232 terms

Nutrition and NG tube

by French system
how are catheters measure?
by the location and cause of the urinary tract problem
how are the type and size of urinary catheter determined?
who's responsible for the insertion of ureteral catheters?
who's responsible for the insertion of urethral catheters?
urinary catheters
_____ is used to maintain urinary flow to divert it to facilitate healing postoperatively, to introduce medications by irrigation, and to dilate or prevent narrowing of some portions of the urinary tract.
___ is gentle washing of an area with a stream of solution delivered through a syringe
introducing a rubber or plastic tube through the meatus and the urethra and into the urinary bladder
patient with: surgical procedures of the bladder, prostate or vagina; with primaryurologic problems such as urethral stricture, and those with multisystemic problems
patients at risk for difficulty with urine elimination
urethral catheters range from ___ for adults
ureteral catheters range from ___
coude catheter
catheters that has a tapered tip; selected for ease of insertion when enlargement of the PROSTATE GLAND is suspected
curved stylet
catheter that is used to assist the physician in the INSERTION OF A URETHRAL CATHETER IN A MALE PATIENT
foley catheter
catheter designed with a balloon near its tip that is possible to inflate after insertion, holding the catheter in the urinary bladder for continuous drainage.
malecot and de pezzer or mushroom catheters
catheter that is used to drain urine from the RENAL PELVIS OF THE KIDNEY.
robinson catheter
has MULTIPLE OPENINGS IN ITS TIP to facilitate intermittent drainage.
ureteral catheters
catheters that are long and slender to pass into the ureters
whistle-tip catheter
catheters that has a slanted, larger orifice at its tip to be used if there is blood in the urine
cystostomy, vesicostomy, or the suprapubic catheter
catheter that is introduced through the abdominal wall above the symphysis pubis to create a temporary urinary diversion; inserted via surgical incision or puncture of the abdominal and bladder walls with a trocar cannula
50 mL
using suprapubic catheter, when the measured residual urine is consistently less than ___, the catheter is usually removed and a sterile dressing placed over the wound
condom catheter or a Texas catheter
condom-styled drainage systems are sometimes referred to as...
main drawback for using this condom catheter or a Texas catheter device is that it sometimes becomes too _____
condom catheter or a Texas catheter
device is not a catheter but rather a drainage system connected to the external male genitalia; it is used for the incontinent male to keep skin irritation from urine to a minimum
employing number of principles to prevent and detect infection and trauma
nursing interventions for the patient with a urinary drainage system include...
check the drainage system for proper placement and function
if urine output falls to less than 50 mL/hr, what should the nurse do?
to irrigate the catheter and/or with a specific order from the physician
when is the only time you should open the drainage system after it is in place?
closed system
what is important to prevent urinary infections?
how many times do you perform catheter care and what type of precautions is used?
twice daily and as needed; and standard
cause urine to reenter the drainage system and contaminate the urinary tract
placing the urinary drainage bad above the level of the catheter insertion will...
when will you assess the drainage system for leaks?
prevent tension on the system or backflow of urine
what is important to know while transferring a patient with the drainage system?
kinks or compression of the drainage tube
what tend to cause pooling of urine within the urinary tract?
blood or exudate
what do you inspect in the entry site of the catheter that can indicate possible trauma or infection?
color and composition
what do you observe of the urine to note any blood or sediment?
withdraw the urine by using a sterile needle and a sterile 10 mL syringe using standard precautions
what do you do next after collecting the specimens from the catheter and cleansing the drainage port with alcohol?
bladder tone and sensation returns
after the urinary catheter is removed, some patients have difficulty voiding until...
running water, placing the patient's hands in water, or pouring water over the perineum
how will you stimulate urination?
possibly the intervention of choice for the patient who experiences spinal cord injury or other neurologic disorders that interfere with urinary elimination
clean technique
the self-catheterization procedure can be modified by ____ at home
an adequate oral fluid intake of 2000 mL/day and assisting pt to toilet on a regular, timed basis
what will help the bladder retrain and prevent the need for excessive catheterization?
