Gastrointestinal Therapeutic Procedures
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Questions and Answers

What is a primary reason for initiating enteral feedings in patients?

  • Preferences for high fiber diets
  • Inability to maintain adequate oral nutritional intake (correct)
  • Avoidance of processed foods
  • Desire for quicker weight loss

Which of the following conditions would NOT typically warrant enteral feeding?

  • Burns and sepsis
  • Healthy appetite with no eating difficulties (correct)
  • Stroke
  • Head and neck cancers

A patient with which of the following conditions is most likely to require enteral feedings due to the risk of aspiration?

  • Osteoporosis
  • Diabetes Mellitus
  • Advanced Parkinson’s disease (correct)
  • Hypertension

Which of the following is an indication that a patient might benefit from enteral feeding?

<p>Decreased prealbumin and malnutrition (C)</p> Signup and view all the answers

What is the main purpose of total parenteral nutrition (TPN)?

<p>To provide nutritional support when the GI tract cannot be used (B)</p> Signup and view all the answers

What is the primary consequence of overfeeding in patients receiving enteral nutrition?

<p>Abdominal distention (C)</p> Signup and view all the answers

What is the typical action taken if residual volumes exceed 100 to 200 mL during enteral feeding?

<p>Hold feeding and restart at a lower rate after rest (A)</p> Signup and view all the answers

How often should residual checks be conducted according to standard facility policy?

<p>Every 4 to 6 hours (D)</p> Signup and view all the answers

Which of the following actions should be taken to ensure the feeding pump operates correctly?

<p>Check pump for proper operation (C)</p> Signup and view all the answers

What could be a reason that some facilities no longer require residual checks?

<p>Findings suggesting residual checks are unnecessary (D)</p> Signup and view all the answers

What is the appropriate nursing action to take if a patient experiences diarrhea during enteral feeding?

<p>Adequately warm the formula and notify the provider (A)</p> Signup and view all the answers

In which situation should a nurse consider evaluating for Clostridium difficile?

<p>When diarrhea persists and has a very foul odor (A)</p> Signup and view all the answers

Which of the following actions is most critical when managing diarrhea in a patient receiving enteral nutrition?

<p>Consult with a dietitian about the composition of the feeding (C)</p> Signup and view all the answers

What is a primary nursing action if diarrhea occurs due to cold formula infusion?

<p>Reduce the feeding rate and monitor for other symptoms (A)</p> Signup and view all the answers

What skin care measure is essential for a patient experiencing diarrhea during enteral feedings?

<p>Provide skin care and protection to prevent breakdown (C)</p> Signup and view all the answers

What is a common contributing factor to constipation?

<p>Lack of free water (D)</p> Signup and view all the answers

What nursing action could help alleviate constipation in a patient receiving tube feeding?

<p>Add water during tube flushes (C)</p> Signup and view all the answers

Which collaborative action is beneficial in addressing constipation in a patient?

<p>Collaborating with a dietitian regarding fiber (B)</p> Signup and view all the answers

Which nursing intervention can support increased physical activity to combat constipation?

<p>Collaborating with a physical therapist (B)</p> Signup and view all the answers

Which of the following is NOT a recognized cause of constipation?

<p>Increased fiber intake (C)</p> Signup and view all the answers

What is the primary cause of aspiration pneumonia in the context of feeding?

<p>Tube displacement (C)</p> Signup and view all the answers

Which nursing action is crucial for preventing aspiration pneumonia during enteral feedings?

<p>Confirming tube placement (A)</p> Signup and view all the answers

When managing a patient suspected of aspiration pneumonia, which action should a nurse take first?

<p>Stop the feeding (C)</p> Signup and view all the answers

Which of the following symptoms should be monitored for indicating a possible aspiration pneumonia?

<p>Elevated temperature (C)</p> Signup and view all the answers

What should a nurse do if breath sounds indicate increased congestion during feedings?

<p>Notify the provider and perform suctioning (B)</p> Signup and view all the answers

What is refeeding syndrome primarily associated with?

<p>Starting enteral feeding in a patient who is in a starvation state. (C)</p> Signup and view all the answers

Which symptom should a nurse monitor for as a possible indicator of refeeding syndrome?

<p>New onset of confusion or seizures. (A)</p> Signup and view all the answers

What nursing action is appropriate if a patient displays signs of refeeding syndrome?

<p>Assess for shallow respirations and muscular weakness. (C)</p> Signup and view all the answers

Which laboratory test should a nurse consider if refeeding syndrome is suspected?

<p>Blood electrolytes to assess for imbalances. (B)</p> Signup and view all the answers

What is a potential complication of refeeding syndrome that nursing staff should be vigilant about?

<p>Severe dehydration and electrolyte depletion. (C)</p> Signup and view all the answers

What is the primary route for administering total parenteral nutrition (TPN)?

<p>Central line (A)</p> Signup and view all the answers

Which of the following components is typically found in total parenteral nutrition (TPN)?

<p>Vitamins and trace elements (B)</p> Signup and view all the answers

What is a common risk associated with the administration of peripheral parenteral nutrition (PPN)?

<p>Phlebitis (B)</p> Signup and view all the answers

In which scenario would total parenteral nutrition (TPN) most likely be indicated?

