ATI -Enteral/Parenteral Flashcards by jessica quintos

Enteral Indications

-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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enteral feeds can be for either ___ or ____

in addition to an oral diet
or
only source of nutrition

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Complications of Enteral Feedings

1 Overfeeding
2 Diarrhea
3 Aspiration PNA
4 Refeeding Syndrome

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Overfeeding

infusion of greater quantity than can be readily digested

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Overfeeding
manifestations

-ab distention
-n/v

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Overfeeding
nursing actions

-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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Diarrhea

secondary to concentration of feeding or its constituents

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Diarrhea
nursing actions

-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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Aspiration Pneumonia

secondary to aspiration of feeding
-can be life-threatening

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primary cause of aspiration of feeding

tube displacement

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Aspiration Pneumonia
prevention

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

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Aspiration Pneumonia
nursing action

-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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Refeeding Syndrome

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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Refeeding Syndrome
nursing actions

-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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Total Parenteral Nutrition

hypertonic IV bolus solution

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TPN purpose

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

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TPN is administered thru…

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

TPN contains…

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

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

700 calories/day

Partial Parenteral Nutritoin or Peropheral Parenteral Nutrition [PPN]

less hypertonic
-intended for short-term use
-

PPN is administered thru

large peripheral vein

dextrose concentration of PPN

10%

PPN risk

phlebitis

TPN
indications

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

pot'l diagnosis that may require TPN

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

pt presentation that may require TPN

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

TPN prep

-obtain lab values bc soln is customized for each client

TPN flow rate

-gradually incr then decr to allow for body adjustment -no more than 10% hourly incr rate -never abruptly stop

TPN nursing actions

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

how often to change TPN tubing + soln

Q24hr

TPN tubing requires...

filter to collect particles

TPN check glucose every...

Q4-6 hr for first 24hr

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

10% dextrose -to minimize hypoglycemia

TPN complications

1 metabolic complications 2 air embolism 3 infection 4 fluid imbalance

common metabolic compications

hypo/hyper glycemia vitamin deficiencies

metabolic complications w TPN nursing actions

-review daily lab results -monitor for hyperglycemia

air embolism

fr pressure changes during tibing changes

air embolism nursing actions

-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

Infection nursing actions

-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)

fluid imbalance nursing actions

-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