indwelling catheters
self-catheterization has been shown to be successful in maintaining continence and results in fewer infections than with the use of _____
external catheters
catheter that is recommended for patient's with prostatic obstruction
urgency, frequency, hesitancy, burning and bladder spasms
signs and symptoms of urinary tract infection
perineal hygiene every 8 hours and cleansing of the first 2 inches of the catheter to remove any secretions or encrustations
to prevent UTIs, it is important that patients receive ____
loop tubing and secure it to the bed linen
before hanging the collection device from the bed frame, make sure to..
urinary incontinence
occurs because pressure in the bladder is too great or because the sphincters are too weak
pelvic floor exercises (kegel exercises)
involves tightening of the ring of muscle around the vagina and the anus for several seconds
what method is helpful when paralyzed patients have overflow incontinence?
crede's method
involves applying manual pressure over the lower abdomen to express urine from the bladder at regular intervals
bladder training
often involves developing the use of the muscles of the perineum to improve voluntary control over voiding
habit training
involves establishing a voiding schedule and provides cooperative patients with opportunity to achieve continence by voiding at regular intervals (every 1.5-2 hours)
clamp-unclamp routine
what does the physician sometimes order to improve bladder tone?
8-24 hours
following surgery, the indwelling cathter will usually be removed after ____ , depending on the type of surgery
8 hours
patients are expected to void adequately no more than ___ after catheter removal
one of the most common type of iatrogenic infections
2 L/day
after the removal of catheter, patients will need to drink atleast __ of fluids to reduce risk of infection
NG tube
flexible, hollow tube that is passed into the stomach via the nasopharynx
NG tube
serves either to remove gastric contents or to administer fluids or nutrient into the sotmach
NG tube
its primary purpose is for decompression or removal of flatus and fluids from the stomach
NG tube
helps prevent vomiting and distention caused by reduced peristalsis resulting from general anesthesia, manipulation of the viscera during surgery, or obstruction of the operative site by edema
Levin tube
one lumen and several openings near the tip
Salem sump tube
double-lumen tube, one provides an air vent and the other is for removal of gastric contents
Levin and Salem sump tube
tubes most commonly used for decompression
nose guard
a tube fixation device using a shaped adhesive patch to the nose and then to the gown with a pin to prevent unnecessary movement
decompression tube
tube that prevents nausea, vomiting, and abdominal distention
every 2 hours
when will you provide mouth care after inserting NG tube to keep dehydration to a minimum
do not swallow any water
it is important to ensure that the patient ___ after insertion of the NG tube
maintaining patient comfort and patency of the tube
what are two of the greatest challenges when inserting NG tube to a patient?
normal saline and Asepto syringe
what do you irrigate the nasogastric tube with regularly?
who is permitted to reposition the tube when certain surgical procedures have been performed?
sterile procedure
inserting a catheter is a ____
supine with thighs slightly abducted
what position do u put male patients for catheter insertion?
dorsal recumbent with knees flexed
what position do u put female patients for catheter insertion?
high Fowler's
in what position is the patient supposed to be when inserting NG tube?
the one with the greater airflow
which nostril will you put the NG tube in?
tip of nose to earlobe to xiphoid process of sternum
how will you measure the total distance when inserting the NG tube?
apply gentle downward pressure to advance tube
what do you do when resistance is felt while inserting the NG tube?
withdraw tube, allow patient to rest, relubricate tube and insert into the other nostril
what do you do when resistance continues while inserting the NG tube?
advance tube 1-2 inches
what do you do with each swallow of the patient while inserting the NG tube?
4 pH or less
gastric aspirates have decidedly acidic ____?
intermittent suction
most effective for decompression
30 degress
unless physician orders otherwise, elevate the patient's head of bed ___ to prevent esophageal reflux and keeps to a minimum irritation caused by tube against posterior pharynx
120 mm Hg
pressure indicated on gauge above ___ leads to gastric bleeding
if you hear no hissing sounds
when do you instruct the patient to cough or reposition patient in the right or left Sims' or the supine position?
gastric contents are aspirated with cone-tipped syringe
after inserting the NG tube, it is possible to be certain it is in the proper place if...
this group's diets are often filled with kilocalorie-rich and nutrient-poor snack foods
this type of diet often completely lacks fruits and vegetables and sometimes milk
iron and calcium, vitamins A and C, and folic acid
common dietary inadequacies in adolescence include..
