INTESTINAL TUBES

y Tube inserted into the intestine for decompression proximal to an obstruction, relief of obstruction, decompression of post op edema at the surgical site y INSERTION:
y Same with NGT but add 3-4 inches to the 3-

measurement for correct tube placement y After inserting NGT into stomach with client in high fowlers, turn client on right side to allow for advancement of the tube through the pylorus of the stomach and into the small intestine (may take up to 24 hours)

y Confirm placement by testing the pH of aspirate ff by X-ray before taping in place

Purpose
CANTOR AND HARRI - Single Lumen t it r r tt ti f t t r t l i t ti r l tr t

Example of Use
‡S tr ‡I t ‡V l l ll ti ti l

Key Points
‡P i t ll i t ‡ t r i t ti t r t l ri i t r ‡ Or r ill ritt t t f i r, ti t iti t t ll ti ll

t

ff t f

Purpose
MILLERABBOTT -L double l . -1 tl l t mercury i t t l i f r drainage r t l i t ti r l tr t

Example of Use
‡S tr ‡I t ‡V l l ll ti ti l

Key Points
‡P i t ll i t ‡ t r i t ti t r t l ri i t r ‡ Or r ill ritt t t f i r, ti t iti t t ll ti ll

t

ff t f

The physician orders an intestinal decompression using a Harris tube for a client after gastric surgery. The primary purpose of this tube is to A. Provide an alternative route for drug administration B. Break up the obstruction C. Preventing the fluids to accumulate in the stomach D. Relieve fluid and gas in the intestine

The physician orders an intestinal decompression using a Harris tube for a client after gastric surgery. The primary purpose of this tube is to A. Provide an alternative route for drug administration B. Break up the obstruction C. Preventing the fluids to accumulate in the stomach D. Relieve fluid and gas in the intestine y Rationale: D. Harris tube is used to decompress the intestine after surgery by removing the fluid and gases that causes build up of pressure.

During insertion of a Miller-Abott tube, the nurse should position the patient in A. Upright in bed B. Semi-fowlers C. Right side lying D. Left side lying

During insertion of a Miller-Abott tube, the nurse should position the patient in A. Upright in bed B. Semi-fowlers C. Right side lying D. Left side lying Rationale: C. the client is placed in a right side lying position to facilitate movement of mercury-weighted tube through the pyloric sphincter.

To decrease the risk of aspiration during insertion of Miller-Abbot tube, the nurse plans to incorporate the following to her care plan A. Inflating the balloon during insertion B. Instructing the client to cough when the tube passes in the pharynx C. Instructing the client to perform Valsalva maneuver D. Placing the client in a high-Fowler s position

To decrease the risk of aspiration during insertion of Miller-Abbot tube, the nurse plans to incorporate the following to her care plan A. Inflating the balloon during insertion B. Instructing the client to cough when the tube passes in the pharynx C. Instructing the client to perform Valsalva maneuver D. Placing the client in a high-Fowler s position Rationale: D. Placing the client in high- Fowler s position decreases the risk of aspiration if vomiting occurs.

Finding for correct placement of Cantor tube includes A. pH of 7 or greater of the aspirate y B. pH of 4.5 or less of the aspirate y C. Presence of gastric contents when checking residuals y D. Auscultation of air when tube is inserted in the abdomen

y y y y

Finding for correct placement of Cantor tube includes A. pH of 7 or greater of the aspirate B. pH of 4.5 or less of the aspirate C. Presence of gastric contents when checking residuals D. Auscultation of air when tube is inserted in the abdomen Rationale: A. Cantor tube is an intestinal tube. The nurse can ensure proper placement by checking the pH of aspirate. pH of 7 or greater indicates intestinal contents not gastric contents.

