Enteral and Parenteral Nutrition
What is the most common cause of aspiration pneumonia in enteral feeding?
Tube Displacement
Why are patients with PUD advised to avoid coffee, tea, and carbonated drinks?
They stimulate gastric acid secretion, worsening ulcers.
What is the key diagnostic finding differentiating small vs. large bowel obstruction?
Projectile vomiting with small bowel obstruction; ribbon-like stools with large bowel obstruction.
What is the first-line diagnostic test for gallstones?
Ultrasound
What causes asterixis (liver flap)?
Increased ammonia levels in hepatic encephalopathy.
Why should a TPN bag and tubing be changed every 24 hours?
To prevent bacterial contamination and bloodstream infections.
A patient taking omeprazole for PUD asks why they should take it before breakfast. What’s the best response?
PPIs work best before the first meal because they block acid production at its peak
Why are elderly patients at higher risk for paralytic ileus postoperatively?
Reduced intestinal motility, polypharmacy (opioids), electrolyte imbalances
Why do patients with acute pancreatitis develop hypocalcemia?
Fat necrosis binds calcium, leading to low serum calcium levels.
Why should a patient with esophageal varices avoid heavy lifting or straining?
Increased abdominal pressure can rupture varices, causing fatal hemorrhage.
A patient receiving enteral feeding develops abdominal distention and nausea. Residual volume is 250 mL. What should the nurse do?
Hold feeding, reassess in 1 hour, and notify provider if residual remains high.
Why is long-term PPI use a concern in elderly patients?
Increased risk of fractures, pneumonia, and C. difficile infection
Why does metabolic alkalosis occur in small bowel obstruction but acidosis in large bowel obstruction?
Loss of gastric acid in small bowel obstruction; retention of acidic intestinal contents in large bowel obstruction.
A patient with cholecystitis has a positive Murphy’s sign. What is this, and how is it tested?
Pain with deep inspiration during RUQ palpation
A patient with cirrhosis has increasing confusion, slurred speech, and flapping hand tremors. What is the priority treatment?
Administer lactulose to remove ammonia via stool
A patient receiving TPN has an air embolism. What are two immediate interventions?
Clamp catheter, place in left Trendelenburg, give 100% oxygen, and call provider.
A patient presents with hematemesis and a rigid abdomen. What life-threatening complication should be suspected, and what is the priority intervention?
GI perforation; prepare for emergency surgery and IV fluids.
A patient with a bowel obstruction has a distended abdomen, high-pitched bowel sounds above the obstruction, and absent bowel sounds below it. What does this indicate?
Mechanical obstruction with complete bowel obstruction
A patient with pancreatitis develops Cullen’s sign and Grey Turner’s sign. What do these indicate?
Severe hemorrhagic pancreatitis—requires ICU monitoring
A patient with ascites requires a paracentesis. What position should they be in, and what is a post-procedure risk?
High Fowler’s position; risk of hypovolemia from fluid removal.
A patient with severe malnutrition begins enteral nutrition and develops confusion, muscle weakness, and respiratory distress. What condition is suspected, and what lab value is key?
Refeeding syndrome; hypophosphatemia
A patient with a history of PUD suddenly has severe, diffuse abdominal pain, tachycardia, and absent bowel sounds. What condition should be suspected, and what is the initial intervention?
Peritonitis from perforation; administer IV fluids, antibiotics, and prep for surgery
What is the most dangerous complication of volvulus and intussusception, and what is the priority intervention?
Bowel ischemia → necrosis → perforation; emergency surgery to prevent peritonitis.
Why must pancreatic enzyme replacement (pancrelipase) be taken with meals and snacks?
To mimic normal digestive enzyme secretion and aid in fat and protein absorption
A patient 7 days post-liver transplant develops tachycardia, RUQ pain, jaundice, and elevated liver enzymes. What is happening, and what is the next step?
Acute graft rejection; increase immunosuppressive therapy immediately.