____ needs increase with the onset of menstruation in girls, and anemia is a common problem
restrictive diets
____ sometimes cause harm by suppressing development and even leading to eating disorders
limiting TV viewing and computer usage
ways to help increase physical activity and thus increase the amount of energy expended
energy needs
what decrease with age?
decreased energy needs and reduced physical activity
combining this often result in weight gain
water, dietary fiber and adequate physical activity
what plays an important role in preventing constipation in older adults?
protein, riboflavin, vitamin B6, folic acid, vitamin B12, vitamin D and calcium
what certain nutrients do older adults may have a greater need for?
increased incidence of chronic medical conditions
this often necessitates the use of therapeutic diets in older adults
what is a common problem among nursing home residents and profoundly influences physical health and quality of life?
excessive sodium or fat restrictions
this often reduce the palatability of food and thereby contribute to poor nutritional intake
inadequate fluid intake and dehydration
what decrease thirst sensation, decreased independence, dysphagia, and incontinence?
pressure sores
what occurs in many nonambulatory residents, increasing kilocalorie, protein, and nutrient needs?
liberalized older adult diet
what diet has mild salt, fat, and concentrated sweets restrictions, but avoids severe restrictions?
liquid nutritional supplements
what often help to increase kilocalorie, protein, and nutrient intake?
a type of drug that is a central nervous system stimulant and a diuretic
300 mg/day
general recommendation for caffeine intake is less than ___
medical nutrition therapy
what is the use of specific nutrition techniques to treat an illness, injury, or condition?
therapeutic diet
what diet is used as a medical treatment?
who instructs and plans the therapeutic diet?
who often serve and monitor the therapeutic diet?
diabetes mellitus
the most common type of carbohydrate-modified diet serves in the treatment of ____
diabetes mellitus
a disease in which the body does not produce or properly use insulin
a hormone that is needed to convert sugar, starches, and other food into the energy needed for life
type I diabetes
a disease in which the body does not produce any insulin; this is most often occuring in children and young adults
type I diabetes
which type of diabetes is required to take daily insulin injections to stay alive?
type II diabetes
a metabolic disorder resulting from the body's inability to make enough or properly use insulin
whole grains, fruits, vegetables and low-fat milk
what types of food contains carbohydrates?
limit saturated fat and dietary cholesterol to help control blood lipid levels
what is the primary dietary fat goal for people with diabetes?
balancing carbohydrate intake with insulin administration
what is the goal of diet in type I diabetes?
provide nutritionally adequate meal plan that achieves and maintains desirable weight, normal blood cholesterol concentration, and normal blood glucose levels
what is the primary goal of diet in people with type II diabetes?
exchange lists
this is often used in diabetic meal planning and are often used in weight reduction programs as well
carbohydrate counting
a meal-planning approach that focuses on the total amount of carbohydrates eaten at meals and snacks
15 g
one carbohydrate choice is equal to ___ of carbohydrate
a person experiencing ___ gives the mistaken impression of being intoxicated
dumping syndrome
possible after surgery in which a portion or all of the stomach is removed (partial or total gastrectomy) or after bariatric surgery for weight reduction
lactose intolerance
this occurs as a result of a lack of the digestive enzyme lactase which causes the GI tract to unable to break down lactose
___ possible diet modifications include high kilocalorie ad protein; dietary adjustments made based on symptoms; possible tube feeding or TPN
tube feeding
what is the administration of nutritionally balanced liquefied foods or formula through a tube inserted into the stomach, the duodenum, or the jejunum by way of nasoenteric tube or a feeding ostomy?
enteral nutrition
what is the administration of nutrients in to the GI tract?
feeding ostomies
what are surgical openings through which a feeding tube passes?
continuous drip pump
what administers the formula slowly over 16-24 hours?
intermittent feedings
this involves giving a specific volume of formula over a short time, about 20-30 minutes and will usually be done 4-6 times daily
intermittent feedings
___ is preferred by many long-term tube-fed patients
Bolus feedings
this is giving a 4-6 hour volume of formula in a matter of minutes but most patients tolerates this poorly
dumping syndrome
this is possible with rapid and concentrated formula delivery
___ is the process of removing poisonous substances through gastric intubation by way of suction
checking for placement of a feeding tube before administering medication or tube feeding
what is critical to safe patient care?
