Term
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Definition
Orogastric (ICU only)
Nasogastric (NGT)
- Large bore (Salem Sump)
- Small bore (Corpak)
Naso-duodenum (ND)
Naso-jejunum (NJ)
Gastrostomy tube (GT)
Jejunostomy tube |
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Term
| Purposes of gastrointestinal intubation |
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Definition
- Decompress stomach to remove contents
- Lavage (flush) to remove toxins/meds
- Diagnose GI disorders
- Administer meds and feedings
- Compress a bleeding site
- Aspirate gastric contents for analysis |
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Term
| Complications of nasogastric intubation |
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Definition
- Aspiration or aspiration pneumonia
- Injury from insertion (performation of mucosa or lung injury from improper placement)
- Nosebleeds
- Tracheal-esophageal fistula
- Erosion or necrosis of tissue |
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Term
| Complications of nasogastric tube feedings |
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Definition
- Obstruction of tube
- Perforation of tube
- Tube migration out of correct position
- Regurgitation or aspiration of feeding
- Diarrhea, N/V
- Abdominal distention, cramping, discomfort from too much feeding or too fast a rate |
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Term
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Definition
- Initial placement checked by X-ray before infusion starts
- Before feeding check with aspiration of gastric contents
- Putting air in does not work |
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Term
| What you need to know about your patient's tube |
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Definition
Purpose
Insertion site
Distal location
Type of tube
Amount of suction
Date of insertion
Initial placement confirmed by XR
Bedside confirmation of placement |
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Term
| Purposes of large bore NGT (Salem Sump) |
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Definition
- Diagnostic: eval of gastric content
- Lavage: remove toxins, poisons
- Decompression: remove accumulated gas/contents
- Provide bowel rest in SBO
- Administer feeding/meds |
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Term
|
Definition
- Replace Salem Sump after 1-2 wks or inserted instead when only for feeding
- Can only be used for meds/feeding (no suction)
- Can't accurately measure residual (hold feeding if residual >200)
- Flush! gets clogged easily |
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Term
|
Definition
- Used for long-term feedings, comatose pts
- Inserted surgically in endoscopy lab
- Tract matures in 3-4 wks
- Nursing implications
Site care, minimize movement of tube
Feeding/med administration
Aspiration precautions |
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Term
| When to administer enteral or parenteral nutrition |
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Definition
- Patient has been or will be unable to eat for 7+ days
- Severe malnourishment or unable to meet nutritional needs orally |
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Term
| Why enteral feeding is preferred to parenteral nutrition |
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Definition
- Preferred when pt has functional gut
- Less expensive
- Less risk of infection
- More easily done at home or LTC
- Maintains mucosal integrity
- Doesn't require special IV access |
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Term
|
Definition
- When pt is on bowel rest of has malabsorption
- Supplies all necessay daily requirements
- Usually given via central line in high-flow large volume vein
- Primary complication: infection
- Change bag and tubing q24hr
- Change central line dressing with sterile technique q1wk |
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Term
|
Definition
- Need extra hydration with it
- Usually well-tolerated (start slowly and advance to ordered rate)
- Monitor for N/V, diarrhea, abd bloating and discomfort |
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Term
| Enteral nutrition aspiration precautions |
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Definition
- HOB at 45 degrees at all time
- Check placement of tube
- Check for residual, if more than 200 hold off
- Monitor respiratory status |
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Term
| What factors determine nutritional status |
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Definition
- Intake of nutrients
- Absorption of nutrients
- Nutrient metabolism
- Nutrient losses
First 3 are profoundly affected by aging (hence old ppl much more likely to be malnourished) |
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Term
| Indicators of malnutrition |
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Definition
- Weight loss of 5% in 30 days
- Weight loss of 10% in 6 months
- BMI <18 |
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Term
|
Definition
- Encourage high calorie choices
- Vitamin B12: gastric atrophy
- Calcium and vit D
- Nutrition supplement drinks btwn meals |
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Term
| Consequences of malnutrition in hospitalized pt |
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Definition
- decreased immune response
- decreased wound healing= pressure ulcers
- decreased muscle mass= functional decline
- decreased cardiac and respiratory function
- depression, fatigue
- increased rate of all complications
- increased LOS |
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Term
| Lab tests for malnutrition |
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Definition
Albumin
- Shows chronic/pre-existing malnutrition
Pre-albumin
- Shows acute malnutrition (2 day half life)
- Can be followed to assess effectiveness of nutritional interventions |
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Term
| Nursing implications of malnutrition |
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Definition
- Monitor food intake
- Monitor how long pt is NPO and get follow up meals ASAP
- May need to handfeed older pts, they need more time to eat
- Be assertive abt getting nutrition consults earlier |
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Term
|
Definition
25-29.9 is overweight
30 or higher is obese |
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Term
| Weight ranges in children (2-18 yrs) |
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Definition
- overweight: 85th-95th percentile for children of same age/sex
- obese: 95th and above percentile for children of same age/sex |
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Term
| Criteria for bariatric surgery |
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Definition
- BMI>40 or BMI>35 w/ comorbid conditions
- failure of medically supervised weight-loss programs
- absence of uncontrolled psychotic or depressive disorders
- Absence of current alcohol or substance abuse |
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Term
| Laparoscopic adjustable gastric band (LAGB) |
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Definition
Works on reducing gastric content and malabsorption
Most common procedure |
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Term
| Laparoscopic sleeve gastrectomy (LSG) |
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Definition
| Restrictive procedure and excision of the grehlin (hunger hormone) producing stomach provides added benefit of early satiety |
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Term
| Roux-en-y gastric bypass (RNYGBP) |
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Definition
- Uses restriction and malabsorption to achieve weight loss
- Food intake limited by dividing stomach to create a 15-30ml pound connected to a loop of small intestine |
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Term
| Nursing care post op bariatric surgery |
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Definition
Pain management
Wound care
Venous thromboembolism prophylaxis
Pulmonary toilet
Early and frequent ambulation
Line and drain maintenance
Fluid balance
Nutrition therapy
Continued education and emotional support |
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Term
| Why obese pts are at higher risk for wound complications |
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Definition
- Poor vascularity of adipose tissue
- Increased wound tension
- Greater intra-abdominal pressure
- Frequent presence of diabetes |
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Term
| Skin care in obese patients |
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Definition
- Pad skin folds
- Avoid plastic-lined underpads bc they create excessive heat and perspiration |
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