A patient with a gastrostomy tube presents with erythema, warmth, and swelling at the tube site, along with mild fever and tachycardia. Which of the following is the most appropriate initial nursing intervention to address the suspected localized infection?

B) Administer prescribed antibiotics and monitor for systemic infection.

A) Apply a cold compress to the gastrostomy site to reduce swelling.

B) Administer prescribed antibiotics and monitor for systemic infection.

C) Increase the frequency of tube feedings to ensure adequate nutrition.

D) Apply an occlusive dressing to the gastrostomy site to protect it from further contamination.

A nurse is caring for a patient with a gastrostomy tube who exhibits erythema, warmth, and swelling around the tube site, along with fever and tachycardia. The patient also reports nausea and abdominal cramping during feeding. Which of the following is the most appropriate initial nursing intervention?

B) Elevate the head of the bed to 30-45 degrees during feeding.

A) Administer antiemetic medication to alleviate nausea.

B) Elevate the head of the bed to 30-45 degrees during feeding.

C) Flush the gastrostomy tube with sterile water to ensure patency.

D) Apply a warm compress to the site to reduce swelling.

A patient with a gastrostomy tube has developed a fever, elevated heart rate, and abdominal pain radiating to the back. An abdominal ultrasound reveals a localized fluid collection near the gastrostomy site. What is the nurse's priority action in managing this patient's care?

B) Notify the surgical team for evaluation of the need for abscess drainage.

A) Administer the newly prescribed antibiotic regimen immediately.

B) Notify the surgical team for evaluation of the need for abscess drainage.

C) Increase the patient's fluid intake to aid in infection control.

D) Educate the patient and family about signs of peritonitis.

A patient with a gastrostomy tube and recent diagnosis of an abdominal abscess is being evaluated for potential surgical intervention. The healthcare team has adjusted the antibiotic regimen based on culture results indicating a resistant bacteria strain. What is the priority nursing intervention to support the patient's current treatment plan?

B) Monitor the patient's vital signs closely for signs of systemic infection.

A) Encourage the patient to increase oral intake to ensure adequate hydration.

B) Monitor the patient's vital signs closely for signs of systemic infection.

C) Educate the patient on the importance of completing the full course of antibiotics.

D) Assist in positioning the patient to facilitate drainage of the abscess site.

A patient with a diagnosed abdominal abscess is being managed with antibiotics and nutritional interventions. The patient's latest lab results show a marginal reduction in white blood cell count and ongoing elevated C-reactive protein levels. Sodium levels are slightly low, and the patient continues to experience nausea. Which nursing intervention is most appropriate to prioritize at this time?

B) Implement a more aggressive hydration strategy with intravenous fluids.

A) Encourage the patient to increase oral fluid intake to address hyponatremia.

B) Implement a more aggressive hydration strategy with intravenous fluids.

C) Administer antiemetic medication to reduce nausea and improve oral intake.

A patient undergoing treatment for an abdominal infection shows a reduction in fever and heart rate but continues to experience nausea and abdominal pain. Laboratory results indicate a marginal reduction in white blood cell count and persistent elevated C-reactive protein levels. Sodium levels are low, likely due to decreased oral intake and gastrointestinal losses. Which nursing intervention should be prioritized to address the patient's current condition?

C) Initiate intravenous fluids to correct electrolyte imbalances and improve hydration.

A) Encourage the patient to consume more oral fluids to improve hydration status.

B) Administer antiemetics to control nausea and facilitate oral intake.

C) Initiate intravenous fluids to correct electrolyte imbalances and improve hydration.

D) Increase the frequency of vital sign monitoring to detect changes in the patient's condition.

A patient with a gastrostomy tube presents with abdominal distension, hypoactive bowel sounds, nausea, and vomiting. Imaging reveals delayed gastric emptying and ascites. Which of the following nursing interventions is the most appropriate initial action to address the patient's symptoms?

C) Initiate gastric decompression via the gastrostomy tube to relieve distension

A) Increase the rate of enteral feedings to improve nutritional intake

B) Administer prokinetic agents as prescribed to enhance gastric motility

C) Initiate gastric decompression via the gastrostomy tube to relieve distension

D) Elevate the head of the bed to 90 degrees to prevent aspiration

A patient with suspected gastroparesis and abdominal distension has been temporarily placed on a decompression regimen via the gastrostomy tube. Which nursing intervention is most appropriate to support the patient's condition during this period?

B) Administer prescribed prokinetic agents and monitor for side effects.

A) Increase the patient's oral fluid intake to promote hydration.

B) Administer prescribed prokinetic agents and monitor for side effects.

C) Resume enteral feeding at a reduced rate to maintain nutritional status.

D) Position the patient flat on their back to reduce abdominal pressure.

A patient with delayed gastric emptying is being treated with a gastrostomy tube for decompression and prokinetic agents. Despite these interventions, the patient continues to experience hypoactive bowel sounds and mild electrolyte imbalances. Which nursing intervention should the nurse prioritize to support the patient's current treatment plan?

