1. 6 reasons for enteral tubes
    • 1. decompress stomach postop
    • 2. abd injury
    • 3. tx int blockage
    • 4. nutritional support
    • 5. med administration
    • 6. collecting specimens
  2. ng tube characteristics
    shorter than ni tube; inserted thru nose, down eso, and into stomach
  3. ni tube characteristics
    longer, inserted thru nose and cont into the duodenum or further
  4. two words interchangeable for ne tube
    nasointerinal and nasoenteric
  5. commonly used ni tube is called
  6. ng and ni tubes primarily used for 1
    feedings for those at risk of aspiration
  7. Examples of dx in need of ng tube
    • 1. absent gag reflex
    • 2. severe gastroesophageal relux disease GERD
  8. measurement is used in the _____ scale
    French Fr
  9. larger # ng tube, the ____ the outside of the rube
  10. common sizes of feeding tubes
    8-12 Fr and length of 36-43 in
  11. lavage means
    washing out the stomach
  12. larger bore ng tubes are __-__ Fr and used for ___________4
    16-18 Fr; gastric decompression, lavage, obtaining specimens, instilling charcoal.
  13. charcoal is used for
    poisoning or drug overdose
  14. one style of double-lumen ng tube
    salem sump pump
  15. double lumen means
    has two seperate channels inside tube
  16. describe the two lumens of salem sump pump (1)(4)
    one vents air; other for drainage, irrigation, instilling meds, or obtaining samples
  17. describe the pigtail lumen of salem sump pump
    air vent, usually blue, extends like pigtail from side of tube near end that connects to the suction tubing
  18. Describe Levin's tube
    only one lumen; used for same reasons but does not have air vent for equalization of vacuum pressure
  19. how long can ng tubes be in
    short term, over 10-14 days can result in necrosis of nasal septum
  20. define gastric decompression
    process of reducing pressure in stom by emptying it's contents, including food, liquids, gastric juices and gas
  21. which tube used for gastric decompression
    double-lumen ng thru nose to stom and connected to suction
  22. what causes mucosal irritation
    end of ng tube adheres to wall of stomach
  23. what helps prevent tube from ahering to the mucosa?
    smaller second air lumen allowing atmospheric air to be drawn into the tube to equalize vac pressure
  24. what must be on drs order for bg placement
    type, size, and purpose.
  25. what to do if info is not on dr order
    call and confirm all 3
  26. how to prepare pt
    be honest, explain; your words and approach matter
  27. preparing supplies 6
    gather supplies, wash hands, id, privacy, raise bed to wrking level, arrange supplies
  28. measuring
    tip of pt nose to earlobe to xiphoid process, mark w tape
  29. insertion
    hand signal, directions to drink and swallow, dont pull out just pause unless tube in lungs
  30. securing tube
    apply tape to nose and tube
  31. verify placement
    aspirate w irrigation syringe for gastric contents. color should be green to yellowish-brwn; check pH should be 1-4. mark insertion site.
  32. "gold standard" for placement
  33. speeds of ng suction
    cont or intermittent, hugh usually only used w intermittent
  34. maintain patency
    check q 2 h to prevent clogs, observe for cont fluctuation and movement of gastric contents thru ng tube and into drainage
  35. verify pt
    aspirate w syringe for gastric contents
  36. attaching ng to suction
    drs order, cont or intermittent suction
  37. removing ng tube
    dr order, tiss and waterproof pad, gloves, 10-20 ml air into tube, remove tape, pinch off tube, hold breath, twist and pull out, biohazard
  38. enteral nutrition
    replace oral intake or supplement
  39. needs for enteral tube
    burns, trauma, severe malnutrition, neurological problems impairing swallowing
  40. feeding tubes
    long term endoscopic placement of percutaneus feeding tube, into stom or jejunum
  41. percutaneous endoscopic gastrostomy tube (PEG)
    placed in stomach
  42. jejunostomy tube (J-tube
    placed in jejunum
  43. preventing leakage around peg tube
    tight suturing around
  44. peg and jtubes should be measured to check placement
  45. intermittent feeding
    pt on long term feedings no longer acutely ill, equal portions throughout day
  46. feeding size and time intermittent
    200-300 ml every 4-6 h
  47. intermittent feeding delivery method
    gravity via bolus or drip set with feeding pump administered over 30-60 min period
  48. temp of formula
    room temp
  49. hob intermittent feddings
    30-45 degrees feeding and 1 h after
  50. continous infusion feedings
    best administered via infusion pump at constant rate over 8-24 h period
  51. check cont infusion every 4 hrs for
    placement check, residual vol, water for hydration, flush for clogging
  52. hob in cont infusion feedings
    30 degree at all times
  53. always check placement before administering any feeding or meds
