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1 Critical Care > ATI -Enteral/Parenteral > Flashcards

ATI -Enteral/Parenteral Flashcards

1
Q

Enteral Indications

A

-functioning GI tract
-unable to swallow/increased aspiration risk (stroke, adv parkinsons, MS)
-inability to eat (coma, intubated)
-cant maintain adeq nutrition (cancer, burn, sepsis)

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2
Q

enteral feeds can be for either ___ or ____

A

in addition to an oral diet
or
only source of nutrition

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3
Q

Complications of Enteral Feedings

A

1 Overfeeding
2 Diarrhea
3 Aspiration PNA
4 Refeeding Syndrome

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4
Q

Overfeeding

A

infusion of greater quantity than can be readily digested

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5
Q

Overfeeding
manifestations

A

-ab distention
-n/v

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6
Q

Overfeeding
nursing actions

A

-residual check Q4-6hr
»slow/withold feeding if resid vol >100-200ml
»restart at a slower rate after a period of rest
-check pump for proper operation
-check pup to ensure infusion is at correct rate

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7
Q

Diarrhea

A

secondary to concentration of feeding or its constituents

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8
Q

Diarrhea
nursing actions

A

-slow rate of feeding + notify
-confer w dietician
-provide skin care + protection
-eval for c.dif if persistent or if it has foul odor

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9
Q

Aspiration Pneumonia

A

secondary to aspiration of feeding
-can be life-threatening

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10
Q

primary cause of aspiration of feeding

A

tube displacement

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11
Q

Aspiration Pneumonia
prevention

A

-confirm tube placement before feedings
-elevate hob at least 30 degree during and for at least 1 hour after feedings

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12
Q

Aspiration Pneumonia
nursing action

A

-stop feeding
-turn pt to one side + suction airway
-admin O2 if indicated
-monitor VS for elevated temp
-auscultate breath sounds for incr congestion or diminished breath sounds
-notify provider
-obtain chest x ray

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13
Q

Refeeding Syndrome

A

occurs when enteral feeding is started in a client who is in a starvation state + whose body has began to catabolize protein + fat for energy
-potly life threatening

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14
Q

Refeeding Syndrome
nursing actions

A

-monitor for new onset of confusion or seizures
-asses for shallow respiration
-monitor for increased muscular weakness
-notify provider
-obtain blood electrolytes

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15
Q

Total Parenteral Nutrition

A

hypertonic IV bolus solution

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16
Q

TPN purpose

A

-prevent + correct nutritional deficiencies
-minimize adverse effects of malnourishment

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17
Q

TPN is administered thru…

A

central line
-tunneled triple lumen catheter or single/double lumen peripherally inserted line (PICC)

18
Q

TPN contains…

A

complete nutrition incl:
-10-50% dextrose
-lipids/essential fatty acids
-proteins
-electroyes
-vitamins
-trace elements

19
Q

standard IV bolus TPN therapy is typically no more than ___ cals/day

A

700 calories/day

20
Q

Partial Parenteral Nutritoin or Peropheral Parenteral Nutrition [PPN]

A

less hypertonic
-intended for short-term use
-

21
Q

PPN is administered thru

A

large peripheral vein

22
Q

dextrose concentration of PPN

A

10%

23
Q

PPN risk

A

phlebitis

24
Q

TPN
indications

A

any condition that
-affects ability to absorb nutrition
-has prolonged recovery
-creates hypermetab state
-creates chronic malnutrition

25
Q

pot’l diagnosis that may require TPN

A

-chronic pancreatitis
-diffuse peritonitis
-short bowel syndrome
-gastric paresis fr DM
-severe burns

26
Q

pt presentation that may require TPN

A

-wt loss >10%
-NPO or unable to eat/drink >5 days
-muscle wasting
-poor tissuehealing
-burns
-bowel disease disorder
-acute kidney failure

27
Q

TPN
prep

A

-obtain lab values
bc soln is customized for each client

28
Q

TPN
flow rate

A

-gradually incr then decr to allow for body adjustment

-no more than 10% hourly incr rate

-never abruptly stop

29
Q

TPN
nursing actions

A

-assess VS Q4-8hr
-wt daily
-check gluc
-sterile procedure to minimize infection

30
Q

how often to change TPN tubing + soln

A

Q24hr

31
Q

TPN tubing requires…

A

filter to collect particles

32
Q

TPN
check glucose every…

A

Q4-6 hr for first 24hr

33
Q

in case TPN is unexpectedly ruined or runs out… have ___ nearby

A

10% dextrose
-to minimize hypoglycemia

34
Q

TPN complications

A

1 metabolic complications
2 air embolism
3 infection
4 fluid imbalance

35
Q

common metabolic compications

A

hypo/hyper glycemia
vitamin deficiencies

36
Q

metabolic complications w TPN nursing actions

A

-review daily lab results
-monitor for hyperglycemia

37
Q

air embolism

A

fr pressure changes during tibing changes

38
Q

air embolism
nursing actions

A

-monitor for manifestations (sudden onset of dyspnea, chest pain, anxiety, hypoxia)
-clamp catheter immediately
-place pt on LEFT side in TRENDELENBURG
-admin O2
-notify provider to aspirate air

39
Q

Infection nursing actions

A

-observe central line for erythema, tenderness, exudate
-change sterile dressing Q2-3 days
-change tubing Q24 hr
-observe for signs (fever, incr WBC, chills, malaise)

40
Q

fluid imbalance
nursing actions

A

-assess lungs for crackles
-monitor for resp distress
-minitor daily wt + I+O
-do not speed up infusion
-gradually incr flow rate until rpescribed infusion rate is achieved

1 Critical Care (17 decks)

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