambu bag when the patient is unable to breathe on their own.

34

How is an ET tube placement confirmed?

X-ray: the tube should be 1 to 2 cm above the carina

Assess respiratory chest wall movement with the use of Ambu bag. Both sides of the chest should inflate. If only one side inflates the tube is too deep and needs to be pulled back.

35

What is a tracheostomy (trach)?

A tracheostomy is an opening on the front of the throat directly into the trachea to establish an airway. A tube is inserted.

The client may or may not be mechanically ventilated.

36

What are the steps to suction a tracheostomy?

Steps to suction a tracheostomy:

  1. prepare suction equipment and turn on suction
  2. hyperoxygenate client
  3. apply sterile gloves
  4. insert catheter without suction applied
  5. apply suction intermittently while rotating the tube and withdrawing the catheter
  6. hyperoxygenate client

Click HERE to view the tracheostomy procedure.

37
Immediate Complication

What is the immediate action if the tracheostomy tube dislodges?

If the tracheostomy tube dislodges:

  1. extend neck and open the tissues of the stoma
  2. pull the retention sutures to spread the opening
  3. use a tracheal dilator to hold the stoma open

38
Immediate Complication

What is the immediate action if the tracheostomy tube falls out within the first 72 hours?

If the tracheostomy tube falls out within the first 72 hours:

  • manually resuscitate using an Ambu bag and call the HCP.

39

What are chest tubes?

Chest tubes drain fluid or air out of a client with a collapsed lung. 

40

What are the 3 chambers in a chest drainage unit (CDU)?

The 3 chambers in a chest drainage unit are:

  1. suction control chamber
  2. water seal chamber
  3. drainage collection chamber

41

What is the purpose of the suction control chamber in a CDU?

Suction control chamber controls the suction on how quickly or slowly fluid or air is removed.

42

What type of bubbling is expected in the suction control chamber?

In the suction control chamber expect gentle, continuous bubbling.

43

What is the purpose of the water seal chamber in a CDU?

Water seal chamber is a tube that is placed in water that allows fluid and air to drain from the pleural space but prevents air from getting back into the pleural space.

44

How should the water move in the water seal chamber?

In the water seal chamber:

  • the water moves up with inhalation
  • water moves down with exhalation

45

What does excessive or continuous bubbling in the water seal chamber indicate?

Excessive or continuous bubbling in the water seal chamber indicates a leak.

The tube may need to be clamped to figure out where the leak is.

46

What has happened if the fluctuation of water stops in the water seal chamber?

If fluctuation of water in the water seal chamber stops, it means:

  • the tube is obstructed
  • there is a dependent loop
  • the lung has re-expanded

47

What is the purpose of the drainage collection chamber in a CDU?

Drainage collection chamber collects drainage from the collapsed lung.

48
Immediate Complication

When should the HCP be notified about chest tubes?

Call HCP about chest tubes if:

  • drainage is >70 - 100 mL/hour
  • drainage suddenly becomes bright red or increases in the amount
  • chest tube comes out of client

49

Can a chest tube be milked or stripped?

NEVER milk or strip a chest tube.

"Milking the tube" is when the tube is squeezed down the length of the tube with the hand. It can cause increased pressure and damage to the lung tissue.

50
Immediate Complication

What should be kept at the bedside for a client with chest tubes?

For a client with chest tubes keep at the bedside:

  • a clamp
    • to check for leaks
  • sterile occlusive dressing
    • in case the tube comes out of the client
  • a bottle of sterile water
    • in case the tube comes out of the CDU

51
Immediate Complication

What is the immediate intervention if the chest tube drainage system breaks or cracks?

Sometimes the CDU falls over and breaks.

Put the chest tube in a bottle of sterile water to act as a water seal so air doesn't go into the client.

 

52
Immediate Complication

What is done if the chest tube comes out of the client's chest wall?

Pinch the opening shut and apply an occlusive sterile dressing taped on 3 sides.