<p>Chronic malnutrition (D)</p> Signup and view all the answers

What dextrose concentration is typically found in peripheral parenteral nutrition (PPN)?

<p>10% or less (A)</p> Signup and view all the answers

Which condition is a potential diagnosis for total parenteral nutrition?

<p>Chronic pancreatitis (B)</p> Signup and view all the answers

A patient requiring total parenteral nutrition is most likely to present with which symptom?

<p>Weight loss greater than 10% of body weight (B)</p> Signup and view all the answers

Which of the following is NOT a client presentation that supports the need for total parenteral nutrition?

<p>Improved appetite (D)</p> Signup and view all the answers

Which factor contributing to a patient's condition would most likely lead to a recommendation for total parenteral nutrition?

<p>Inability to absorb nutrients due to bowel disease (B)</p> Signup and view all the answers

In which situation would total parenteral nutrition be most critical?

<p>Severe burns with extensive tissue loss (A)</p> Signup and view all the answers

What is an important first step in the preparation of a client for total parenteral nutrition (TPN)?

<p>Determine the client’s readiness for TPN (A)</p> Signup and view all the answers

Which laboratory values should be monitored daily for a client receiving TPN?

<p>Daily laboratory values, including electrolytes (B)</p> Signup and view all the answers

What is the recommended rate change when adjusting the flow rate for TPN?

<p>Increasing or decreasing by no more than 10% each hour (C)</p> Signup and view all the answers

Why is it important to customize TPN solutions based on daily laboratory results?

<p>To ensure the solutions meet the client’s nutritional needs (D)</p> Signup and view all the answers

What is a potential consequence of not adjusting the flow rate gradually when administering TPN?

<p>Increased risk of metabolic derangements (A)</p> Signup and view all the answers

What is the consequence of abruptly changing the rate of total parenteral nutrition (TPN)?

<p>Alteration of blood glucose levels (C)</p> Signup and view all the answers

What is the purpose of changing the TPN tubing and solution bag every 24 hours?

<p>To maintain the sterility of the solution (A)</p> Signup and view all the answers

Which measure is essential when preparing the TPN solution?

<p>Following aseptic technique with a laminar flow hood (A)</p> Signup and view all the answers

What should be monitored daily in patients receiving TPN?

<p>Daily weight (B)</p> Signup and view all the answers

Why should the TPN IV line not be used for other IV bolus solutions?

<p>To prevent contamination and interruption of the flow rate (D)</p> Signup and view all the answers

What should be checked in clients receiving total parenteral nutrition (TPN) every 4 to 6 hours during the first 24 hours?

<p>Capillary glucose levels (B)</p> Signup and view all the answers

Why is supplemental regular insulin often required for clients on total parenteral nutrition?

<p>The pancreas may not produce enough insulin initially (D)</p> Signup and view all the answers

What is the primary reason for keeping dextrose 10% in water at the bedside for TPN patients?

<p>To reduce risk of hypoglycemia during abrupt changes (D)</p> Signup and view all the answers

What should NOT be done if a TPN bag is unavailable or administered late?

<p>Increase the infusion rate to catch up (A)</p> Signup and view all the answers

How does age affect glucose tolerance in clients receiving TPN?

<p>Older adults tend to have decreased glucose intolerance (D)</p> Signup and view all the answers

What is a common metabolic complication associated with total parenteral nutrition (TPN)?

<p>Hyperglycemia (D)</p> Signup and view all the answers

Which nursing action is essential for ensuring the safety and appropriateness of a patient's TPN regimen?

<p>Review results of daily laboratory monitoring for TPN components (A)</p> Signup and view all the answers

What is the appropriate response if a patient develops signs of hyperglycemia while receiving TPN?

<p>Monitor blood glucose levels closely and administer insulin if necessary (C)</p> Signup and view all the answers

What is the primary goal when replacing fluid needs in a patient receiving total parenteral nutrition?

<p>To prevent fluid volume excess (B)</p> Signup and view all the answers

Which of the following vitamin deficiencies is a possible metabolic complication of TPN?

<p>Vitamin B12 deficiency (C)</p> Signup and view all the answers

What should be done immediately if an air embolism is suspected during total parenteral nutrition administration?

<p>Clamp the catheter and place the client on their left side in Trendelenburg position. (C)</p> Signup and view all the answers

Which of the following symptoms should a nurse monitor for when assessing a patient for signs of an air embolism?

<p>Sudden onset of dyspnea. (C)</p> Signup and view all the answers

Why is it important to notify a provider if an air embolism is suspected?

<p>So trapped air can be aspirated. (D)</p> Signup and view all the answers

What is the best immediate nursing action if a patient begins to show anxiety and hypoxia during TPN administration?

<p>Provide supplemental oxygen and clamp the catheter. (D)</p> Signup and view all the answers

What is the primary reason for placing a client on their left side in Trendelenburg position during air embolism management?

<p>To promote venous return to the heart. (C)</p> Signup and view all the answers

What is a critical nursing action to mitigate the risk of infection when administering total parenteral nutrition (TPN)?

<p>Regularly inspect the central line insertion site for signs of infection. (A)</p> Signup and view all the answers

Which factor increases the risk of fluid imbalance in clients receiving total parenteral nutrition?

