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MedSurg 2 > Advanced Nutrition > Flashcards

Advanced Nutrition Flashcards

1
Q

Feeding a Pt with Dysphagia

A
  • ensure pt is awake, alert, and ready to fully participate
  • position in high fowlers (40-60 degrees)
  • assess risk of aspiration
  • if paralysis, place food on unaffected side
  • signs of aspiration = coughing, throat clearing
  • protect safety, independence, dignity, common courtesy
  • assess for appropriateness to delegate feeding to UAP
  • no straws
  • thickened liquids?
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2
Q

Enteral Nutrition

A

aka tube feeding, goes through GI tract

administration of nutritionally balanced liquefied food or formula through tube inserted into:

  • stomach
  • duodenum
  • jejunum

provides nutrients alone or supplement to oral or parenteral nutrition

  • easy to administer
  • safer, less expensive, and more physiologically efficient than parenteral

feedings can be started when bowel sounds are present, usually w/in 24 hours after surgical placement

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3
Q

Indications for Enteral Nutrition

A 
anorexia
orofacial fractures
head/neck cancer
neurologic or psychiatric conditions
extensive burns
critical illness
chemotherapy
radiation therapy
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4
Q

Enteral Nutrition: Delivery Options

A

continuous infusion or bolus by pump
bolus by gravity
bolus by syringe

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5
Q

Enteral Nutrition: Tubing Types

A

Polyurethane or silicone tube:

  • radiopaque (can see on xray)
  • placement in small intestine (decreased likelihood of regurgitation and aspiration when placed in intestine, passed pyloric sphincter, instead of stomach)

NG and Naso-intestinal tubes:

  • clog easily
  • can be dislodged by vomiting or coughing
  • can be knotted/kinked in GI tract
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6
Q

Percutaneous Endoscopic Gastronstomy

A

gastrostomy tube placement via percutaneous endoscopy

w/ use of endoscopy, a gastrostomy tube is inserted through the esophagus into the stomach and then pulled through a stab wound made in the abdominal wall

retention disk and bumper secure the tube

most feedings can start w/in 4 hours of insertion

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7
Q

Gastrostomy and Jejunostomy Tubes

A

may be used when a pt requires tube feeding for an extended time
*pt must have intact, unobstructed GI tract

can be placed surgically, radiologically, or endoscopically

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8
Q

Enteral Nutrition: Tube Position

A
  • x-ray confirmation for new nasal or orogastric tubes
  • mark exit site of tube
  • check placement before feeding/drug administration or every 4 hours w/ continuous feeds (book says every 8 hours)

can check tube placement w/ aspiration of stomach contents, pH check

ideally placement should be confirmed w/ more than 1 test

*x-ray is most accurate assessment

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9
Q

Enteral Nutrition: Medication Administration

A
  • use liquid form of medication if possible
  • crushed meds mix in warm water
  • flush before and after w/ water (10-20ml before and 30-60ml after) to prevent clogging of tube (sterile water only)
  • do not crush enteric coated or sustained released meds
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10
Q

Enteral Nutrition: Site Care

A
  • assess the skin around tube daily
  • monitor bumper tension (too tight, can cause irritation and breakdown, can also get imbedded into skin)
  • apply a dressing until site is healed
  • after healed, wash with soap and water
  • protective ointment or skin barrier
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11
Q

Enteral Nutrition: Misconnection

A

inadvertent connection between an enteral feeding system and a non-enteral feeding system (IV line, peritoneal dialysis catheter, tracheostomy tube cuff)

severe pt injury or death can result

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12
Q

Enteral Nutrition: General Nursing Considerations

A 
daily weights
bowel sounds before feedings
accurate I&O
initial glucose checks
label w/ date and time started
pump tubing changed q24h
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13
Q

Enteral Nutrion: Complications

A
  • vomiting (have suction equipment at bedside)
  • dehydration (more calorically dense, less water formula contained, check for high protein content)
  • diarrhea (common especially early on)
  • constipation
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14
Q

Enteral Nutrition: Gastrostomy or Jejunostomy Feedings - Complications

A
  • residuals, assess and document every 4 hours
  • skin irritation
  • pulling out of tube (teach pt/family about feeding administration, tube care, and complications)
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15
Q

Enteral Nutrition: Gerontologic Considerations

A

more vulnerable to complications:

  • fluid and electrolyte balances
  • glucose intolerance
  • decreased ability to handle large volumes
  • increased risk of aspiration
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16
Q

Parenteral Nutrition

A

aka TPN, HAL

administration of nutrients directly into the bloodstream

goal = meet nutritional needs and allow growth of new body tissue

customized to meet each patient’s needs

17
Q

Indications for Parenteral Nutrition

A 
chronic severe diarrhea and vomiting
complicated surgery or trauma
GI obstruction
GI tract anomalies and fistulae
Intractable diarrhea
Severe anorexia nervosa
Severe malabsoprtion
Short bowel syndrome

*anything that’s causing problems in the gut or where nutritional needs are not being met or not being met with enteral

18
Q

Parenteral Nutrition: Composition

A

base solution contains dextrose and protein in the form of amino acids

prescribed electrolytes, vitamins, and trace elements are added to customize

IV fat emulsion is added to complete the nutrients

19
Q

Parenteral Nutrition: Methods of Administration

A

central parenteral nutrition:
-used for long-term support
-through catheter whose tip lies in superior vena cava
(peripherally inserted central catheters)

peripheral parenteral nutrition (PPN):

  • for short-term therapy or special conditions
  • through peripherally inserted catheter or vascular access device
  • protein and caloric requirements can’t be too high
  • used when risk of central catheter is too great
20
Q

Parenteral Nutrition: Tonicity of Nutrition

A

Central solutions are hypertonic
-large veins can handle high glucose content

Peripheral solutions are less hypertonic

  • peripheral veins cannot handle as high glucose content
  • NOT preferred route of administration
21
Q

Parenteral Nutrition: Solutions

A

prepared by pharmacist or trained technician under strict aseptic techniques

must be refrigerated until 30 minutes before use

must be labeled w/ nutrition contents, all additives, time mixed, date and time of expiration

usually 2 RN check

22
Q

Parenteral Nutrition: Complications

A

Refeeding Syndrome:

  • fluid retention and electrolyte imbalances
  • hypophosphatemia is hallmark sign
  • pts predisposed by long-standing malnutrition states (ex. chronic alcohol syndrome)

Metabolic Problems:

  • altered renal function from bypassing GI system and hitting kidneys hard
  • essential fatty acid deficiency
  • hyperglycemia, hypoglycemia
  • hyperlipidemia
  • liver dysfunction

Catheter-related problems:

  • air embolus
  • catheter-related sepsis
  • dislodgement, thrombosis of vein, phlebitis
  • hemorrhage, occlusion
  • pneumothorax, hemothorax, hydrothorax
23
Q

Parenteral Nutrition: Nursing Management

A
  • VS: every 4-8 hours
  • daily weights
  • blood glucose (check initially every 4-8 hours)
  • infusion pump must be used, periodically check volume infused
  • monitor labs (electrolytes, BUN, CBC, liver enzymes)
  • dressing changes
  • watch for complications
  • examine bag for signs of contamination and recheck against orders
  • discontinue PN solution at end of 24hrs
  • change tubing every 24hrs (filters needed on all tubing)

MedSurg 2 (18 decks)

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