Gastrointestinal Therapeutic Procedures Quiz
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Questions and Answers

What is the primary purpose of enteral feedings?

  • To provide nutrition to clients who cannot swallow or eat enough orally (correct)
  • To eliminate the need for oral intake completely
  • To manage gastrointestinal obstructions without surgery
  • To assist in weight loss during obesity surgeries

Which of the following is NOT an indication for enteral feeding?

  • Dysphagia due to a stroke
  • Healthy individuals seeking to gain weight (correct)
  • Head and neck cancers causing inability to eat
  • Increased metabolic demands due to burns

Which client presentation would be most indicative of the need for enteral feedings?

  • Stable weight with a well-balanced diet
  • Occasional difficulty swallowing food
  • Increased energy levels and normal nutritional intake
  • Malnutrition characterized by low prealbumin and transferrin (correct)

What complication can arise from enteral feedings if not managed properly?

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

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

<p>Mild seasonal allergies affecting appetite (C)</p> Signup and view all the answers

What nursing action should be taken if a residual volume of 150 mL is noted during a check?

<p>Hold feeding and notify the provider. (D)</p> Signup and view all the answers

What is a possible cause of diarrhea in a patient receiving enteral feedings?

<p>Concentration of the feeding constituents. (A)</p> Signup and view all the answers

Which nursing action is essential prior to commencing enteral feedings?

<p>Check the feeding pump operation. (A)</p> Signup and view all the answers

If a patient exhibits signs of abdominal distention and vomiting, what complication might they be experiencing?

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

What should be done if diarrhea has a very foul odor and persists?

<p>Check for Clostridium difficile infection. (B)</p> Signup and view all the answers

What nursing action is important for preventing aspiration pneumonia during enteral feedings?

<p>Elevate the head of the bed at least 30° (D)</p> Signup and view all the answers

What is a common consequence of constipation in patients receiving enteral feedings?

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

What should be done if a patient exhibits signs of aspiration during feeding?

<p>Stop feeding and turn the client to one side (A)</p> Signup and view all the answers

Which of the following actions is necessary when managing a patient with diarrhea suspected to be caused by Clostridium difficile?

<p>Evaluate for foul-smelling diarrhea (C)</p> Signup and view all the answers

What is a common factor contributing to constipation in enterally fed patients?

<p>Inadequate fluid intake (D)</p> Signup and view all the answers

What is a critical nursing action to take when refeeding syndrome is suspected?

<p>Monitor for new onset of confusion or seizures (B)</p> Signup and view all the answers

Which electrolyte imbalance is most commonly associated with refeeding syndrome?

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

What assessment finding might indicate worsening of refeeding syndrome?

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

Why is it important to obtain blood electrolytes when managing a patient with refeeding syndrome?

<p>To evaluate electrolyte levels (B)</p> Signup and view all the answers

What is a potential consequence of refeeding syndrome if not recognized and treated promptly?

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

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

<p>To prevent or correct nutritional deficiencies (B)</p> Signup and view all the answers

Which of the following accurately describes the concentration of dextrose in total parenteral nutrition?

<p>Between 10% to 50% (A)</p> Signup and view all the answers

What is a common risk associated with total parenteral nutrition administration?

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

Which route is typically used for the infusion of total parenteral nutrition?

<p>Large peripheral vein or central line (D)</p> Signup and view all the answers

How does peripheral parenteral nutrition (PPN) differ from total parenteral nutrition (TPN)?

<p>PPN is intended for short-term use and is less hypertonic (A)</p> Signup and view all the answers

Which condition is likely to create a hypermetabolic state that may require enteral feeding?

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

What is a significant indicator that a patient may need enteral feeding?

<p>Muscle wasting and poor tissue healing (B)</p> Signup and view all the answers

Which of the following diagnoses is associated with chronic malnutrition that may necessitate enteral feeding?

<p>Short bowel syndrome (A)</p> Signup and view all the answers

Which client presentation is most concerning and indicates a high probability for nutritional intervention?

<p>Inability to eat or drink for more than 5 days (C)</p> Signup and view all the answers

Which of the following conditions can significantly affect the ability to absorb nutrition?

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

What is the maximum percentage increase in the TPN flow rate per hour to allow for body adjustment?

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

What procedure should be followed regarding changing the TPN solution bag?

<p>Change every 24 hours regardless of contents (D)</p> Signup and view all the answers

What should be done if there is a need to change the central line dressing?