<p>TPN is hyperosmotic, leading to potential fluid shifts. (B)</p> Signup and view all the answers

What is an appropriate nursing intervention if a patient experiences systemic infection symptoms while on TPN?

<p>Notify the physician and administer prescribed antibiotics as needed. (C)</p> Signup and view all the answers

How should TPN be administered to avoid complications?

<p>Use a controlled infusion pump to maintain the prescribed rate. (C)</p> Signup and view all the answers

What should be monitored closely to assess for fluid volume excess in patients receiving total parenteral nutrition?

<p>Patient weight and intake/output records. (B)</p> Signup and view all the answers

What is the primary therapeutic goal of performing a paracentesis?

<p>Relief of abdominal ascites pressure (C)</p> Signup and view all the answers

In which settings can a paracentesis be appropriately performed?

<p>In a provider’s office, outpatient center, or acute care setting (C)</p> Signup and view all the answers

Why is ultrasound commonly used during a paracentesis procedure?

<p>To enhance the visual guidance for needle insertion (B)</p> Signup and view all the answers

What can be done with the ascitic fluid after it is drained during a paracentesis?

<p>It can be sent for laboratory culture (B)</p> Signup and view all the answers

Which of the following statements about the procedure of paracentesis is incorrect?

<p>The procedure is only performed by surgical specialists. (A)</p> Signup and view all the answers

What is the primary reason for performing a paracentesis in patients with ascites?

<p>To relieve respiratory distress (B)</p> Signup and view all the answers

Which condition is most commonly associated with the development of ascites?

<p>Cirrhosis of the liver (D)</p> Signup and view all the answers

What symptom is primarily observed in patients with ascites?

<p>Increased abdominal girth (D)</p> Signup and view all the answers

What is a potential complication to monitor for after a paracentesis procedure?

<p>Hemorrhage (A)</p> Signup and view all the answers

How is the effectiveness of ascites treatment evaluated post-paracentesis?

<p>Monitoring of respiratory distress (C)</p> Signup and view all the answers

Which nursing action is essential to ensure client readiness for a paracentesis?

<p>Assess pertinent blood testing results. (D)</p> Signup and view all the answers

What position should a client with ascites be placed in prior to a paracentesis?

<p>Upright position or high-Fowler’s position. (C)</p> Signup and view all the answers

Which laboratory results should a nurse particularly focus on before a paracentesis procedure?

<p>Albumin, protein, glucose, amylase, BUN, and creatinine. (D)</p> Signup and view all the answers

What is a common preprocedure nursing action regarding client consent for a paracentesis?

<p>Verify that the client has signed the informed consent form. (C)</p> Signup and view all the answers

What might be administered to a client prior to or after a paracentesis to restore fluid balance?

<p>IV bolus fluids or albumin. (C)</p> Signup and view all the answers

What is an appropriate action to take immediately after a paracentesis procedure?

<p>Monitor the patient's vital signs. (A)</p> Signup and view all the answers

What complication should be monitored for in the first 48 hours after a paracentesis?

<p>Bowel perforation indicated by fever. (B)</p> Signup and view all the answers

What is the recommended action if there is evidence of leakage at the insertion site after a paracentesis?

<p>Change to a dry sterile gauze dressing as needed. (D)</p> Signup and view all the answers

What should be documented after performing a paracentesis?

<p>The characteristics of fluid removed and the insertion site details. (D)</p> Signup and view all the answers

Which statement is true regarding the use of diuretics after a paracentesis?

<p>Administering spironolactone may help control fluid volume post-procedure. (A)</p> Signup and view all the answers

What dietary recommendation should a patient follow after undergoing paracentesis?

<p>Maintain a low-sodium diet (C)</p> Signup and view all the answers

Which symptom indicates possible hypovolemia that a nurse should monitor after paracentesis?

<p>Diaphoresis (B)</p> Signup and view all the answers

What action should be taken to help prevent complications during fluid removal in paracentesis?

<p>Administering plasma expanders like albumin (B)</p> Signup and view all the answers

What change in mental status may indicate an issue after fluid removal in paracentesis?

<p>Decreased alertness and confusion (A)</p> Signup and view all the answers

Which position change recommendation is crucial for a patient post-paracentesis?

<p>Change positions slowly to minimize fall risk (B)</p> Signup and view all the answers

What is the main purpose of nasogastric (NG) decompression in clients with an intestinal obstruction?

<p>To relieve abdominal distention (B)</p> Signup and view all the answers

Which of the following conditions is associated with a mechanical intestinal obstruction?

<p>Tumors in the intestine (B)</p> Signup and view all the answers

Which symptom is least likely to indicate an intestinal obstruction?

<p>Fever and chills (B)</p> Signup and view all the answers

Which type of bowel sounds might be expected in a patient with an intestinal obstruction?

<p>Hyperactive and high-pitched bowel sounds (B)</p> Signup and view all the answers

What could be a potential cause of functional intestinal obstruction?

<p>Absence of peristalsis due to disease (C)</p> Signup and view all the answers

Which action is important for maintaining proper function of the nasogastric (NG) tube after the procedure?

<p>Assess and maintain proper function of the NG tube and suction equipment. (D)</p> Signup and view all the answers

What should be incorporated into intake and output (I&O) calculations regarding the nasogastric tube?

