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?

Decreased prealbumin and malnutrition Signup and view all the answers

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

To provide nutritional support when the GI tract cannot be used Signup and view all the answers

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

Abdominal distention Signup and view all the answers

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

Hold feeding and restart at a lower rate after rest Signup and view all the answers

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

Every 4 to 6 hours Signup and view all the answers

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

Check pump for proper operation Signup and view all the answers

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

Findings suggesting residual checks are unnecessary Signup and view all the answers

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

Adequately warm the formula and notify the provider Signup and view all the answers

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

When diarrhea persists and has a very foul odor Signup and view all the answers

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

Consult with a dietitian about the composition of the feeding Signup and view all the answers

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

Reduce the feeding rate and monitor for other symptoms Signup and view all the answers

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

Provide skin care and protection to prevent breakdown Signup and view all the answers

What is a common contributing factor to constipation?

Lack of free water Signup and view all the answers

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

Add water during tube flushes Signup and view all the answers

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

Collaborating with a dietitian regarding fiber Signup and view all the answers

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

Collaborating with a physical therapist Signup and view all the answers

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

Increased fiber intake Signup and view all the answers

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

Tube displacement Signup and view all the answers

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

Confirming tube placement Signup and view all the answers

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

Stop the feeding Signup and view all the answers

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

Elevated temperature Signup and view all the answers

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

Notify the provider and perform suctioning Signup and view all the answers

What is refeeding syndrome primarily associated with?

Starting enteral feeding in a patient who is in a starvation state. Signup and view all the answers

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

New onset of confusion or seizures. Signup and view all the answers

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

Assess for shallow respirations and muscular weakness. Signup and view all the answers

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

Blood electrolytes to assess for imbalances. Signup and view all the answers

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

Severe dehydration and electrolyte depletion. Signup and view all the answers

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

Central line Signup and view all the answers

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

Vitamins and trace elements Signup and view all the answers

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

Phlebitis Signup and view all the answers

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

Chronic malnutrition Signup and view all the answers

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

10% or less Signup and view all the answers

Which condition is a potential diagnosis for total parenteral nutrition?

Chronic pancreatitis Signup and view all the answers

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

Weight loss greater than 10% of body weight Signup and view all the answers

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

Improved appetite 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?

Inability to absorb nutrients due to bowel disease Signup and view all the answers

In which situation would total parenteral nutrition be most critical?

Severe burns with extensive tissue loss Signup and view all the answers

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

Determine the client’s readiness for TPN Signup and view all the answers

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

Daily laboratory values, including electrolytes Signup and view all the answers

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

Increasing or decreasing by no more than 10% each hour Signup and view all the answers

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

To ensure the solutions meet the client’s nutritional needs Signup and view all the answers

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

Increased risk of metabolic derangements Signup and view all the answers

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

Alteration of blood glucose levels Signup and view all the answers

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

To maintain the sterility of the solution Signup and view all the answers

Which measure is essential when preparing the TPN solution?

Following aseptic technique with a laminar flow hood Signup and view all the answers

What should be monitored daily in patients receiving TPN?

Daily weight Signup and view all the answers

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

To prevent contamination and interruption of the flow rate 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?

Capillary glucose levels Signup and view all the answers

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

The pancreas may not produce enough insulin initially Signup and view all the answers

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

To reduce risk of hypoglycemia during abrupt changes Signup and view all the answers

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

Increase the infusion rate to catch up Signup and view all the answers

How does age affect glucose tolerance in clients receiving TPN?

Older adults tend to have decreased glucose intolerance Signup and view all the answers

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

Hyperglycemia Signup and view all the answers

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

Review results of daily laboratory monitoring for TPN components Signup and view all the answers

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

Monitor blood glucose levels closely and administer insulin if necessary Signup and view all the answers

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

To prevent fluid volume excess Signup and view all the answers

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

Vitamin B12 deficiency Signup and view all the answers

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

Clamp the catheter and place the client on their left side in Trendelenburg position. 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?

Sudden onset of dyspnea. Signup and view all the answers

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

So trapped air can be aspirated. 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?

Provide supplemental oxygen and clamp the catheter. 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?

To promote venous return to the heart. Signup and view all the answers

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

Regularly inspect the central line insertion site for signs of infection. Signup and view all the answers

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

TPN is hyperosmotic, leading to potential fluid shifts. Signup and view all the answers

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

Notify the physician and administer prescribed antibiotics as needed. Signup and view all the answers

How should TPN be administered to avoid complications?

Use a controlled infusion pump to maintain the prescribed rate. Signup and view all the answers

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

Patient weight and intake/output records. Signup and view all the answers

What is the primary therapeutic goal of performing a paracentesis?

Relief of abdominal ascites pressure Signup and view all the answers

In which settings can a paracentesis be appropriately performed?

In a provider’s office, outpatient center, or acute care setting Signup and view all the answers

Why is ultrasound commonly used during a paracentesis procedure?

