Enteral/Parenteral Flashcards
1
Q
What is enteral nutrition?
A
nutrition delivered through GI system
2
Q
What kind of diet does a patient eat who is NPO?
A
Nothing by mouth (Nil per os)
3
Q
What foods are included in a clear liquid diet?
A
Tea, soda, light colored jello, clear broth
4
Q
Why would someone be in a clear liquid diet?
A
Slowly reintroduce foods after surgery, severe vomiting
5
Q
What foods are included in a full liquid diet?
A
Everything in clear liquid diet plus anything that becomes liquid at room temperature (ice cream, sherbert)
6
Q
What is included in a soft diet?
A
Puree foods, foods that don’t require chewing
For patients with poor dentition or difficulty swallowing
(pasta, pudding, applesauce, yogurt, eggs)
7
Q
What kind of diet is “as tolerated?”
A
Per the patient
8
Q
What is a restrictive diet?
A
Limitation on certain items
9
Q
Types of restrictive diets
A
Cardiac diet = low sodium, low fat
Diabetic diet = low sugar, consistent carbs
Obese patient = calorie restriction
Renal diet = low protein, low sodium, low potassium, fluid restriction
10
Q
What is an NGT?
A
Nasogastric tube
11
Q
What is the purpose of placing an NGT?
A
Gastric decompression, gastric lavage, gastric feeding
12
Q
How do we know a newly placed NGT is in the correct place and ready to use?
A
x-ray and “ready to use” order
13
Q
How do we know our NGT is in the correct place once confirmed by x-ray?
A
Assess visual characteristics of aspirate, observe for respiratory distress, confirm exit site markings
14
Q
Who can insert an NGT?
A
Nurses, providers, nursing students (under supervision)
15
Q
If the patient is receiving tube feeding through an NGT what does it mean to “check the residual?”
A
Use a syringe to pull back on the NGT to check gastric contents to see if the patient is absorbing the tube feed
16
Q
What do we do with the residual if there is any?
A
Return it to the stomach (keeps pH balanced)
17
Q
What is a Salem sump?
A
An NGT used for suctioning
18
Q
What is the pigtail for a Salem sump?
A
Blue portion, to insert air (has holes on the bottom to prevent adhesion to the stomach lining; allows fluid to move)
19
Q
Is a Salem sump short term or long term?
A
Short term
20
Q
What is a levine?
A
An NGT used for tube feeding (and suctioning)
21
Q
What is a PEG?
A
Percutaneous endoscopic gastronomy tube
Used for long term tube feeding (bolus or continuous feeding)
22
Q
Where is a PEG located?
A
It creates feeding access from the stomach through the abdomen
23
Q
What is a gastrojejunostomy tube?
A
- It has three lumens (as compared to the two lumens in the peg)
- It creates the ability to tube feed the patient through the jejunal port while connecting the gastric port for suction
- It is long term
24
Q
What is a kangaroo (patrol) pump used for?
A
It controls the amount of tube feed administered to the patient
25
If using a bag with your kangaroo pump, how much tube feed can be placed in the bag?
Only 8 hours worth of tube feeding
26
How much medication can you add to the bag of tube feed?
None, never add medication to a tube feed bag
27
How often is the tube feed bag changed?
Every 24 hours
28
What position should your patient be in when receiving tube feeding?
Minimally, Semi-Fowlers (30-45 degrees)
29
At what point would tube feeding be held?
When the residual is 1.5 to 2 times the rate. Residual amount is still returned to the stomach
30
The tube feed is running at 40CC/hr. Residual is 60. Do we hold the tube feed?
40 x 1.5 = 60, yes hold tube feed
31
The tube feeding is a hypertonic solution. What could this cause in the patient beginning tube feedings?
Hypertonic feedings cause an osmotic gradient that attracts water from the body into the lumen of the GI tract, causing diarrhea from the fluid shift
32
Does diarrhea mean the patient can no longer receive tube feeding formula?
No, they may just need time to adjust to formula or change in feed
33
What is a Stopcock (Lopez valve)?
