Critical Thinking Questions and Exercises

Chapter 36

Discussion and Analysis

1. Discuss the purposes for gastric intubation.

 To decompress the stomach and remove gas and fluid

 To lavage the stomach and remove ingested toxins or other harmful materials
 To diagnose disorders of GI motility and other disorders
 To administer medications and feedings
 To compress a bleeding site
 To aspirate gastric contents for analysis

2. Describe the color of aspirate that distinguishes gastric tube placement versus intestinal
placement.

Gastric placement aspirate is cloudy and green, tan, off-white, or brown while intestinal
aspirate is clear and yellow to bile colored.

3. Demonstrate, via simulation, the steps a nurse would take to declog an enteral feeding
tube.

Always before attempting to declog a feeding tube verify placement by measuring the
length of the exposed portion of the tube and comparing the length with the original
documentation. An increase in the length of the exposed tube may indicate
dislodgement. There are 2 ways to declog a feeding tube the first is air insufflation.
Inject 20 ml of air with a 30-60 ml syringe then pull back on the plunger. If ineffective,
inject an additional 20 ml of air. Replace the large syringe with a 10 ml syringe and
aspirate again. If still unsuccessful, notify the physician. The second method is using
digestive enzymes and warm water. You must obtain a physician’s order for the enzyme.
With a 30-50 ml syringe aspirate as much liquid as possible from the feeding tube. Using
manual pressure instill 5 ml of warm water for 1 minute. Use a back and forth motion to
help dislodge the occlusion. Clamp the tube for up to 15 minutes. Follow the above
steps with enzyme solution instead of warm water and repeat once if necessary. If
unsuccessful notify the physician.

4. Describe the signs and symptoms that a nurse should assess for a patient experiencing
one of three potential complications of enteric tube placement: fluid volume deficit,
pulmonary complications, and tube-related irritations.

Pulmonary complications:
 S/S: Coughing during administration of foods or medications, difficulty clearing the
airway, tachypnea, and fever.

5. Discuss nursing interventions for four gastrointestinal complications of enteral therapy:

diarrhea, nausea and vomiting, gas/bloating/cramping, and constipation.

Diarrhea:

Assess fluid and electrolyte levels, implement changes in tube feeding formula or rate,
review medications. Appropriate rate of infusion, and temperature of formula. Avoid
multiple elixirs and pro-motility medications.

Nausea and Vomiting:

Check residuals, if greater than or equal to 200 ml reinstill and recheck, report if residual
is consistently high.

Gas/bloating/cramping:

Notify physician if persistent, keep tubing free of air.

Constipation:

Check fiber and water content and report findings. Administer adequate amount of
hydration as flushes. Consider cathartic.

6. Explain why an infusion pump is always used to administer parenteral nutrition.

An infusion pump is always used for the administration of PN to prevent fluid overload
and ensure correct amount is given as prescribed.

Clinical Situations

1. Speed of infusion, temperature and volume of feeding, malnutrition, and medication

therapy.
2. Cleocin, Inderal, Theophylline
3. A
4. D

Case Study

1. B
2. C
3. C
 4. D
5. D

Applying concepts

1. Acute Pain
Risk for infection related to presence of wound and tube
Risk for impaired skin integrity at tube insertion site

2. Wound infection, cellulitis and leakage

GI bleeding
Premature dislodgement of tube

3. Leakage of fluid

4. Seepage of gastric acid and spillage of feeding

5. 30 to 60 seconds

6. Elevate the syringe to keep the line straight, or apply gentle pressure with the bulb
syringe.

7. The higher the elevation the higher the pressure of gravity which could cause too much
pressure on the incision or too rapid infusion.

8. To facilitate digestion and reduce the risk for aspiration.