<p>NG tube flushes and drainage. (B)</p> Signup and view all the answers

Which patient action is recommended to support intestinal movement after nasogastric decompression?

<p>Reposition frequently in bed and get out of bed as able. (B)</p> Signup and view all the answers

Which finding would indicate a need for further assessment of the nasogastric tube's position?

<p>Decreased drainage, increased nausea, vomiting, or distention. (D)</p> Signup and view all the answers

Which laboratory results are pertinent to evaluate during postprocedure care for a patient with an NG tube?

<p>Electrolytes and hematocrit. (D)</p> Signup and view all the answers

What is a potential complication that nurses should monitor for in patients undergoing nasogastric decompression?

<p>Fluid and electrolyte imbalance (A)</p> Signup and view all the answers

Which nursing action should be prioritized when monitoring for signs of metabolic acidosis or alkalosis in patients with a nasogastric tube?

<p>Monitor intake and output (I&amp;O) for discrepancies (D)</p> Signup and view all the answers

What specific area should a nurse assess to identify possible skin breakdown in a patient with a nasogastric tube?

<p>Nasal skin for irritation (A)</p> Signup and view all the answers

In the context of nasogastric decompression, what type of obstruction is associated with metabolic alkalosis?

<p>High obstruction (C)</p> Signup and view all the answers

Which of the following symptoms is indicative of a low obstruction during nasogastric decompression?

<p>Constipation and bloating (B)</p> Signup and view all the answers

What characterizes an ileostomy compared to a colostomy?

<p>It results in frequent and liquid stool drainage. (A)</p> Signup and view all the answers

What is the primary role of a stoma in ostomy surgery?

<p>It facilitates drainage from an internal organ. (A)</p> Signup and view all the answers

Which factor distinguishes the stool produced by the transverse colon in a colostomy?

<p>It is more formed compared to other areas. (B)</p> Signup and view all the answers

What common misconception might people have about the permanence of ostomies?

<p>Most ostomies are temporary. (D)</p> Signup and view all the answers

In which situation is a colostomy likely to produce more liquid stools?

<p>When the opening is in the ascending colon. (B)</p> Signup and view all the answers

Under which condition would an ileostomy be indicated?

<p>Crohn’s disease (A)</p> Signup and view all the answers

What is a primary consideration during the preprocedure phase for ostomy placement?

<p>Determining the client’s readiness for the procedure (A)</p> Signup and view all the answers

What is the role of the wound ostomy care nurse (WOCN) prior to an ostomy procedure?

<p>To initiate referral and assist in ostomy placement marking (A)</p> Signup and view all the answers

Which of the following diagnoses would most likely require a colostomy?

<p>Cancer (D)</p> Signup and view all the answers

What essential education should be provided to the client regarding ostomy management?

<p>Management and care of the ostomy (A)</p> Signup and view all the answers

What is the optimal appearance of a stoma that a nurse should assess for?

<p>Pink and moist (C)</p> Signup and view all the answers

Which factor has the least influence on the fitting of an ostomy appliance?

<p>Dietary restrictions of the client (C)</p> Signup and view all the answers

What is the purpose of applying skin barriers and creams to the peristomal skin?

<p>To prevent leakage and protect skin integrity (C)</p> Signup and view all the answers

What should be monitored when caring for a new ileostomy to prevent complications?

<p>Fluid and electrolyte imbalances (A)</p> Signup and view all the answers

When should an ostomy bag be emptied to maintain proper management?

<p>When it is one-third to one-half full of drainage (B)</p> Signup and view all the answers

Which food should be avoided immediately after an ostomy involving the small intestine is placed?

<p>High-fiber foods (D)</p> Signup and view all the answers

What is an effective way to minimize odor when the ostomy pouch is open?

<p>Use filters or deodorizers (B)</p> Signup and view all the answers

Which of the following foods is known to cause gas in ostomy patients?

<p>Beer (C)</p> Signup and view all the answers

What dietary change can help reduce gas for a person with an ostomy?

<p>Eat yogurt, crackers, and toast (B)</p> Signup and view all the answers

Why is it important to evaluate for evidence of blockage when slowly introducing high-fiber foods after an ostomy?

<p>Blockage can lead to severe complications. (D)</p> Signup and view all the answers

What is a clear indication of serious impairment of blood flow to the stoma?

<p>Black or purple color (B)</p> Signup and view all the answers

Which of the following is a typical manifestation of stomal ischemia?

<p>Pale pink color (D)</p> Signup and view all the answers

What nursing action is appropriate when assessing a stoma that may indicate ischemic changes?

<p>Obtain vital signs and oxygen saturation (C)</p> Signup and view all the answers

What color and condition of the stoma should prompt immediate medical intervention?

<p>Black or purple and dry (B)</p> Signup and view all the answers

What color change in the stoma may suggest an underlying issue that requires monitoring?

<p>Pale pink or bluish purple color (D)</p> Signup and view all the answers

What is a common manifestation of intestinal obstruction that nursing staff should assess for?

<p>Hypoactive or absent bowel sounds (A)</p> Signup and view all the answers

Which nursing action is critical when monitoring a patient with a stoma for intestinal obstruction?