C) Continue monitoring electrolyte levels and adjust intravenous fluid therapy as needed.

A) Encourage the patient to ambulate regularly to promote bowel motility.

B) Administer anti-emetic medication prior to meals to prevent nausea.

C) Continue monitoring electrolyte levels and adjust intravenous fluid therapy as needed.

D) Increase the frequency of tube feedings to ensure adequate nutrition.

A patient with persistent nausea and vomiting due to delayed gastric emptying is being managed with decompression, prokinetic agents, and electrolyte replacement. Despite these interventions, the patient still shows hypoactive bowel sounds and mild electrolyte imbalances. Which nursing intervention should be prioritized to ensure patient safety and improve clinical outcomes?

A) Increase the frequency of electrolyte monitoring to every 4 hours.

B) Administer a full liquid diet to promote gastric motility.

C) Elevate the head of the bed to 30 degrees at all times.

D) Encourage ambulation to stimulate bowel activity.

gastrostomy tube - Nursing Case Study

Pathophysiology

• Primary mechanism: Gastrostomy tube insertion establishes a direct access route to the stomach through the abdominal wall, bypassing oral intake. This is crucial for patients with conditions that impair normal swallowing or gastrointestinal passage, ensuring adequate nutrition and medication delivery.

• Secondary mechanism: The tube allows for decompression of gastric contents, which can prevent complications like gastric distension and aspiration in patients with impaired gastric emptying or bowel obstructions, promoting comfort and reducing risk of aspiration pneumonia.

• Key complication: Infection at the insertion site is a common risk, requiring strict adherence to aseptic techniques and regular site care to prevent local and systemic infections.

Patient Profile

Demographics:

58-year-old female, retired teacher

History:

• Key past medical history: Stroke 2 years ago, resulting in dysphagia; hypertension

• Current medications: Amlodipine 5 mg daily, Aspirin 81 mg daily, Omeprazole 20 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Redness and discomfort around the gastrostomy tube site

• Key symptoms: Mild fever, increased drainage from the tube site, difficulty with feeding through the tube

• Vital signs: Temperature 100.4°F, Pulse 96 bpm, Respiratory rate 18 breaths per minute, Blood pressure 130/85 mmHg

Section 1

The nurse begins the initial assessment with a focused examination of the gastrostomy tube site. Upon inspection, the skin around the tube is erythematous, with notable warmth and slight swelling, indicating possible localized infection. Palpation elicits tenderness, and there is an increase in serous drainage mixed with purulent fluid. The patient's mild fever and tachycardia, in conjunction with these local signs, raise suspicion of a superficial infection that may be progressing.

Further assessment reveals the patient is experiencing discomfort during feeding, with reports of nausea and mild abdominal cramping. These symptoms suggest potential complications with gastric stasis or partial obstruction, possibly due to inflammation. Auscultation of the abdomen indicates hypoactive bowel sounds, which may correlate with decreased gastrointestinal motility. The nurse also notes that the patient's blood pressure has remained stable, which is reassuring but warrants continued monitoring given the risk of systemic infection.

In response to these findings, the healthcare team decides to conduct laboratory tests, including a complete blood count (CBC) and culture of the drainage, to identify the presence of infection and guide further treatment. The patient's white blood cell count is slightly elevated at 11,500/mm³, supporting the likelihood of an infectious process. These results, coupled with the clinical presentation, underscore the need to initiate empirical antibiotics while awaiting culture results. The team also consults with a dietitian to adjust the feeding regimen, aiming to minimize gastric discomfort and facilitate better tolerance. These steps are critical in preventing further complications and ensuring the patient's recovery trajectory remains on course.

Section 2

As the healthcare team continues to monitor the patient, a notable change in status occurs within 48 hours. Despite the initiation of empirical antibiotics, the patient’s fever has risen to 101.5°F, and their heart rate remains elevated at 112 beats per minute, suggesting that the infection may be more entrenched than initially suspected. The patient reports increasing nausea and abdominal pain, which now radiates to the back, and there is a significant drop in oral intake due to discomfort. These symptoms prompt the team to reassess the situation and consider the possibility of deeper complications, such as a developing abscess or peritonitis.

Additional diagnostic imaging, specifically an abdominal ultrasound, is performed to evaluate for potential intra-abdominal complications. The results reveal a small, localized collection of fluid near the gastrostomy site, consistent with an abscess formation. This finding corroborates the clinical picture of a more severe infection and necessitates an adjustment in the treatment plan. The team decides to consult with a surgical specialist to evaluate the need for drainage of the abscess and to reassess the gastrostomy tube placement for any mechanical issues contributing to the patient's symptoms.