radiologic confirmation
the most dependable means of checking tube placement is through ____
pH measurement
what is the second best method for confirming feeding tube placement?
auscultatory method
____ is insufflating air with a syringe through a tube and then using a stethoscope to listen for a gurgling sound over the epigastric region
esophageal varices
patients with a history of ____ should never be placed an NG tube in because it could cause uncontrolled bleeding and the patient could die
green, brown, or tan to off-white secretions
fluid is medium golden brown or bile stained
fluid is pale, clear yellow, and watery
0 to 4
gastric contents will usually have a pH range of ___
tracheobronchial and pleural secretions will usually have a pH greater than ___
7 or greater
intestinal contents will usually have a pH of __
bolus or intermittent feedings
administering the tube feeding with 60 mL bulb or plunger syringe
continuous drip method
administering the tube feeding with gavage bag
every 4 hours
when will you check residuals and verify tube placement with patients who receive continuous drip feedings?
30-60 minutes
usually continuous drip method infuses for ____ three to six times per day
feeding via infusion pump
administering the tube feeding as a continuous drip via infusion pump and lasts for no more than 8 hours
too cold or is infusing too fast
complaints of cramping possibly indicate tube feeding is ___
2 lb; fluid retention
sudden gain weight of more than ___ in 24 hours usually indicates ____
what is the most appropriate tube for tube feeding?
gastrostomy tube
aspirating gastric secretions
jejunostomy tube
aspirating intestinal secretions
syringe feedings
usually gastrostomy and jejunostomy feedings are give continuously to ensure proper absorption
continuous drip method
fill feeding with enough formula for 4 hours of feeding
every 6 hours
monitor fingerstick blood glucose ___ until maximum administration rate is reached and maintained for 24 hours
parenteral nutrition or hyperalimentation
term that is used to describe intravenous feedings and possible to administer through peripheral veins
total parenteral nutrition
refers to the administration of a hypertonic solution into a large central vein
infusing the solution into the superior vena cava via a catheter threaded through either the subclavian or the internal jugular vein
glucose, amino acids, vitamins, minerals, and electrolytes
TPN and PPN formulas are composes of....
when IV nutrition is necessary, what is the first choice of administration?
those needing 3000 kcal/day or less, those needing supplementation to oral diet, or those requiring short term therapy (less than 3 weeks)
who are the candidates for PPN?
those who need more kcal than can be administered peripherally or those requiring fluid restriction and those who have to be on IV feeding for more than 3 weeks
TPN is indicated for patients needing a highly concentrated formula such as...
concentrated formula
what delivers more kcal and nutrients in a smaller volume?
only one-third full
how much will you fill the spoon so that the patient can easily chew and swallow the mouthful?
an abnormal circulatory condition in which an embolus travels through the blood stream and becomes lodged in a blood vessel
it will sometimes increase excretion of vitamin C and possibly lead to loss of iron from the GI tract
what effect does aspirin sometimes have on nutritional status?
fat and cholesterol controlled diets
this diet helps reduce the risk of atherosclerosis and certain cancers
fat controlled diet
desirable for the prevention and treatment of atherosclerosis, heart disease, and hyperlipidemia and diabetes
fat controlled diet
limits total fat, saturated fat, and trans fatty acids
TLC diet
the first step in treatment of patients with elevated blood lipids and existing cardiovascular disease
inclusion of monosaturated fats in the diet
this often helps lower blood cholesterol and triglyceride levels
omega 3 fatty acids
a particular type of unsaturated fat found in fatty fish, flaxseed oil, and soy products
encourage moderation
rather than totally eliminating high fat foods, _____
40 inches or more
abdominal obesity waist circumference in men
35 inches or more
abdominal obesity waist circumference in women
100 mg/dL or higher
fasting blood sugar
lifestyle therapy
the first-line intervention in the treatment of metabolic sydrome
metabolic syndrome
a constellation of metabolic risk factors including abdominal obesity, dyslipidemia, elevated blood pressure and insulin resistance
patients with cystic fibrosis
experience pancreatic insufficiency and this malabsorption of fat
oral enzyme therapy
use of this before meals and snacks helps reduce malabsorption, allowing CF patients to consume a diet higher in fat
gallbladder disease
this often calls for a low fat diet
25 g/day
low fat diets sometimes restrict dat to as lttle as ____
medium chain triglycerides MCT)
