NR 324 Adult Health 1 exam 3 FINAL/ NR 324 Adult
Health 1 (2024/2025)/ NR 324 Adult Health 1 exam 3.
Barium enema
examination of large intestine;
Before: give laxatives and enemas until clear of stool evening before
-clear liquid diet evening before
-NPO 8hr before
After: give fluids, laxatives or suppositories to assist in expelling barium
-observe stool for passage of contrast medium
-educate pt stool may be white for up to 72 hr
With a barium enema what do you want to explain to the patient in regards of what they might feel
They might feel cramping and the urge to defecate may occur
-pt will be placed in various positions
What is Enteral nutrition (EN)
Indications
Tube feeding
-nutritionally balanced liquefied food or formula into the stomach, duodenum, or jejunum
Indications:
-anorexia
-orofacial fractures
-head/neck cancer
-neurologic
-psychiatric conditions
-extensive burns
-critical illness
-chemotherapy
-radiation therapy
Contraindications to enteral nutrition
,-intentional obstruction
-ileus
-peritonitis
-bowel ischemia
-intractable vomiting and diarrhea
Enteral nutrition formulas and delivery options
-variety of formulas for patients with diabetes, liver, kidney, and lung disease
-concentrations from 1 to 2 cal/mL
-osmolarity, amount of protein, sodium, and fat vary
Delivery options:
-continuous infusion by pump
-cyclic feeding by pump
-intermittent by gravity
-intermittent bolus by syringe
Esophagastroduodenoscopy (EGD)
Visualize esophagus, stomach, duodenum
-detects inflammation, ulcerations, tumors, varices, or mallory-weiss tears
Before:
-NPO for 8 hrs
-explain that local anesthesia may be sprayed on throat
-verify signed consent
After:
-keep NPO after procedure until gag reflex returns
-gently tickle back of throat to test gag reflex
-use warm saline gargles for relief of sore throat
-check temp q15-30min for 1-2 hr
Colonoscopy
Examination of colon, biopsies and polyps removed; bowel prep before and observe for perforation
Before: low residue or full liquid diet the day before until bowel cleansing begins
-pt drinks 2L dose of oral polyethylene glycol the night before
-second 2L 4-6 hr before procedure
-explain pt will be side-lying position and sedation given
Nutrition, medication and decompression; proper technique during use, verify placement
-bc of small diameter they are more easily clogged when feedings are thick and are more difficult to use
for checking residual volumes
They are particularly prone to obstruction when oral drugs have not been thoroughly crushed and
dissolved in water before administration
-Can be dislodged by vomiting or coughing
-Can be knotted/kinked in GI tract
NG tube management
Check Aspiration risk before inserting
Obtain x-ray to confirm tube placement
If intermittent delivery is used HOB should remain elevated 30-60 min after feedings
Check gastric residual volumes before each feeding and every 4 hours during the first 48 hrs
Mark exit site at time of initial x-ray and check tuber external length at regular intervals
Observe for negative pressure when attempting to withdraw fluid from feeding
Provide skin care around tube and assess daily (rinse with sterile water )
What are the main complications of tube feedings?
Vomiting
Dehydration
Diarrhea
Constipation
-Elevate HOB a minimum of 30 degrees but preferably 46 degrees to decrease complications and risk
for aspiration
Nursing management of tube feedings
1. Check tube placement before feeding and each drug administration.
2. Assess for bowel sounds before feeding.
3. Use liquid medications rather than pills.
• Dilute viscous liquid medications.
• Do not add medications to enteral feeding formula.
4. If using tablets, crush drugs to a fine powder and dissolve in water to avoid clogging
5. Follow measures to decrease aspiration risk:
, • Keep HOB elevated to 30- to 45-degree angle.
• Check for residual volumes per facility policy.
6. Assess regularly for complications (e.g., aspiration, diarrhea, abdominal distention, hyperglycemia,
constipation, and fecal impaction).
NG tube insertion
Use a guide wire to help with correct placement
**never put guidewire back in
Goes in through the nares through the esophagus and into the stomach and may go into the duodenum
-Have patient swallow when passing through the throat
For a patient with an NG tub, what task can be delegated?
LPN: • Insert NG tube for stable patient.
• Irrigate NG and gastrostomy tubes.
• Give bolus or continuous enteral feeding for stable patient.
• Remove NG tube.
• Give medications through NG or gastrostomy tube to stable patient.
• Provide skin care around gastrostomy or jejunostomy tubes.
UAP: • Provide oral care
• Weigh pt
.• Position and maintain patient with the head of bed elevated.
• Notify RN or LPN about patient symptoms (e.g., nausea, diarrhea) that may indicate problems with
enteral feedings.
• Alert RN or LPN about enteral feeding infusion pump alarms.
• Empty drainage devices and measure output.
Gastrostomy tube
nutrition, medication; proper technique for use, verify placement, monitor for infection, HOB elevated
Ileostomy
semiliquid, fluid needs increased
-should be observed for signs and symptoms of fluid and electrolyte imbalance, particularly potassium,
sodium, and fluid deficits.
Colonostomy
Ascending- semiliquid stool, fluid needs increased
Transverse- semiliquid to semiformed stool, possibly increased fluid needs
Sigmoid- formed stool, no change in fluid needs, can regulate bowel patterns
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