1. Know how to measure the length of the NG Tube for insertion and what the differences between a continuous, bolus and cyclic feeding are. a. Place bed at 45 degrees fowler position b. Measure tube length from nostril to earlobe to xiphoid process c. Lube tip of tube d. With patient head back insert tube e. When at pharynx have patient tilt head forward and sip on water to pass by sphincter into esophagus f. Advance until you reach your measured length g. Secure and mark tube and aspirate for stomach content h. Check placement with x-ray
No solid food-liquefied food or formula Bolus-250-400ml in short period 15-30min Cyclic- while sleeping 8-12hrs. off when awake Continuous- continued feeding over 12-24hrs Intermittent- 250-400ml over 30-60min by gravity 2. Know what a hiatal hernia is and what you would teach your client about managing the symptoms. Also know the name of the surgery that is used to correct a hiatal hernia.

Hiatal hernia- protrusion of part of the stomach into the lower portion of the thorax through the diaphragm
Causes-congenital weakness of diaphragm, multiple pregnancy obesity and aging
Treatment- lifestyle changes-diet low in alcohol, chocolate, citrus, caffeine and high fat foods, weight loss, sitting up in bed, stop smoking, medications-H2 antagonists, possible surgery
Surgery-Fundoplication or anti reflux surgery.

3. What could be a post-op complication of an inguinal hernia repair? Scrotum Edema-swelling of the testicular sac.

4. Know the order you would perform an abdominal assessment and what questions may be pertinent to include. a) Observe: contour of abdomen, breathing effort, skin integrity, rashes, etc. b) Auscultation: bowel sounds a. Normal 5-30 per min b. Hypo less than 5min c. Hyper more than 30min d. Listen a full 5 min in each quadrant to confirm absent bowel sounds c) Percussion of abdomen: dullness over solid organs and resonance over hollow/air filled organs d) Abdominal palpation: palpate all quadrants to identify pain, tenderness, soft/firm, masses, distention e. Probe near liver to assess for enlargement and pain in this area is suggestive of liver disorder, gallbladder or intestinal disease. f. If pain location is known then palpate starting away from pain location and work towards pain.
Questions might include: Chief Complaint
Current nutrition, metabolic and elimination patterns?
Why pt sought treatment and current symptoms?
How long have they had symptoms and what relieves it?
Any food that causes problems?
Quality of appetite?
Problem chewing and swallowing?
Weight gain or loss?
Bowel patterns? Stool color, shape, etc
Family history of problem?
Work history of possible toxins?
Allergies, meds, OTC meds that may caused problems?
5. Understand causes and treatment options for nausea and vomiting. Where are vomiting and appetite centers located? What is the valsalva maneuver?
Causes-Drugs, infections, food poisioning, emotional stress, intestinal obstruction and early pregnancy
Treatment-eliminate cause ex. Stopping a drug, dealing with stress, antibiotics for infection, surgery for obstruction, antiemetic, food restrictions etc.
The vomiting center is located in the Medulla part of brain.
Valsalva maneuver is done by bearing down like trying to have a bowel movement. Cause vagal tone which decreases HR, causes dizziness, hypotention and bradycardia.
6. Understand any pre-op procedures, patient teaching, and complications for a cholecystogram, barium enema, ultrasound and liver biopsy. We discussed a key important fact with each of the tests!
Cholecystography- patient swallows iodine pills- 6 pills after a fat-free meal the night before. 1 pill every 5 mins after meal with 250ml of water NPO after midnight x-ray radiographs done next day to examine if iodine is found in gallbladder next fatty food is given to see