NR 324 Adult Health 1 exam 3 FINAL/ NR 324 Adult Health 1 (2024/2025)/ NR 324 Adult Health 1 exam 3.

NR 324 Adult Health 1 exam 3 FINAL/ NR 324 Adult Health 1 (2024/2025)/ NR 324 Adult Health 1 exam 3. Barium enema examination of large intestine; Before: give laxatives and enemas until clear of stool evening before -clear liquid diet evening before -NPO 8hr before After: give fluids, laxatives or suppositories to assist in expelling barium -observe stool for passage of contrast medium -educate pt stool may be white for up to 72 hr With a barium enema what do you want to explain to the patient in regards of what they might feel They might feel cramping and the urge to defecate may occur -pt will be placed in various positions What is Enteral nutrition (EN) Indications Tube feeding -nutritionally balanced liquefied food or formula into the stomach, duodenum, or jejunum Indications: -anorexia -orofacial fractures -head/neck cancer -neurologic -psychiatric conditions -extensive burns -critical illness -chemotherapy -radiation therapy Contraindications to enteral nutrition -intentional obstruction -ileus -peritonitis -bowel ischemia -intractable vomiting and diarrhea Enteral nutrition formulas and delivery options -variety of formulas for patients with diabetes, liver, kidney, and lung disease -concentrations from 1 to 2 cal/mL -osmolarity, amount of protein, sodium, and fat vary Delivery options: -continuous infusion by pump -cyclic feeding by pump -intermittent by gravity -intermittent bolus by syringe Esophagastroduodenoscopy (EGD) Visualize esophagus, stomach, duodenum -detects inflammation, ulcerations, tumors, varices, or mallory-weiss tears Before: -NPO for 8 hrs -explain that local anesthesia may be sprayed on throat -verify signed consent After: -keep NPO after procedure until gag reflex returns -gently tickle back of throat to test gag reflex -use warm saline gargles for relief of sore throat -check temp q15-30min for 1-2 hr Colonoscopy Examination of colon, biopsies and polyps removed; bowel prep before and observe for perforation Before: low residue or full liquid diet the day before until bowel cleansing begins -pt drinks 2L dose of oral polyethylene glycol the night before -second 2L 4-6 hr before procedure -explain pt will be side-lying position and sedation given After: observe for complications -monitor vital signs Complications of a colonoscopy -Abdominal cramps -Rectal bleeding -Perforation (malaise, abdominal distention, tenesmus) Nasogastric tube Nutrition, medication and decompression; proper technique during use, verify placement -bc of small diameter they are more easily clogged when feedings are thick and are more difficult to use for checking residual volumes They are particularly prone to obstruction when oral drugs have not been thoroughly crushed and dissolved in water before administration -Can be dislodged by vomiting or coughing -Can be knotted/kinked in GI tract NG tube management Check Aspiration risk before inserting Obtain x-ray to confirm tube placement If intermittent delivery is used HOB should remain elevated 30-60 min after feedings Check gastric residual volumes before each feeding and every 4 hours during the first 48 hrs Mark exit site at time of initial x-ray and check tuber external length at regular intervals Observe for negative pressure when attempting to withdraw fluid from feeding Provide skin care around tube and assess daily (rinse with sterile water ) What are the main complications of tube feedings? Vomiting Dehydration Diarrhea Constipation -Elevate HOB a minimum of 30 degrees but preferably 46 degrees to decrease complications and risk for aspiration Nursing management of tube feedings 1. Check tube placement before feeding and each drug administration. 2. Assess for bowel sounds before feeding. 3. Use liquid medications rather than pills. • Dilute viscous liquid medications. • Do not add medications to enteral feeding formula. 4. If using tablets, crush drugs to a fine powder and dissolve in water to avoid clogging 5. Follow measures to decrease aspiration risk: • Keep HOB elevated to 30- to 45-degree angle. • Check for residual volumes per facility policy. 