<p>Use sterile technique including a mask (A)</p> Signup and view all the answers

What is a key reason for not using the TPN line for other IV bolus solutions?

<p>It can lead to contamination and flow rate interruption (C)</p> Signup and view all the answers

Why should TPN not be abruptly stopped?

<p>It can cause electrolyte imbalances (C)</p> Signup and view all the answers

What is the recommended frequency for checking capillary glucose in clients receiving TPN during the first 24 hours?

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

Which of the following is a potential metabolic complication associated with TPN therapy?

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

What should be administered at the bedside to minimize the risk of hypoglycemia during TPN therapy?

<p>Dextrose 10% in water (D)</p> Signup and view all the answers

Why should the infusion rate not be increased to catch up if a TPN bag is late?

<p>It may lead to hyperglycemia. (D)</p> Signup and view all the answers

How frequently should fluid needs be monitored in clients receiving TPN to prevent fluid volume excess?

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

What is the initial nursing action to take if air embolism is suspected in a client?

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

Which manifestation could indicate a systemic infection in a patient with a central line?

<p>Increased white blood cell count (B)</p> Signup and view all the answers

How often should the dressing on a central line be changed according to standard protocol?

<p>Every 48 to 72 hours (A)</p> Signup and view all the answers

What is a critical contraindication for using a TPN line?

<p>Using it for bolus fluids (B)</p> Signup and view all the answers

What early sign should a nurse monitor for in a client at risk of air embolism?

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

What is a significant risk associated with the hyperosmotic nature of TPN solutions?

<p>Fluid shifts that may lead to volume excess (A)</p> Signup and view all the answers

Why should the infusion rate of TPN not be increased to compensate for a late infusion?

<p>It could lead to hyperglycemia due to rapid dextrose administration (A)</p> Signup and view all the answers

Which nursing action is essential to monitor for fluid and electrolyte imbalances in older adult clients receiving TPN?

<p>Monitor daily weight and input &amp; output (C)</p> Signup and view all the answers

What is the appropriate response if respiratory distress is noted in a client receiving TPN?

<p>Administer supplemental oxygen and assess lung sounds (A)</p> Signup and view all the answers

How should the flow rate of TPN be adjusted during the initial infusion period?

<p>Gradually increase until the prescribed rate is achieved (B)</p> Signup and view all the answers

What is the primary complication that paracentesis aims to alleviate?

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

Which of the following is NOT a setting where paracentesis can be performed?

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

Which symptom is a key indicator for considering paracentesis in a patient?

<p>Compromised lung expansion (C)</p> Signup and view all the answers

Which laboratory analysis may be performed on the ascitic fluid obtained from a paracentesis?

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

What is a common cause of abdominal ascites that may lead to a paracentesis procedure?

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

What factors should be assessed to determine a client's readiness for a medical procedure?

<p>Age, chronic diseases, and acute diseases (D)</p> Signup and view all the answers

What is the primary nursing action prior to a procedure that involves urinary concerns?

<p>Ensure the client has voided or insert an indwelling urinary catheter (C)</p> Signup and view all the answers

Which action is recommended regarding client position before a procedure for comfort?

<p>Position the client in a high-Fowler's position or on the edge of the bed (A)</p> Signup and view all the answers

What is an essential step in client education regarding needle insertion during a procedure?

<p>Communicate that there may be pressure or pain with needle insertion (A)</p> Signup and view all the answers

Which type of fluids may be administered to a client before or after a paracentesis to restore fluid balance?

<p>Colloids such as albumin (B)</p> Signup and view all the answers

Flashcards

Enteral Feedings

Nutrients delivered through the gastrointestinal tract, often for clients unable to eat normally.

Indications for Enteral Feedings

Used when oral intake is insufficient due to medical conditions like difficulty swallowing or increased metabolic needs.

Potential Diagnoses Related to Enteral Feedings

Conditions that affect swallowing or oral intake, like head and neck cancers, strokes, and burns.

Client Presentation with Enteral Feedings

Symptoms of malnutrition, such as low protein/albumin levels, can occur if there is insufficient nutrition.

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Aspiration Pneumonia

Potential complication of difficulty swallowing where food enters the lungs.

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Overfeeding Complication

Occurs when too much formula is infused, leading to bloating, nausea, and vomiting.

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Overfeeding Action: Residual Check

Regularly measuring leftover formula in the stomach to assess digestion. May be done every 4-6 hours.

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Overfeeding Action: Slowing Feeding

Reducing the infusion rate when too much formula is left in the stomach.