<p>Monitor and record output from the stoma (C)</p> Signup and view all the answers

After discharge, which indicator should clients be educated to recognize as a sign of possible intestinal obstruction?

<p>Manifestations such as nausea and distention (A)</p> Signup and view all the answers

What symptom is NOT typically associated with intestinal obstruction?

<p>Diarrhea (C)</p> Signup and view all the answers

Which of the following findings would indicate a possible complication of an intestinal obstruction?

<p>Abdominal distention (D)</p> Signup and view all the answers

What is the normal postoperative output for an ileostomy?

<p>More than 1,000 mL/day (D)</p> Signup and view all the answers

After surgery, how does the output for a transverse colostomy typically change over several days to weeks?

<p>Resembles semi-formed stool (D)</p> Signup and view all the answers

What characteristics describe the output of a sigmoid colostomy 4 to 5 days after surgery?

<p>Small to moderate amount of mucus with semi-formed stool (A)</p> Signup and view all the answers

Which statement accurately describes the pattern of output from an ileostomy compared to preoperative patterns?

<p>Output resumes a pattern somewhat similar to preoperative pattern over time (D)</p> Signup and view all the answers

What can typically be expected in terms of output consistency after several days to weeks post-surgery for an ileostomy?

<p>Becomes more paste-like as the small intestine takes over absorptive functions (D)</p> Signup and view all the answers

Flashcards

Enteral feedings purpose

Provides nutrition to a client with a working GI tract but who can't swallow or eat enough.

Enteral feeding indications

Conditions like difficulty swallowing, inadequate oral intake, or increased nutritional needs.

Enteral feeding client presentation

Symptoms like malnutrition, low blood proteins, or aspiration pneumonia.

Why use enteral feedings?

To supply nutrition to clients who cannot take food/fluids by mouth or have a decreased ability to eat enough for their needs.

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Conditions using enteral feeding

Head/neck cancer patients, stroke patients & those who cannot maintain an adequate diet or who need extra nutrients.

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Overfeeding

Giving more food than the body can handle, leading to bloating, nausea, and vomiting.

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Residual check

Measuring the amount of leftover food in the stomach to assess how much is being absorbed.

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Residual volume

The amount of food left in the stomach after a feeding.

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Slow or withhold feeding

Stopping or reducing the rate of feeding when there's excessive food leftover in the stomach.

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Restart at lower rate

Gradually resuming feeding at a slower rate after a period of rest to avoid overfeeding.

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Diarrhea with enteral feedings

Diarrhea can happen due to a cold formula, feeding infused too quickly, or a concentrated formula.

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Nursing actions for diarrhea

If diarrhea occurs due to a feeding, slow down the feeding rate, check the formula temperature, and consult a dietitian.

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C. difficile and diarrhea

If diarrhea persists, especially with a foul odor, consider Clostridium difficile infection.

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Skin care with diarrhea

Provide skin care and protection to prevent irritation and skin breakdown due to frequent stooling.

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Notify the provider for diarrhea

Inform the healthcare provider if diarrhea persists despite nursing interventions.

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What causes constipation?

Constipation can be caused by a lack of physical activity, insufficient water intake, or a low-fiber diet.

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Nursing Action: Constipation

Nurses can help prevent constipation by encouraging increased physical activity, making sure the patient is well-hydrated, and consulting a dietitian to choose a high-fiber formula.

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Increase water during flushes

When flushing feeding tubes, add extra water to help soften stool and prevent clogging.

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Collaborate with a dietitian

Working with a dietitian helps select the right formula for the patient, ensuring adequate nutrition and fiber intake.

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Increase physical activity

Encourage the patient to move around as much as possible, as this helps stimulate bowel function.

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Aspiration pneumonia

A serious infection of the lungs that occurs when food, liquid, or vomit is inhaled into the airways.

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Tube displacement

The most common cause of aspiration pneumonia, happens when the feeding tube moves out of position in the stomach.

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How to prevent aspiration pneumonia?

Confirm tube placement before feeding, elevate the head of the bed during and after feeding, and suction the airway if needed.

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What are the signs of aspiration pneumonia?

Increased temperature, congestion in the lungs, and decreased breathing sounds.

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Nursing actions for suspected aspiration pneumonia

Stop feeding, turn the client, suction, administer oxygen, monitor vital signs, and notify the provider.

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Refeeding Syndrome

A potentially life-threatening condition that occurs when a starving person is suddenly re-fed, causing electrolyte imbalances and organ damage.

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Refeeding Syndrome: Why is it dangerous?

It occurs because the starving body has adapted to conserve energy, causing shifts in electrolytes and fluid balance when fed, impacting vital organs.

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Signs of Refeeding Syndrome

New onset of confusion, seizures, shallow breathing, increased muscular weakness.

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Nursing Actions for Refeeding Syndrome

Monitor for signs, notify the provider, obtain blood electrolytes if needed.

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Refeeding Syndrome Prevention

Slowly increase calorie intake, monitor electrolytes, and provide adequate hydration.

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What is TPN?

Total parenteral nutrition is a highly concentrated IV solution containing all necessary nutrients delivered through a central line to provide complete nutrition when oral or enteral feeding isn't possible.

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Why use TPN?

TPN is used to address nutritional deficiencies, treat prolonged malnourishment, and support patients who can't absorb nutrients through their gut.