6. Assess regularly for complications (e.g., aspiration, diarrhea, abdominal distention, hyperglycemia, constipation, and fecal impaction). NG tube insertion Use a guide wire to help with correct placement **never put guidewire back in Goes in through the nares through the esophagus and into the stomach and may go into the duodenum -Have patient swallow when passing through the throat For a patient with an NG tub, what task can be delegated? LPN: • Insert NG tube for stable patient. • Irrigate NG and gastrostomy tubes. • Give bolus or continuous enteral feeding for stable patient. • Remove NG tube. • Give medications through NG or gastrostomy tube to stable patient. • Provide skin care around gastrostomy or jejunostomy tubes. UAP: • Provide oral care • Weigh pt .• Position and maintain patient with the head of bed elevated. • Notify RN or LPN about patient symptoms (e.g., nausea, diarrhea) that may indicate problems with enteral feedings. • Alert RN or LPN about enteral feeding infusion pump alarms. • Empty drainage devices and measure output. Gastrostomy tube nutrition, medication; proper technique for use, verify placement, monitor for infection, HOB elevated Ileostomy semiliquid, fluid needs increased -should be observed for signs and symptoms of fluid and electrolyte imbalance, particularly potassium, sodium, and fluid deficits. Colonostomy Ascending- semiliquid stool, fluid needs increased Transverse- semiliquid to semiformed stool, possibly increased fluid needs Sigmoid- formed stool, no change in fluid needs, can regulate bowel patterns Diarrhea Assessment- loose stools, abdominal cramps, pain, fever Complications: dehydration, electrolyte imbalance, intestinal perforation Management: self limiting, replace fluids and electrolytes, diet, protect skin, isolation, stool culture, anti-diarrheals, antibiotics Constipation Assessment- stools are absent or hard, dry, and difficult to pass, abdominal distention, bloating, increased flatulance and increased rectal pressure Complications- hemorrhoids, perforation, rectal mucosal ulcers and fissures Diagnostics: abdominal x-rays, barium enema, colonoscopy, sigmoidoscopy Management: increasing dietary fiber, fluid intake (2L/ days), exercise, laxatives, enemas, do not delay defecation gastroesophageal reflux disease (GERD) Assessment- heartburn, dyspepsia, regurgitation, coughing Complications- esophagitis, asthma, Barrets esophagus, pneumonia Tests: endoscopy, biopsies, barium swallow, motility studies -Management- smoking cessation, nutrition (no alcohol/caffeine/acidic foods), weight loss, HOB elevated, medications, surgery, endoscopic therapy GERD acronym G- generally known as heartburn E- epigastric pain and spasm usually follow a meal R- radiating pain to arms arms and chest is common D- diet therapy Hiatal hernia Two types: sliding and rolling (can be emergency) Assessment: asymptomatic or resemble GERD Complications: strangulation, GERD, esophagitis, hemorrhage, ulcerations Tests: esophagram (barium swallow) Management: similar to GERD, surgery Peptic ulcer disease condition characterized by erosion of the GI mucosa from the digestive action of hydrochloric acid and pepsin -pH increases to 3.5 or more when foods or antacids neutralize stomach acid or drugs block acid secretion -H. pylori is main organism of PUD - Any portion of the GI tract that comes into contact with gastric secretions is susceptible to ulcer development Gastric or duodenal (differ in their incidence and presentation Lifestyle factors: alcohol and coffee stimulate acid secretion and smoking and psychologic distress What does Helicobacter pylori cause? Ulcers bc of its production of enzyme urease -•Urease activates immune response •Antibody production •Release of inflammatory cytokines •Response to H. pylori is variable What effect does Aspirin and NSAIDs have on peptic ulcers? •Inhibit prostaglandin synthesis •Increase gastric acid secretion •Reduce integrity of the mucosal barrier •Responsible for majority of non-H. pylori peptic ulcers •NSAIDs in presence of H. pylori increase risk of PUD What is released from damaged mucosa with peptic ulcers? Histamine is released from the damaged mucosa, resulting in vasodilation and increased capillary permeability and further secretion of acid and pepsin Acute vs. Chronic peptic ulcers Acute: is associated with superficial erosion and minimal inflammation -short duration and resolves quickly when cause is identified and removed Chronic: one of long duration, eroding through the muscular wall with the formation of fibrous tissue -present continuously for many months or intermittently throughout lifetime --More common Gastric ulcer Nutrition-client education: