Nokea
The management of the patients gastrostomy is an assessment priority for the home care nurse. What statement would indicate that the patient is managing the tube correctly?
- A. I clean my stoma twice a day with alcohol.
- B. The only time I flush my tube is when Im putting in medications.
- C. I flush my tube with water before and after each of my medications.
- D. I try to stay still most of the time to avoid dislodging my tube.
Correct Answer: C
Rationale: Frequent flushing is needed to prevent occlusion, and should not just be limited to times of medication administration. Alcohol will irritate skin surrounding the insertion site and activity should be maintained as much as possible.
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A patient has been brought to the emergency department by EMS after telling a family member that he deliberately took an overdose of NSAIDs a few minutes earlier. If lavage is ordered, the nurse should prepare to assist with the insertion of what type of tube?
- A. Nasogastric tube
- B. Levin tube
- C. Gastric sump
- D. Orogastric tube
Correct Answer: D
Rationale: An orogastric tube is a large-bore tube inserted through the mouth with a wide outlet for removal of gastric contents; it is used primarily in the emergency department or an intensive care setting. Nasogastric, Levin, and gastric sump tubes are not used for this specific purpose.
A patients health decline necessitates the use of total parenteral nutrition. The patient has questioned the need for insertion of a central venous catheter, expressing a preference for a normal IV. The nurse should know that peripheral administration of high-concentration PN formulas is contraindicated because of the risk for what complication?
- A. Chemical phlebitis
- B. Hyperglycemia
- C. Dumping syndrome
- D. Line sepsis
Correct Answer: A
Rationale: Formulations with dextrose concentrations of more than 10% should not be administered through peripheral veins because they irritate the intima (innermost walls) of small veins, causing chemical phlebitis. Hyperglycemia and line sepsis are risks with both peripheral and central administration of PN. PN is not associated with dumping syndrome.
A patient is concerned about leakage of gastric contents out of the gastric sump tube the nurse has just inserted. What would the nurse do to prevent reflux gastric contents from coming through the blue vent of a gastric sump tube?
- A. Prime the tubing with 20 mL of normal saline.
- B. Keep the vent lumen above the patients waist.
- C. Maintain the patient in a high Fowlers position.
- D. Have the patient pin the tube to the thigh.
Correct Answer: B
Rationale: The blue vent lumen should be kept above the patients waist to prevent reflux of gastric contents through it; otherwise it acts as a siphon. A one-way anti-reflux valve seated in the blue pigtail can prevent the reflux of gastric contents out the vent lumen. To prevent reflux, the nurse does not prime the tubing, maintain the patient in a high Fowlers position, or have the patient pin the tube to the thigh.
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.
You are caring for a patient who was admitted to have a low-profile gastrostomy device (LPGD) placed. How soon after the original gastrostomy tube placement can an LPGD be placed?
- A. 2 weeks
- B. 4 to 6 weeks
- C. 2 to 3 months
- D. 4 to 6 months
Correct Answer: C
Rationale: An alternative to the PEG device is a low-profile gastrostomy device (LPGD). LPGDs may be inserted 2 to 3 months after initial gastrostomy tube placement.