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What is a central line?

A central line is a thin, flexible tube inserted into a large vein in the chest, allowing direct access to the bloodstream for long-term medication or fluid delivery.

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What does TPN contain?

TPN includes a high concentration of dextrose (sugar), lipids (fats), protein, electrolytes, vitamins, and trace elements.

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What are the risks of TPN?

TPN carries risks like infection, phlebitis (vein inflammation), and electrolyte imbalances.

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What is Total Parenteral Nutrition (TPN)?

TPN is a specialized IV solution providing all essential nutrients directly into the bloodstream, used when oral or enteral feeding is impossible.

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Who needs TPN?

TPN is prescribed for patients with conditions like chronic pancreatitis, severe burns, short bowel syndrome, or when they're unable to eat for extended periods.

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TPN Delivery

TPN is administered through a central line, a thin, flexible tube placed in a large vein in the chest, allowing access to the bloodstream for long-term nutrient delivery.

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TPN Content

TPN solutions contain high concentrations of dextrose (sugar), lipids (fats), protein, electrolytes, vitamins, and trace elements, providing a complete nutritional package.

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TPN Risks

TPN carries potential risks like infection, phlebitis (inflammation of the vein), and electrolyte imbalances, requiring close monitoring.

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TPN Readiness

Evaluating if a client is ready to receive TPN, taking into account their physical condition and ability to tolerate the feeding.

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TPN Customization

TPN solutions are tailored to each client based on their individual needs, considering daily lab results and specific requirements.

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TPN Flow Rate

The rate of TPN infusion is adjusted gradually, increasing and decreasing slowly to minimize stress on the body.

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TPN - What is it?

TPN is total parenteral nutrition, a concentrated IV solution with all essential nutrients delivered through a central line when oral or enteral feeding is impossible.

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Why is TPN used?

TPN helps address nutritional deficiencies, treat prolonged malnourishment, and support patients who can't absorb nutrients normally.

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TPN Abrupt Stop

Never stop TPN abruptly. A sudden change in the rate can cause significant blood glucose fluctuations and potential harm.

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TPN Sterile Technique

Use meticulous sterile procedures when handling TPN to prevent infection. This includes preparing the solution, changing tubing, and managing lines.

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TPN Tubing Change

Change the TPN tubing and solution bag every 24 hours, even if not empty, to minimize the risk of contamination and bacterial growth.

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TPN Line Use

Do not use the TPN line for other IV medications or boluses. This prevents contamination and ensures the correct flow rate.

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TPN Solution Additives

Never add anything to the TPN solution yourself. This can introduce contaminants or cause incompatibility issues.

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TPN & Glucose Monitoring

Check the client's blood sugar every 4-6 hours for the first 24 hours of receiving TPN. This helps prevent dangerously high or low blood sugar levels.

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TPN & Insulin

Clients on TPN often need extra insulin until their pancreas can produce enough on its own. This is because TPN delivers a high amount of glucose, which needs insulin to be used for energy.

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TPN & Dextrose 10% Solution

Keep a bag of dextrose 10% in water at the bedside in case the TPN solution is damaged or unavailable. This helps prevent a sudden drop in blood sugar.

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TPN & Late Infusion

If the TPN bag is delayed, do not try to 'catch up' by speeding up the infusion rate. This can cause dangerously high blood sugar levels.

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TPN & Older Adults

Older adults are more likely to develop high blood sugar while receiving TPN. They may need closer monitoring and adjustments to their TPN solution.

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TPN Complications: Metabolic

Potential problems during TPN that affect how the body uses energy and nutrients. This includes issues like high blood sugar, low blood sugar, and vitamin deficiencies.

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TPN & Hyperglycemia

High blood sugar levels, a common complication of TPN, because it delivers a large amount of sugar directly into the bloodstream.

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TPN & Hypoglycemia

Low blood sugar levels can occur if the TPN infusion is interrupted or if the body isn't using the sugar in the TPN effectively.

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TPN Nursing Actions: Monitoring

Nurses carefully review daily lab results to ensure the TPN components match the patient's needs, monitor for high blood sugar, and provide extra fluids as needed.

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TPN & Fluid Management

Fluid needs are often met with a separate IV bolus to avoid overloading the body with fluids from the TPN solution.

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Air embolism

A serious condition that occurs when air enters the bloodstream and travels to the lungs or heart, blocking blood flow.

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Air embolism: Signs

Sudden onset of shortness of breath, chest pain, anxiety, and low blood oxygen levels.

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Air embolism: Nursing Actions

Clamp the catheter immediately, position the client on their left side in Trendelenburg position, administer oxygen, and notify the provider.

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Air embolism: What happens?

A sudden pressure change during tubing changes can cause air to enter the IV line and travel to the bloodstream.

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Air embolism: Why is it dangerous?

A large amount of air in the bloodstream can obstruct the flow of blood to the vital organs, leading to serious complications.

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TPN and Infection Risk

Total Parenteral Nutrition (TPN) is a concentrated nutrient solution given through a central line, increasing the risk of infection due to the direct access to the bloodstream.

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TPN and Fluid Imbalance

TPN is hyperosmotic, meaning it has a higher concentration of solutes than blood, potentially causing fluid shifts and placing the client at risk for fluid volume excess.