In conjunction with surgical evaluation, the patient's antibiotic regimen is modified based on preliminary culture results, which indicate the presence of a resistant strain of bacteria. The healthcare team collaborates closely with the infectious disease specialist to ensure appropriate antibiotic coverage. Meanwhile, the dietitian works to adapt the feeding protocol, transitioning to a lower-volume, more easily digestible formula to alleviate gastrointestinal strain. These interventions aim to address both the localized infection and the patient's overall nutritional status, setting the stage for potential surgical intervention if the patient's condition does not stabilize.

Section 3

As the healthcare team continues to manage the patient's condition, they closely monitor the response to the updated antibiotic regimen and nutritional interventions. Over the next 24 hours, the patient's vital signs show some stabilization; the fever has decreased slightly to 100.9°F, and the heart rate has lowered to 105 beats per minute. However, the patient still reports persistent abdominal pain, albeit slightly less severe, and nausea continues to be a significant concern. These symptoms, along with the reduced oral intake, prompt the team to conduct further laboratory tests to assess the patient's inflammatory markers and overall status.

The latest lab results show a marginal reduction in white blood cell count, now at 13,000/mm³, indicating a potential initial response to the antibiotics. However, the C-reactive protein (CRP) remains elevated at 12 mg/L, suggesting ongoing inflammation. Electrolyte panels reveal mild hyponatremia, with sodium levels at 132 mEq/L, likely due to decreased oral intake and gastrointestinal losses. These findings lead the team to consider that while the infection is beginning to respond to treatment, the patient's nutritional and fluid status needs closer attention.

In response to these lab results and the patient's clinical presentation, the interprofessional team decides to implement a more aggressive hydration strategy and adjust the electrolyte balance, administering intravenous fluids with careful monitoring. They also decide to increase the frequency of small-volume, nutrient-dense enteral feedings to support the patient's energy needs without exacerbating gastrointestinal discomfort. The collaborative approach aims to enhance the patient's recovery trajectory, ensuring that any further complications are swiftly addressed and paving the way for potential surgical intervention if the abscess does not resolve with medical management alone.

Section 4

As the interprofessional team continues to monitor the patient's status, signs of new complications begin to emerge. Despite the aggressive hydration and adjusted enteral feeding strategy, the patient develops increasing abdominal distension and tenderness upon palpation. There is a noted change in bowel sounds, which are now hypoactive, suggesting potential gastrointestinal motility issues. The patient's nausea persists, and they report a new onset of vomiting, which raises concerns about gastric emptying or potential obstruction.

Given these developments, the team orders an abdominal X-ray and an ultrasound to further investigate the cause of these symptoms. The imaging results reveal a moderately distended stomach with a delay in gastric emptying, indicating possible gastroparesis or a partial obstruction at the level of the gastrostomy. Additionally, there is an accumulation of fluid in the abdominal cavity, suggestive of ascites, which could be contributing to the discomfort and distension. These findings necessitate a reassessment of the current feeding regimen and a possible surgical consultation to address the mechanical issues.

In response to the new diagnostic information, the healthcare team opts to temporarily pause enteral feedings and focus on decompression of the stomach via the gastrostomy tube. They initiate a regimen of prokinetic agents to facilitate gastric motility and consult with a surgical team to evaluate the potential need for intervention to relieve any obstruction. Continuous monitoring of the patient's fluid balance and electrolyte status becomes paramount, as does the reassessment of the patient's overall nutritional strategy. This proactive management aims to prevent further deterioration and to stabilize the patient's condition, allowing for a safe and effective recovery process.

Section 5

Response to Interventions

Following the implementation of the decompression strategy and administration of prokinetic agents, the healthcare team closely monitors the patient for any signs of clinical improvement. Within 24 hours, the patient's abdominal distension shows slight reduction, and the tenderness upon palpation decreases. The decompression via the gastrostomy tube successfully drains a significant amount of gastric contents, offering some relief in terms of nausea and vomiting. The patient's vital signs remain stable, with a blood pressure of 118/72 mmHg, heart rate of 88 bpm, and respiratory rate of 18 breaths per minute. However, they continue to experience hypoactive bowel sounds, indicating ongoing motility issues.

Laboratory results reveal a mild electrolyte imbalance, with a sodium level of 133 mEq/L and potassium at 3.2 mEq/L, likely secondary to the persistent vomiting and drainage. The team promptly addresses this with electrolyte replacement therapy, adjusting the patient's intravenous fluids to include appropriate amounts of sodium and potassium. Additionally, the patient is started on a low-dose erythromycin regimen to further enhance gastric motility, in conjunction with the already prescribed metoclopramide.

Despite these interventions, the patient's gastric emptying remains delayed, prompting the surgical team to schedule an endoscopic evaluation. This procedure aims to definitively assess and address any anatomical obstructions at the gastrostomy site. The interprofessional team continues to evaluate the patient's response to treatment, emphasizing the need for comprehensive nutritional support and careful monitoring of hydration status. The goal remains to stabilize the patient's condition sufficiently to allow for a safe surgical intervention if necessary, while minimizing the risk of further complications from prolonged gastric stasis and electrolyte disturbances.