this type of fat is absorbed readily and requires minimal digestion
chronic renal failure and cirrhosis of the liver
this sometimes warrant protein restrictions
renal failure
the kidney is unable to excrete protein waste products
waste products will sometimes build up in the blood stream
eggs, meat, poultry, fish, and milk products
high quality proteins are found in
plant products such as dried beans and whole grains
incomplete proteins include food products such as
often responsive to a lowered sodium intake
DASH diet
involves limiting sodium intake to either 2400 or 1500 mg/day
8-12 servings/day
DASH diet emphasizes fruit and vegetable intakes of ____
2-4 servings
DASH diet emphasizes ____ of low or nonfat milk products
restricted when water retention or edema is present
no added salt diet
the least restrictive allowing 2000-3000 mg/day of sodium
increased intake of potassium
sometimes helps with blood pressure control
dysrhythmias and sudden cardiac arrest
if dietary intake is not controlled, blood potassium levels will potentially increase to the point of causing _____
increased fluid intake
common dietary treatment for renal calculi and UTI
fluids, electrolytes, and protein
after a severe burn, these are given intravenously rather than orally because burn patients experience a temporary loss of bowel function
diabetes mellitus
carbohydrate, fat and controlled, high fiber
dumping syndrome
carbohydrate restricted, no concentrated sweets, small frequent feedings
chest tube
a tube that returns negative pressure to the intrapleural space
chest tube
used to remove abnormal accumulations of air and fluid from the pleural space
endotracheal tube
tube used to maintain a patent airway that is indicated when the client needs mechanical ventilation
sengstaken-blakemore tube
triple lumen gastric tube with an inflatable esophageal balloon, an inflatable gastric balloon and a gastric aspiration lumen
sengstaken-blakemore tube
used as a treatment modality for the client with esophageal varices
an artificial opening created in the trachea to establish an airway
Lavacuator tube
used to remove toxic substance from the stomach
Levin tube
used to drain fluid and gas from the stomach
miller abbott tube
used to drain and decompress the small intestine
every 4 hours
determine tube placement ____ and before administering feedings or medications
residual volume
check ___ every 4 hours before each feedin or before giving medications
if the residual is less than 100 mL
this means that the feeding is administered
300-400 mL of formula over a 30-60 minute period every 3-6 hours
administration of intermittent or bolus
administered continuously for 24 hours; and infusion pump regulates the flow
administered during the day or night time for 8-16 hours
continuous and cyclic feedings
what do you use a feeding pump for?
high fowler's
what position should the patient be for intermittent or bolus feeding?
semi fowler's
what position should the patient be for continuous feeding?
every 24 hours
when will you change the feeding container and tubing?
bowel sounds are absent
feedings can not be administered if ___
reinstill the residual and administer the feeding
the nurse aspirates 90 mL of residual tube feeding. what should the nurse do with the aspirated feeding?
discontinue suctioning until the client is stabilized and monitor VS
a nurse is providing endotracheal suctioning to a client who is mechanically ventilated when the client becomes restless and tachycardic. what should the nurse do?
take and hold a deep breath
when removing a NG tube, you instruct the client to __
clamp the NG tube for 30 mins after medication administration
a nurse is preparing to administer medication through a NG tube that is connected to suction. which of the following indicates the accurate procedure for medication administration?
inserts the catheter 2.5-5 cm and inflates the balloon
a nurse is inserting an indwelling urinary catheter into a male client. as the catheter is inserted into the urethra, urine begins to flow into the tubing. at this point, the nurse:
continue to monitor because this is an expected finding
a nurse is assigned to assist with caring for a client who has a chest tube. the nurse notes fluctuations of the fluid level in the water seal chamber. based on this observation, which action would be appropriate?
perform valsalva's maneuver
a nurse is assigned to assist the physician with the removal of a chest tube. the nurse instructs the client to do which of the following during this process?
hold the feeding
a nurse is preparing to administer an intermittent tube feeding to a client with a NG tube. the nurse checks the residual and obtains an amount of 200 mL. the nurse would :
air embolism
a bolus of air enters the vein through an inadequately primed IV line, from a loose connection, or during a tubing change or the removal of the IV
administered through central access when the client requires a larger concentration of carbs greater than 10% glucose concentration