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TPN Nursing Action: Infection Prevention

Nurses must observe the central line insertion site for signs of infection, change dressings and IV tubing according to protocols, and monitor clients for systemic infection.

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TPN Nursing Action: Fluid Management

To prevent fluid overload, nurses assess for lung crackles, monitor daily weight and intake & output, and administer TPN at the prescribed rate using an infusion pump.

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TPN: Why not use for other fluids?

Using the TPN line for IV bolus fluids and medications increases the risk of infection. It's important to maintain dedicated access for the concentrated nutrient solution.

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What is paracentesis?

Paracentesis is a procedure where a needle is inserted into the peritoneal cavity (the space around the abdominal organs) to drain excess fluid, known as ascites.

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Purpose of Paracentesis

The primary goal of paracentesis is to relieve pressure in the abdomen caused by the buildup of fluid (ascites). This can improve breathing, reduce discomfort, and help with other symptoms.

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Where is Paracentesis done?

A paracentesis can be performed in various settings: a doctor's office, an outpatient center, a radiology department, or even at the bedside in a hospital setting.

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Why Ultrasound for Paracentesis?

Ultrasound guided paracentesis helps ensure the needle is inserted into the right place, reducing the risk of complications and improving accuracy.

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What Happens to the Drained Fluid?

After paracentesis, the drained fluid (ascites) is sent to a lab for analysis. This can help determine the cause of the fluid buildup and guide further treatment.

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What is ascites?

Ascites is the buildup of fluid in the abdominal cavity, often due to liver problems.

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Why is a paracentesis done?

To relieve pressure in the abdomen caused by fluid buildup (ascites), improving breathing and comfort.

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What is the main indication for treating ascites with paracentesis?

Respiratory distress, when a patient has trouble breathing due to abdominal pressure from ascites.

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Why is ultrasound used during a paracentesis?

To guide the needle accurately and reduce the risk of complications.

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What is the main indication for paracentesis?

The main indication for paracentesis is respiratory distress, when a patient has trouble breathing due to abdominal pressure from ascites.

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Paracentesis

A procedure where fluid is drained from the abdomen using a needle, primarily to relieve pressure caused by ascites (fluid buildup in the abdominal cavity).

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Why ultrasound during paracentesis?

Ultrasound helps guide the needle accurately, especially important for avoiding complications and ensuring the fluid is drained from the correct location.

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What's drained during paracentesis?

The procedure removes excess fluid called 'ascites' which builds up in the abdomen, often due to liver issues.

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Post-Paracentesis Care

After the procedure, pressure is applied at the insertion site, dressing is changed, and vital signs are monitored closely. Possible risks such as infection or fluid leakage are assessed.

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Hypovolemia after Paracentesis

Removal of ascites fluid can lead to hypovolemia (low blood volume) because the fluid contains protein, causing shifting of intravascular volume.

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Nursing Actions for Hypovolemia

Preventative measures include slow drainage of fluid, administration of plasma expanders (albumin) to counter protein loss, and monitoring for signs of hypovolemia (tachycardia, hypotension, pallor, diaphoresis, dizziness).

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What is Nasogastric Decompression?

Nasogastric decompression is a procedure used to relieve pressure and bloating in the abdomen caused by an intestinal obstruction. A nasogastric (NG) tube is inserted through the nose into the stomach, and suction is applied to remove the buildup of gas and fluids.

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Why is NG Decompression used?

NG decompression is used when a person has an intestinal obstruction, which prevents food and waste from moving through the digestive system normally. This can be caused by a mechanical blockage (like a tumor) or a functional problem (like a lack of muscle movement in the intestines).

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What are the signs of an intestinal obstruction?

A person with an intestinal obstruction might experience vomiting (including fecal material), absence or high-pitched bowel sounds, intermittent abdominal pain, distention, and hiccups.

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What is a Mechanical Intestinal Obstruction?

A mechanical intestinal obstruction is caused by a physical blockage in the digestive system. Examples include tumors, adhesions (scar tissue), and impactions (a buildup of stool).

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What is a Functional Intestinal Obstruction?

A functional intestinal obstruction occurs when the muscles of the digestive system don't work properly, even though there isn't a physical blockage. This can be caused by surgery, trauma, infections, or conditions that affect muscle movement.

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Nasogastric decompression

A procedure using a tube inserted through the nose into the stomach to relieve abdominal pressure caused by an intestinal obstruction, by removing gas and fluids with suction.

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Intestinal obstruction

A blockage in the intestines that prevents normal movement of food and waste, caused by physical blockages or problems with muscle function.

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Mechanical obstruction

A physical blockage in the digestive system, caused by things like tumors, scar tissue, or stool buildup.

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Functional obstruction

A blockage caused by problems with muscle movement in the intestines, even without a physical barrier.

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NG tube placement

The process of inserting a thin tube through the nose and into the stomach to help relieve pressure or drain fluids.

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What is an ostomy?

A surgical opening created to connect the inside of the body to the outside, allowing for bodily waste to be expelled. This opening can be either temporary or permanent.

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What's the difference between an ileostomy and a colostomy?

An ileostomy is an opening in the small intestine (ileum), resulting in frequent and liquid stool. A colostomy is an opening in the large intestine (colon), with the location determining the consistency of stool. Ascending colon = liquid, Transverse colon = formed, Sigmoid colon = near-normal.

