Summary
Summary NURB 3130 Exam 3 Study Guide
- Course
- NURB 3130
- Institution
- Northwestern State University Of Louisiana
This is a comprehensive and detailed study guide on Exam 3 for NURB 3130. *An Essential Study Resource!! Here for YOU!!
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Exam 3 SG3130
Upper GI
Chapter 46, 301-307—GI diagnostic procedures medsurg ATI
- GI series: Imaging—swallowing dye and take an x-ray
o Low fiber diet, don’t smoke or eat before this, & informed consent
o Constipation is a problem; aspiration if trouble swallowing
o Teach: drink water, plenty of fiber, get up and move around, stool softener; stool
may be a diff color following procedure (clay colored)
- Upper GI Endoscopy
- Lower GI- Colonoscopy
Digestive and GI Treatment Modalities Chapter 44
- Gastrointestinal Intubation- NG tube (Salem Sump)—Short Term use
o Nurse management: (1244) – NG & Enteral Feedings video
Explain the purpose **
Gagging will occur until it is past the throat
Placement and positioning **
Position of the blue tube is above the waste
White plug—one way anti reflux valve—prevents backflow of fluid
Keep it open
o Measuring- NG Tube Insertion
Tip of the nose, to the ear, to the xyphoid process
Mark where you measure and go that far when inserting
Ensures you aren’t in the lungs
X-ray to confirm positioning at the beginning—not daily
Or you can aspirate and check the pH
If in lung, they will cough show sx of aspiration; assess respiratory
o Secure NG Tube
Tape or a cover
Clamped or to low wall suction when not in use—depending on patient
- PEG Tube:
o Body image issues
o Skin irritation and infections—leaking of gastric contents—teach how to clean
- Nursing Diagnosis:
o Imbalanced nutrition: less than body requirements
o Risk for infection r/t presence of wound and tube
o Risk for impaired skin integrity at tube insertion site
o Disturbed body image related to presence of tube
- Nursing interventions:
o Meeting nutritional needs
o Preventing infection and providing skin care
o Enhancing body image
o Monitoring and managing potential complications
Enteral Feedings:
, - Advantages
o preserves normal sequence of intestinal and hepatic metabolism, fat metabolism
and lipoprotein synthesis, normal insulin and glucagon ratios
- CHECK PLACEMENT BEFORE FEEDING—x-ray not needed—document the tube is
in place
- Clamp your feeding before moving your patient to other parts of the hospital
- Open system: bag with a tube that you pour cans in; it can hang for 24 hours; open a new
bag label
o Pour as you need to prevent contamination
- Closed continuous: can stay for 24-48 hours; or depending on hospital policy
- continuous via pump
Monitoring with feedings:
- assessment:
o tube placement, patients position, and formula flow rate
o Elevated BS, decreased urine output, sudden weight gain, edema
o Infection control: replace open system formula 4-8 hours; tubing 24 hrs
o Check gastric residual before feeding (ever 4 with continuous)
- Oral and nasal care: every shift
o Check mucous membranes and look for dryness or breakdown
- Potential Complications: pg 1251 44-3
o GI:
o Constipation: need extra water (free water—order)—lack of water
o Diarrhea: check rate, cold formula, medications—watch F&E
o Gas/Bloating: air in tube or excess fiber—notify HCP if persistent
o N/V: change in formula or decreased gastric emptying—check residuals if >200
reassess
o Mechanical: Aspiration pneumonia, nasopharyngeal irritation, tube displacement,
tube obstruction
o Metabolic: dehydration and azotemia (excessive urea in blood); hyperglycemia
- Dumping syndrome: body has a difficult time regulating food (sugar)—dumps too
quickly into the small intestine—cause bloating, gas, tachypnea, diarrhea
o Slow the formula rate
o Administer at room temp
o Administer continuous rather than bolus
o Give minimal amount of water
o Direct result of surgical removal of a large portion of stomach and pyloric
sphincter
o ↓ ability of stomach to control amount of gastric chyme entering small intestine
Large bolus of hypertonic fluid enters intestine
↑ fluid drawn into bowel lumen