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Diarrhea Complication

Can occur due to cold formula, rapid infusion, or concentrated formula.

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Diarrhea Action: Slowing Feeding

Reduce the infusion rate to allow the stomach to catch up.

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Constipation with Enteral Feeding

Constipation can occur due to lack of activity, low water intake, or insufficient fiber in the feeding formula.

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Preventing Aspiration Pneumonia

Aspiration pneumonia can happen if feeding material enters the lungs. To prevent this, confirm tube placement before each feeding, elevate the head of the bed, and monitor for signs of respiratory distress.

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Tube Displacement

The primary cause of aspiration pneumonia is tube displacement, where the feeding tube shifts from its intended location.

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Diarrhea and Foul Odor

Diarrhea with a strong, unpleasant odor can suggest a Clostridium difficile infection, especially if it persists.

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Nurse Actions for Diarrhea

If diarrhea occurs, slow down the feeding rate, check for cold formula, and consider a formula change. Evaluate for C. difficile if the diarrhea has a foul odor.

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Refeeding Syndrome

A dangerous condition developing when severely malnourished individuals receive food too quickly, disrupting their metabolism and causing electrolyte imbalances.

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Refeeding Syndrome: Cause

Occurs when the body, depleted from prolonged starvation, switches to using stored fat and protein for energy, leading to a sudden shift in electrolyte levels when feeding resumes.

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Refeeding Syndrome: Symptoms

Includes confusion, seizures, weakness, shallow breathing, and potential electrolyte disturbances, requiring close monitoring.

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Refeeding Syndrome: Nursing Action

Nurses monitor for the above symptoms, notify the provider, and obtain blood electrolytes as needed, preventing serious complications.

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Refeeding Syndrome: Prevention

Gradually increasing calorie intake, monitoring electrolytes closely, and consulting with a dietitian helps prevent this condition.

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TPN

Total Parenteral Nutrition: A highly concentrated IV solution providing complete nutrition to those unable to eat. Administered through a central line for long-term nutritional support.

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TPN Composition

TPN contains dextrose (calories), lipids/essential fatty acids, protein, electrolytes, vitamins, and trace elements.

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TPN vs. PPN

TPN is a hypertonic solution delivered through a central line, while PPN (peripheral parenteral nutrition) is less concentrated and given through a peripheral vein.

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Risks of TPN

TPN risks include phlebitis (inflammation of a vein) and potential for complications due to its high nutrient concentration.

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How does TPN help?

TPN prevents or corrects nutritional deficiencies, minimizing adverse effects of malnutrition in individuals unable to eat.

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What are the indications for enteral feeding?

Enteral feeding is indicated when a patient cannot absorb nutrients orally due to conditions like chronic pancreatitis, short bowel syndrome, or severe burns. It's also used for prolonged recovery, hypermetabolic states, and chronic malnutrition.

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What's the client presentation for enteral feeding?

Clients needing enteral feeding often experience weight loss greater than 10% of their body weight, are NPO (nothing by mouth) for more than 5 days, or have muscle wasting, poor tissue healing, burns, bowel disease disorders, or acute kidney failure.

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What is refeeding syndrome?

Refeeding syndrome occurs when severely malnourished individuals are fed too quickly, leading to electrolyte imbalances and metabolic complications.

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What are the symptoms of refeeding syndrome?

Refeeding syndrome can cause confusion, seizures, weakness, shallow breathing, and electrolyte disturbances, requiring close monitoring.

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What are some ways to prevent refeeding syndrome?

Preventing refeeding syndrome involves gradually increasing calorie intake, monitoring electrolytes closely, and consulting with a dietitian.

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TPN Rate Adjustment

TPN flow rate is gradually increased and decreased to allow body adjustment. An abrupt change can alter blood glucose levels significantly.

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TPN Contamination Prevention

TPN solution is prepared aseptically using a laminar flow hood. Tubing and bag are changed every 24 hours. A filter prevents particles from entering the solution.

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TPN Line Usage

The TPN line should not be used for other IV bolus solutions to prevent contamination and interruption of flow rate. Nothing should be added to the solution due to risks of incompatibility.

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Central Line Dressings

Sterile technique, including a mask, should be used when changing the central line dressing. Follow facility procedures.

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Daily Weight Assessment

Weights should be assessed daily to monitor fluid balance and client progress.

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TPN & Glucose Monitoring

For the first 24 hours after starting TPN, check the client's blood sugar every 4-6 hours to prevent hyperglycemia and hypoglycemia.

