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A patients enteral feedings have been determined to be too concentrated based on the patients development of dumping syndrome. What physiologic phenomenon caused this patients complication of enteral feeding?
- A. Increased gastric secretion of HCl and gastrin because of high osmolality of feeds
- B. Entry of large amounts of water into the small intestine because of osmotic pressure
- C. Mucosal irritation of the stomach and small intestine by the high concentration of the feed
- D. Acid-base imbalance resulting from the high volume of solutes in the feed
Correct Answer: B
Rationale: When a concentrated solution of high osmolality entering the intestines is taken in quickly or in large amounts, water moves rapidly into the intestinal lumen from fluid surrounding the organs and the vascular compartment. This results in dumping syndrome. Dumping syndrome is not the result of changes in HCl or gastrin levels. It is not caused by an acid-base imbalance or direct irritation of the GI mucosa.
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A nurse is writing a care plan for a patient with a nasogastric tube in place for gastric decompression. What risk nursing diagnosis is the most appropriate component of the care plan?
- A. Risk for Excess Fluid Volume Related to Enteral Feedings
- B. Risk for Impaired Skin Integrity Related to the Presence of NG Tube
- C. Risk for Unstable Blood Glucose Related to Enteral Feedings
- D. Risk for Impaired Verbal Communication Related to Presence of NG Tube
Correct Answer: B
Rationale: NG tubes can easily damage the delicate mucosa of the nose, sinuses, and upper airway. An NG tube does not preclude verbal communication. This patients NG tube is in place for decompression, so complications of enteral feeding do not apply.
A nurse is creating a care plan for a patient who is receiving parenteral nutrition. The patients care plan should include nursing actions relevant to what potential complications? Select all that apply.
- A. Dumping syndrome
- B. Clotted or displaced catheter
- C. Pneumothorax
- D. Hyperglycemia
- E. Line sepsis
Correct Answer: B,C,D,E
Rationale: Common complications of PN include a clotted or displaced catheter, pneumothorax, hyperglycemia, and infection from the venous access device (line sepsis). Dumping syndrome applies to enteral nutrition, not PN.
A patients NG tube has become clogged after the nurse instilled a medication that was insufficiently crushed. The nurse has attempted to aspirate with a large-bore syringe, with no success. What should the nurse do next?
- A. Withdraw the NG tube 3 to 5 cm and reattempt aspiration.
- B. Attach a syringe filled with warm water and attempt an in-and-out motion of instilling and aspirating.
- C. Withdraw the NG tube slightly and attempt to dislodge by flicking the tube with the fingers.
- D. Remove the NG tube promptly and obtain an order for reinsertion from the primary care provider.
Correct Answer: B
Rationale: When a tube is first noted to be clogged, a 30- to 60-mL syringe should be attached to the end of the tube and any contents aspirated and discarded. Then the syringe should be filled with warm water, attached to the tube again, and a back-and-forth motion initiated to help loosen the clog. Removal is not warranted at this early stage and a flicking motion is not recommended. The tube should not be withdrawn, even a few centimeters.
A nurse is caring for a patient with a nasogastric tube for feeding. During shift assessment, the nurse auscultates a new onset of bilateral lung crackles and notes a respiratory rate of 30 breaths per minute. The patients oxygen saturation is 89% by pulse oximetry. After ensuring the patients immediate safety, what is the nurses most appropriate action?
- A. Perform chest physiotherapy.
- B. Reduce the height of the patients bed and remove the NG tube.
- C. Liaise with the dietitian to obtain a feeding solution with lower osmolarity.
- D. Report possible signs of aspiration pneumonia to the primary care provider.
Correct Answer: D
Rationale: The patient should be assessed for further signs of aspiration pneumonia. It is unnecessary to remove the NG tube and chest physiotherapy is not indicated. A different feeding solution will not resolve this complication.
A patient is postoperative day I following gastrostomy. The nurse is planning interventions to address the nursing diagnosis of Risk for Infection Related to Presence of Wound and Tube. What intervention is most appropriate?
- A. Administer antibiotics via the tube as ordered.
- B. Wash the area around the tube with soap and water daily.
- C. Cleanse the skin within 2 cm of the insertion site with hydrogen peroxide once per shift.
- D. Irrigate the skin surrounding the insertion site with normal saline before each use.
Correct Answer: B
Rationale: Infection can be prevented by keeping the skin near the insertion site clean using soap and water. Hydrogen peroxide is not used, due to associated skin irritation. The skin around the site is not irrigated with normal saline and antibiotics are not administered to prevent site infection.