E. ESOPHAGEAL AND GASTRIC TUBES
Purpose
SENGSTAKEN AKEMORE TUBE ± triple lumen with inflatable esophageal and gastric balloon, gastric aspiration lumen
Apply pressure against

Example of use
Bleeding esophageal varices

Key points
. Gastric balloonpressure at gastroesophageal junction to compress gastric varices and decrease blood flow

esophageal
veins to control bleeding

Continuation of Key points
2. Esophageal balloon compress esophageal varices 3. If bleeding does not stop w/ gastric balloon, inflate esophageal ballon to 25 to 45 mmHg 4. X-ray of chest and upper abdomen confirms placement 5. Gastric contents aspirated thru gastric lavage or intermittent suction via the gastric aspiration port 6. Insert NGT in opposite nares to collect secretion that accumulate above the esophageal balloon

SENGSTAKEN BLAKEMORE TUBE

y MINNESOTA TUBE

four lumen gastric tube (additional lumen for aspirating esophagopharyngeal secretions )

Nursing Considerations for Sengstaken Blakemore
y Provide oral care q2 hours and inspect the oral cavity y y y y

for continued bleeding. Label each lumen Place client in upright or fowler s position Double clamp the balloon parts to prevent air leaks Keep scissors at bedside monitor for respiratory bedside; distress

Nursing Considerations
y To prevent ulceration or necrosis of the esophagus,

release esophageal pressure as prescribed by agency y Monitor for increased bloody drainage, which may indicate persistent bleeding y Monitor for signs of esophageal rupture drop in BP, increased HR and back and upper abdominal pain

y Balloons are generally deflated after 24 to 48 hours to assess for continued bleeding. The esophageal balloon is deflated first (if previously inflated), followed by the gastric balloon 12 to 24 hours later. y The tube is generally left in place for another 12-24 hours 12before removal. y The esophageal balloon must be deflated before the gastric balloon is deflated. The balloons may only be re-inflated by a physician.

A patient has a bleeding esophageal varices and is inserted with a Sengstaken-Blakemore tube. After the tube is inserted, the client shows difficulty of breathing. The nurse s initial action would be to A. Encourage him to take a deep breath B. Placing him in a Fowler s position C. Notifying the physician immediately D. Deflating the esophageal balloon

A patient has a bleeding esophageal varices and is inserted with a Sengstaken-Blakemore tube. After the tube is inserted, the client shows difficulty of breathing. The nurse s initial action would be to A. Encourage him to take a deep breath B. Placing him in a Fowler s position C. Notifying the physician immediately D. Deflating the esophageal balloon Rationale: D. If the client s airway is obstructed, esophageal balloon should be immediately deflated using a scissor to allow the patient to breath.

The nurse understands the correct intervention for a patient prescribed with a Minnesota tube when she performs the following, except A. Placing the client in Sim s right lateral position for insertion B. Preparing patient for radiography to verify placement C. Double clamps the balloon ports to prevent air leaks D. Maintaining the head of patient elevated after insertion

The nurse understands the correct intervention for a patient prescribed with a Minnesota tube when she performs the following, except A. Placing the client in Sim s right lateral position for insertion B. Preparing patient for radiography to verify placement C. Double clamps the balloon ports to prevent air leaks D. Maintaining the head of patient elevated after insertion Rationale: A. Minnesota tube is a form of a modified Sengstaken-Blakemore tube with additional lumen for aspirating esophageal secretions. Patient should be placed in an upright or Fowler s position during insertion.

A nurse who deflates the esophageal balloon (Sengstaken-Blakemore tube) of a client anticipates the risk for A. Tracheal deviation B. Recurrent hemorrhage C. Esophageal necrosis D. Aspiration due to gag reflex stimulation

A nurse who deflates the esophageal balloon (Sengstaken-Blakemore tube) of a client anticipates the risk for A. Tracheal deviation B. Recurrent hemorrhage C. Esophageal necrosis D. Aspiration due to gag reflex stimulation Rationale: B. Sengstaken-Blakemore tube is used to decompress esophageal varices to prevent bleeding.

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