ADVANCED SKILLS

Nutrition and Elimination

Learning Objective-

  • Describe the physiology of bowel elimination.
  • Identify variables that influence bowel elimination.
  • Demonstrate how to promote regular bowel habits: use laxatives and antidiarrheal medications, empty the colon of feces, design and implement bowel retraining programs, and use comfort measures to ease defecation.
  • Discuss different types of enemas and how they are administered.
  • Describe nursing care of a patient with an ostomy.
  • Describe similarities and differences in ostomies by location, function, and drainage characteristics.
  • Identify ostomy care appliances and products and describe the rationale for their use.
  • Demonstrate the measurement of stoma size and select an appropriate appliance for the stomal opening.
  • Identify actions which aid in odor control of ostomy appliances.
  • Identify the purpose of ostomy irrigation and describe two methods of irrigation.
  • Explain the reasons for skin breakdown and identify nursing actions to reduce excoriation.
  • Describe the uses and rationales behind nasogastric tubes.
  • Discuss nursing interventions necessary to maintain patency of a nasogastric tube.
  • Demonstrate insertion and proper maintenance of a nasogastric tube.
  • Describe nursing measures to alleviate discomfort associated with a nasogastric tube.
  • Describe various types of feeding tubes including nasogastric, gastrostomy and jejunostomy.
  • Compare and contrast bolus, intermittent, and continuous techniques for tube feeding.
  • Identify basic principles of enteral feeding pumps.
  • Describe data to assess for patients receiving tube feedings.

A. Nasogastric Tube

1. NGT Insertion

2. NGT Feedings

3. NGT Removal

4. Gastrostomy Tubes

Required Text and Resources:

Yoost & Crawford (2016) Fundamentals of Nursing, Chapter 30

Lewis (2014) Medical-Surgical Nursing (9th ed.) Chapter 40, p.p. 897-900 and Chapter 42, p.p. 947-948

Mosby video series. Nursing Concepts Online. Advanced Skills, Nutrition and Elimination Skills– NGT / Enteral

Practicum:

Practice nasogastric intubation and skills related to nasogastric decompression on manikins in the skills lab.

Have a peer review your ability to perform nasogastric intubation.

Practice gavage techniques using the bolus and continuous techniques for NG and gastrostomy tubes.

Have a peer review your ability to give a feeding via feeding tube utilizing bolus method, or an enteral feeding pump, irrigate a NG tube connected to suction, and remove a NG tube.

Review Gastrostomy/PEG tubes and discuss the similarities and differences with nasal enteral tubes.

B. Bowel

1. Enema

2. Ostomy Care

3. Removal of Fecal Impaction

Required Text and Resources:

Yoost & Crawford (2016) Fundamentals of Nursing, Chapter 40

McKinney (2013) Maternal-Child Nursing (5th ed.), Pages 938

Lewis (2014) Medical-Surgical Nursing (9th ed.) Chapter 43, p.p. 966-968, 990- 904

Mosby video series. Nursing Concepts Online. Advanced Skills, Nutrition and Elimination Skills – Bowel Elimination

Practicum:

Practice administration of enemas using simulators in skills lab.

Have a peer review your technique for enema administration via prepackaged disposable container.

Have two peers review your ability to perform a cleansing enema.

Have a peer review your technique for removing a fecal impaction using the simulator provided in skills lab.

Practice measuring stoma size, ostomy appliance removal, ostomy irrigation, skin care and application of an ostomy appliance.

Have a peer review your ostomy care and irrigation skills using checklist in syllabus

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