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What is a stoma?

The artificial opening created during ostomy surgery, serving as the exit point for waste.

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What is the main purpose of an ostomy?

To provide a way for waste to exit the body when the normal pathway is blocked or not functioning properly.

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Why are ostomies sometimes temporary?

Ostomies can be temporary if the underlying condition causing the need for the ostomy is treatable, allowing the body to heal and restore normal function.

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Ileostomy

A surgical opening in the ileum (small intestine) allowing for waste removal, usually needed when the entire colon must be removed due to diseases like Crohn's or ulcerative colitis.

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Colostomy

A surgical opening in the colon (large intestine) allowing for waste removal. It's often needed when removing a part of the colon due to cancer, trauma, or to give the colon a chance to heal.

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Ostomy Placement Marking

The process of marking the exact location on the abdomen where the ostomy will be created, ensuring it's in the best position for functionality and comfort.

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WOCN Role

A Wound Ostomy Continence Nurse (WOCN) is specialized in providing care and education for patients with ostomies, including educating patients about their specific needs and how to manage their ostomy.

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Ostomy Care Training

Essential education for patients with ostomies, covering how to manage their ostomy, empty the appliance, change the bag, and maintain optimal skin health.

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What's an ostomy appliance?

A device that collects stool from an ostomy opening, usually consisting of a pouch and a skin barrier.

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Why are skin barriers important?

Skin barriers are used around the stoma to protect the skin from irritation and leakage from the ostomy bag.

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How does stoma output vary?

The consistency of ostomy output depends on the location of the ostomy. Ileostomies have more liquid and acidic output compared to colostomies.

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What's the key to proper ostomy appliance fit?

The appliance needs to fit snugly around the stoma while protecting the surrounding skin.

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Ileostomy vs. Colostomy

An ileostomy is an opening in the small intestine (ileum), resulting in frequent and liquid stool. A colostomy is an opening in the large intestine (colon), with the location determining the consistency of stool. Ascending colon = liquid, Transverse colon = formed, Sigmoid colon = near-normal.

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Why have an ostomy?

To provide a way for waste to exit the body when the normal pathway is blocked or not functioning properly.

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Odor Management

Foods like fish, eggs, asparagus, garlic, beans, and dark green leafy vegetables can cause odor. Buttermilk, cranberry juice, parsley, and yogurt help to decrease odor.

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Stomal Ischemia

Reduced blood flow to the stoma, causing it to turn pale pink or bluish purple and become dry. This can be a serious complication after ostomy surgery.

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Stomal Necrosis

Death of the stoma tissue due to severe lack of blood flow. The stoma appears black or purple and requires immediate medical intervention.

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What are signs of stomal ischemia?

The stoma may become pale pink or bluish purple and dry. This indicates a decreased blood supply to the area.

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What to do if you see a black or purple stoma?

This is a serious sign of stomal necrosis and requires immediate medical attention. Contact a healthcare professional immediately.

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Stomal Appearance: Normal vs. Ischemia

A healthy stoma is pink or red and moist, while a stoma with ischemia appears pale pink or bluish purple and dry.

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Signs of Intestinal Obstruction

Symptoms include vomiting (possibly with fecal matter), high-pitched or absent bowel sounds, stomach pain that comes and goes, a swollen belly, and hiccups.

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Stoma

The artificial opening created during ostomy surgery. It serves as the exit point for waste and can be temporary or permanent.

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Normal Postoperative Output (Ileostomy)

Ileostomy output can be more than 1,000mL/day, often bile-colored and liquid. After a few days, it decreases to around 500-1,000mL/day and becomes more paste-like. Blood may be present in the first few days.

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Normal Postoperative Output (Colostomy)

Colostomy output depends on the location of the opening. An ascending colostomy has semi-liquid, mucus-containing output. A sigmoid colostomy has a smaller amount of mucus with semi-formed stool, resembling a normal bowel movement.

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Study Notes

Gastrointestinal Therapeutic Procedures

  • Performed for sustaining nutritional intake and treating GI obstructions, obesity, and other disorders.
  • Nurses providing care for clients undergoing these procedures need expertise in enteral feedings, TPN, abdominal paracentesis, nasogastric decompression, bariatric surgeries, and ostomies.

Enteral Feedings

  • Used for clients with functioning GI tracts unable to swallow or consume sufficient calories/protein orally.
  • Can supplement oral diets or be the sole nutritional source.

Indications

  • Inability to eat due to medical conditions (e.g., head and neck cancers)
  • Difficulty swallowing or increased aspiration risk (e.g., stroke, advanced Parkinson's disease, multiple sclerosis)
  • Inability to maintain adequate oral intake and need for supplementation due to high metabolic demands (e.g., burns, sepsis)

Client Presentation

  • Malnutrition (low prealbumin, transferrin, or total iron-binding capacity)
  • Aspiration pneumonia

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Description

This quiz covers essential knowledge on gastrointestinal therapeutic procedures, focusing on enteral feedings, TPN, and other nursing care techniques. It highlights the indications for these interventions, especially in patients with swallowing difficulties or malnutrition. Assess your understanding of the care required for patients undergoing these procedures.

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