To enhance the visual guidance for needle insertion Signup and view all the answers

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

It can be sent for laboratory culture Signup and view all the answers

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

The procedure is only performed by surgical specialists. Signup and view all the answers

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

To relieve respiratory distress Signup and view all the answers

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

Cirrhosis of the liver Signup and view all the answers

What symptom is primarily observed in patients with ascites?

Increased abdominal girth Signup and view all the answers

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

Hemorrhage Signup and view all the answers

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

Monitoring of respiratory distress Signup and view all the answers

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

Assess pertinent blood testing results. Signup and view all the answers

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

Upright position or high-Fowler’s position. Signup and view all the answers

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

Albumin, protein, glucose, amylase, BUN, and creatinine. Signup and view all the answers

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

Verify that the client has signed the informed consent form. Signup and view all the answers

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

IV bolus fluids or albumin. Signup and view all the answers

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

Monitor the patient's vital signs. Signup and view all the answers

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

Bowel perforation indicated by fever. Signup and view all the answers

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

Change to a dry sterile gauze dressing as needed. Signup and view all the answers

What should be documented after performing a paracentesis?

The characteristics of fluid removed and the insertion site details. Signup and view all the answers

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

Administering spironolactone may help control fluid volume post-procedure. Signup and view all the answers

What dietary recommendation should a patient follow after undergoing paracentesis?

Maintain a low-sodium diet Signup and view all the answers

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

Diaphoresis Signup and view all the answers

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

Administering plasma expanders like albumin Signup and view all the answers

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

Decreased alertness and confusion Signup and view all the answers

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

Change positions slowly to minimize fall risk Signup and view all the answers

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

To relieve abdominal distention Signup and view all the answers

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

Tumors in the intestine Signup and view all the answers

Which symptom is least likely to indicate an intestinal obstruction?

Fever and chills Signup and view all the answers

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

Hyperactive and high-pitched bowel sounds Signup and view all the answers

What could be a potential cause of functional intestinal obstruction?

Absence of peristalsis due to disease Signup and view all the answers

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

Assess and maintain proper function of the NG tube and suction equipment. Signup and view all the answers

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

NG tube flushes and drainage. Signup and view all the answers

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

Reposition frequently in bed and get out of bed as able. Signup and view all the answers

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

Decreased drainage, increased nausea, vomiting, or distention. Signup and view all the answers

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

Electrolytes and hematocrit. Signup and view all the answers

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

Fluid and electrolyte imbalance 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?

Monitor intake and output (I&O) for discrepancies 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?

Nasal skin for irritation Signup and view all the answers

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

High obstruction Signup and view all the answers

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

Constipation and bloating Signup and view all the answers

What characterizes an ileostomy compared to a colostomy?

It results in frequent and liquid stool drainage. Signup and view all the answers

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

It facilitates drainage from an internal organ. Signup and view all the answers

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

It is more formed compared to other areas. Signup and view all the answers

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

Most ostomies are temporary. Signup and view all the answers

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

When the opening is in the ascending colon. Signup and view all the answers

Under which condition would an ileostomy be indicated?

Crohn’s disease Signup and view all the answers

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

Determining the client’s readiness for the procedure Signup and view all the answers

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

To initiate referral and assist in ostomy placement marking Signup and view all the answers

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

Cancer Signup and view all the answers

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

Management and care of the ostomy Signup and view all the answers

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

Pink and moist Signup and view all the answers

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

Dietary restrictions of the client Signup and view all the answers

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

To prevent leakage and protect skin integrity Signup and view all the answers

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

Fluid and electrolyte imbalances Signup and view all the answers

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

When it is one-third to one-half full of drainage Signup and view all the answers

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

High-fiber foods Signup and view all the answers

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

Use filters or deodorizers Signup and view all the answers

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

Beer Signup and view all the answers

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

Eat yogurt, crackers, and toast 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?

Blockage can lead to severe complications. Signup and view all the answers

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

Black or purple color Signup and view all the answers

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

Pale pink color Signup and view all the answers

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

Obtain vital signs and oxygen saturation Signup and view all the answers

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

Black or purple and dry Signup and view all the answers

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

Pale pink or bluish purple color Signup and view all the answers

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

Hypoactive or absent bowel sounds Signup and view all the answers

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

Monitor and record output from the stoma Signup and view all the answers

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

Manifestations such as nausea and distention Signup and view all the answers

What symptom is NOT typically associated with intestinal obstruction?

Diarrhea Signup and view all the answers

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

Abdominal distention Signup and view all the answers

What is the normal postoperative output for an ileostomy?

More than 1,000 mL/day Signup and view all the answers

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

Resembles semi-formed stool Signup and view all the answers

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

Small to moderate amount of mucus with semi-formed stool Signup and view all the answers

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

Output resumes a pattern somewhat similar to preoperative pattern over time 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?

Becomes more paste-like as the small intestine takes over absorptive functions Signup and view all the answers

Study Notes