o Occurs at end of meal or 15-30 minutes after eating
Symptoms include
Weakness, sweating, palpitations, dizziness, abdominal cramps,
borborygmi, urge to defecate
Last no longer than an hour
, - DC Teaching: know how to maintain the tube and keep patient; room temp formula
- Maintaining Nutritional Balance and Tube Function
o Measure gastric residual volumes (GRV) before intermittent feedings and every 4-
8 hours during continuous feedings
o Do not mix medications with feedings
o Maintain delivery system - avoid bacterial contamination, do not hang more than
4 hours of feeding in an open system
Parenteral Nutrition:
- Indications
o Inadequate food or fluids within 7-10 day timeframe
o Table 44-4, page 1257
Insufficient oral intake
Impaired ability to absorb
- Formulas
o 1-3 liters over 24 hours
o Filter used to prevent admin of precipitate
- Monitoring
o Labs (chemistry/CBC), wt, I&Os, glucose every 4 hours
o New orders every 24 hours—labs drawn and make orders off those
- Administration Methods
o PPN (less hypertonic) via a peripheral IV—10% or less glucose
o CPN via CVAD (central) – more than 10% glucose
Teach home care—s/sx of infection (redness, drainage, smell, fatigue)
o Quality/Safety Alerts – page 1257—inspect solution before infusion (oily,
separation, or any precipitate (white crystals)
Potential complications of PN:
- Pneumothorax—get xray
- Air embolism—check caps and tubing connections
- Clotted or displaced catheter—flush
- Sepsis—qsen—meticulous aseptic technique
- Hyperglycemia/rebound hypoglycemia—check BS for hyper; don’t stop abruptly and if
you do hang d10 until you get more feedings to prevent rebound hypoglycemia
- Fluid overload—respiratory assessment (crackles)—infusion pump verify rate
Age-related:
- Arthritis, sensory impairment (can’t hear the pump), constipation, impaired thirst, obesity,
diabetes, depression/dementia, multiple medications
Management of Patients with Oral and Esophageal Disorders Chapter 45
- Cancer of Oral Cavity and Pharynx
o Curable with early diagnosis
o Risk Factors
o Use of any type of tobacco; Excessive use of alcohol; Infection with human
papillomavirus (HPV); History of previous head/neck CA
o Education against high-risk behaviors
o Usually squamous cell - Lips, lateral tongue & floor of mouth are most
common
, - Clinical Manifestations
o Early stages: little to none
o Later stages: painless sore or lesion, bleeds and will not heal
o Oral CA—red or white patch in mouth or throat; painless indurated, hard ulcer
with raised edges; as it progresses- tenderness, difficulty swallowing, chewing,
speaking, blood tinged sputum, or enlarged lymph nodes
o Human Papillomavirus Prevention
HPV vaccine
- Nursing Management
o Metastasis through the lymph system in the neck – neck dissection with
reconstruction
Neck exercises
AIRWAY
o Preoperatively - Nutritional status – enteral/parenteral feedings; adequate food
and fluids; weight
o Communication impaired
o Postoperatively – airway is priority with suction available
o Promoting mouth care
Xerostomia – dry mouth & Stomatitis – inflammation/breakdown of oral
mucosa
- Esophageal Disorders
o Achalasia
Absent or ineffective peristalsis of distal esophagus with failure of
esophageal sphincter to relax with swallowing
Slow progression
Dysphagia; food regurgitation; chest discomfort or epigastric pain &
pyrosis (heartburn); pulmonary complications – aspiration
o Treatment:
teach drink fluids and eat slowly
Calcium channel blocker helps decrease esophageal pressure
Pneumatic dilation—stretched narrowed area
Perforation is a low risk
Controlled environment
o Hiatal Hernia
Opening in diaphragm where esophagus normally passes is enlarged; part
of stomach moves up into lower portion of thorax
o 2 types - Sliding - more prominent (95%); Paraoesophageal
o Clinical Manifestations
Asymptomatic
Intermittent epigastric pain, fullness after meals
Pyrosis, regurgitation, dysphagia
Commonly associated with GERD
o Diagnostic - Barium swallow; EGD
o Treatment - Frequent, small meals; upright 1 hr. after meals***; surgical repair if
symptomatic
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