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TPN Insulin Needs

Clients receiving TPN often need supplemental insulin initially, as the pancreas needs time to ramp up its insulin production.

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TPN Solution Backup

Keep a bag of 10% dextrose on hand in case the current TPN bag is damaged or delayed to prevent sudden blood sugar drops.

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Older Adults & TPN

Older adults are more prone to glucose intolerance. Closely monitor blood sugar levels when administering TPN.

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Air Embolism Risk

A change in pressure, often during tubing changes, can introduce air into the bloodstream, potentially leading to an air embolism.

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Air Embolism: Nursing Actions

If you suspect an air embolism, immediately clamp the catheter, position the client on their left side in Trendelenburg, administer oxygen, and notify the provider.

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Central Line Infection Risk

Central lines provide a pathway for bacteria to enter the bloodstream, especially when concentrated glucose solutions are used.

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Central Line Infection: Observe for Signs

Monitor the insertion site for redness, tenderness, or drainage, and assess the client for fever, elevated white blood cell count, chills, and general malaise.

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TPN Line: Avoid Other Fluids

Do not use the TPN line for other IV bolus fluids or medications because it increases the risk of infection and potential incompatibility.

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TPN and Fluid Imbalance

Total Parenteral Nutrition (TPN) is a concentrated solution that can cause the body to retain fluids, leading to fluid overload.

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Monitor for Fluid Overload

Watch for signs of fluid overload in patients receiving TPN, such as shortness of breath, swelling, and weight gain.

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TPN Infusion Rate

Gradually increase the flow rate of TPN to avoid sudden changes in fluid volume.

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TPN and Older Adults

Older adults are more vulnerable to fluid imbalances and complications from TPN.

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Lung Assessment with TPN

Listen to the patient's lungs for crackling sounds (rales) to detect fluid buildup.

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What is a paracentesis?

A procedure where a needle or trocar is inserted into the abdominal cavity to drain excess fluid (ascites).

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Why is a paracentesis done?

To relieve pressure from fluid buildup (ascites) in the abdomen, often caused by liver issues.

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Potential diagnoses for ascites

Cirrhosis of the liver is a common cause, leading to fluid buildup in the belly known as ascites.

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Client presentation with ascites

Clients with ascites often experience shortness of breath, swollen abdomen, and rapid weight gain.

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Safety precautions for paracentesis

Ultrasound is commonly used during paracentesis to guide the needle and ensure safe placement.

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Paracentesis: Purpose

A procedure that drains excess fluid (ascites) from the abdomen to relieve pressure and improve breathing.

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What causes ascites?

Ascites is often caused by liver issues like cirrhosis, where the liver can't properly filter fluid, leading to buildup in the belly.

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Paracentesis: Who benefits?

Clients with ascites, often experiencing shortness of breath, a swollen abdomen, and rapid weight gain, benefit from paracentesis to relieve pressure.

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Paracentesis: Safety First

An ultrasound is crucial during the procedure to guide the needle and ensure safe placement, minimizing risks of complications.

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Pre-Procedure: Client Prep

Ensure the client has signed informed consent, gather necessary equipment, and have the client void or insert an indwelling urinary catheter.

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Study Notes

Gastrointestinal Therapeutic Procedures

  • Performed for nutritional maintenance and treatment of obstructions, obesity, and related disorders.
  • Nurses need knowledge of various procedures like enteral feedings, TPN, paracentesis, decompression, bariatric surgeries, and ostomies.

Enteral Feedings

  • Administered to clients with a functioning GI tract who can't swallow or consume enough calories/protein orally.
  • May supplement an oral diet or be the sole source of nutrition.

Indications for Enteral Feedings

  • Inability to eat due to medical conditions (e.g., head and neck cancers).
  • Conditions causing difficulty swallowing or aspiration risk (e.g., stroke, Parkinson's).
  • Insufficient oral intake requiring supplementation due to increased metabolic needs (e.g., burns, sepsis).

Client Presentation of Malnutrition linked to Enteral Feedings

  • Malnutrition symptoms: decreased prealbumin, transferrin, or total iron-binding capacity.
  • Risk of aspiration pneumonia.

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Description

This quiz focuses on key gastrointestinal therapeutic procedures that nurses need to be proficient in for nutritional maintenance and treatment of related disorders. It covers topics such as enteral feedings, indications for usage, and the clinical presentation of malnutrition. Test your knowledge on these essential nursing practices and improve your patient care skills.

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