  54. residual vol is
    amount of formula still remaining in stomach from last feeding
  55. danger of residual vol
    aspiration by means of esophagus lying in vicinity of larynx
  56. what to note every day
    any redness, tenderness, irritation, or drainage indicating infection
  57. new sites should be
    cleaned w gauze and sterile saline daily
  58. new sites should be covered w
  59. complications
    n/d (indicating intolerance of formula), clogged feeding tubes, aspiration adverse event, metabolic problems, contamination
  60. metabolic problems associated w
    hyperglycemia, dehydration, fluid overload, electrolyte imbalance
  61. tip of tube referred to as
    y-port connector
  62. what hold peg in place
    gastric bumper and external disc
  63. jtube secured w
  64. hyperalimentation
    parenteral hyperalimentation is the iv infusion of basic nutrients into central vein in amnts sufficient to acheive tissue synthesis and growth
  65. complications of hyperalimentation therapy
    sweating, drowsiness or headache, shakiness, abd cramps, rash, cramps, swollen ankles, wt loss/gain
  66. what causes tube displacement
    excessive coughing, tension of tube, trach suctioning, airway intubation
  67. nasopharyngeal irrigation
    tube position
  68. diarrhea
    hypersmolar feedings, rapid infusion, temp too cold/hot, bact contamination
  69. dehydration and azotemia
    feeding w insufficient fluid intake, excessive urea from high-protein mixtures or formulas lacking fat
  70. atelactasis and possible pneumonia
    aspirated tube feeding
  71. nurse must know in obtaining specimens 5
    • 1 reason
    • 2 pt prep and teaching
    • 3 correct method for collection and handling
    • 4 care of pt after
    • 5 procedure carefully followed
  72. steps for specimen 10
    • 1 check order
    • 2 review order, assess pt, gather equipment
    • 3 explain procedure
    • 4 prepare environment
    • 5 perform procedure
    • 6 make pt comfortable n safe
    • 7 care of equipment and specimen
    • 8 send to lab
    • 9 eval pt response
    • 10 document
  73. the RIGHTS
    pt, time to be done, specimen, amnt, container, label, requisition, method, attitude
  74. requisition is
    instructions for lab
  75. 8 specimen types
    • 1 routine
    • 2 mid-stream or clean catch
    • 3 urine dipsticks
    • 4 sterile
    • 5 from cath drainage tube
    • 6 24h, preservatives/refridge
    • 7 c&s
    • 8 glucose and ketones
  76. routine specimen eg
    urinalysis ua
  77. glucose or ketones steps
    pee, void it, mark time, 24 h, refridge and no light
  78. ketones increase as
    urine stands at room temp, old urine will give false positive
  79. blood samples
    occult blood, c&s, AFB
  80. AFB stands for
    acid-fast bacillus
  81. sputum samples
    c&s, cytology, AFB
  82. when to get cough sample
    first thing is am
  83. AFB looks for
    tb and microbacterium
  84. gastric secretions samples
    pH and AFB
  85. biggest reason for inaccurate results
  86. how to prevent contamination
    place lid sterile side up, dont touch inside
  87. instruct pt on need for accuracy
    no tp no bm
  88. void as close to time possible
  89. have pt void half h before C&S and
    dont throw it away
  90. routine urinalysis
    not sterile - can be collected in clean anything
  91. note menstruation for ua
  92. label specimens w
    name, date, time
  93. clean catch or midstream
    void smal amnt, then collect midstream, discard last of urine
  94. most commonly ordered ua
    clean catch or midstream
  95. most characteristic of urine bd is making
    clean catch midstream
  96. cleansing male and female
    female cleanse labia front to back inner and outer; male circular motion tip to shaft
  97. clean catch sterile or not
    men - sterile, female - clean
  98. why is female only considered clean
    microorganisms on labia
  99. sterile specimen from indwelling cath
    obtain a 21-25 gauge needle, alcohol swab, clamp, and specimen cont
  100. clamp tube below port for how long
    30 min before specimen
  101. fculture requires how much urine
    3 ml
  102. routine ua requires at least
    10 ml
  103.  24 h urine specimen
    keep refridgerated or on ice, preservatives can be used, dark colored container
  104. urine dipsticks are used for
    glucose, protein, bilirubin, or blood
  105. kits available for urine dipstick w appropriate REAGENT
    tablets, fluids, impregnated paper, etc
  106. urine dipstick chemical touching will
    cause a chemical change
  107. normal specific gravity is
    1.010 - 1.025 g/ml
  108. instruments used for specific gravity
    urinometer or hydronometer
  109. 2 details for calibrated scale for specific gravity
    put urine in tube then the urinometer, dont allow to touch sides

    eye level reading at bottom of meniscus formed by urine, density of urine floats the urinometer
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