A device that allows access to NGT/PEG/G-J tubes without disconnecting the system
For feeding and medication administration
34
What is a bolus feeding?
Feeding that is done all at once instead of continously through a pump
35
At what point is a bolus tube feed held?
When the residual is 250cc-500cc
36
What is GRV?
Gastric residual volume;
37
What is parenteral?
Delivered intravenously
38
What are some examples of fluid delivered parenterally?
IV fluids, electrolytes, nutrition, medication, blood products
39
What is an isotonic solution?
- Solutions that have the same osmolarity of the cells
- Normal saline (0.9% Sodium Chloride)
40
What is a hypotonic solution?
- Solutions that have the a lower osmolarity as the cells, so fluid shifts into the cell
- 1/2 normal saline (0.45% sodium chloride)
- Use cautiously as can cause fluid depletion and cardiovascular collapse
41
What is a hypertonic solution?
- Osmotic pressure is greater than in the cell, pulls fluid out of the cell and into intarvascular space
- 3%-5% sodium chloride
- Needs strict monitoring **INFUSED IN ICU**
- Increased risk of circulatory overload, HTN, & pulmonary/cerebral edema
42
What is an angiocath?
Device used for venous access, peripheral IV
43
What needs to be done to IV tubing before it can be used?
Prime it, get the air out of it
44
How do we set a fluid rate to gravity?
Fill the drip chamber of the tubing halfway with fluid. Count the drips for one minute or 30 seconds times 2
45
IV complications: What is infiltration?
-IV fluid goes into the surrounding tissue, needle may slip out of vein or perforate vein
- S/S: pain, burning, soft swelling
- Can apply heat/cold/elevate extremity
46
Why is "time taping" important?
To make sure the fluid is infusing at a prescribed rate; correct volume in correct amount of time
47
An order reads 1000CC over 8 hours. How many CC/hour?
1000CC/8hr =125CC/hr
48
IV complications: What can cause bruising?
A "blown vein" or improper insertion/removal technique
49
IV complications: what is an air embolism?
Air entering the CV system from too much air in IV tubing, placement of a central line
50
What is phlebitis?
Inflammation of the vein
51
What can cause phlebitis?
Too large of a catheter in a small vein, Iv was in for too long, irritating fluid infusion, poor veins
52
What are signs of infection at IV site?
Redness, pain, warmth, pus
53
IV complications: What is fluid overload?
- Too much fluid is infused or infused too quickly.
- Can result in HTN, edema, dyspnea, heart issues
54
IV orders: What is a maintenance order?
Fluid administered to patient, at a prescribed rate to attain homeostatic fluid status
55
IV orders: What is a bolus?
A large amount of fluid in a short amount of time
Pump can be set to 999CC/hr
56
IV orders: What is KVO?
Keep vein open
10-20cc/hr to keep vein from clotting
57
What is a banana bag/Osler bag?
- Isotonic solution with added vitamins and minerals
- Yellow in color
- Usually given to patients with alcoholism
58
What is an infusion pump?
Pump that regulates infusion of IV fluids
59
Types of infusion pumps
Alaris: allows 4 different infusions with various rates
IMED: Only does 2 infusions
60
What does It mean when the pump says occlusion fluid side?
A problem exists above the pump
61
What does it mean when the pump says occlusion patient side?
A problem exists below the IV pump
62
What is piggyback tubing?
- Used to connect a second bag of fluid to the primary line
(aka secondary tubing)
- Blue hanger used to drop bigger IV bag a little lower
63
What does IV push mean?
Infusing medication through a syringe directly into a PIV or a primary line
64
What do we do before and after an IV push medication is administered?
Flush with normal saline
65
What is the importance of the IV push chart?
- It provides information regarding what unit a med can be pushed on
- How much med can be given
- if the med should be diluted and important info/possible adverse events
66
The nurse flushes a line, then infuses 5CC of medication over 2 minutes per IV push chart. The nurse then prepares the flush. How much and at what rate will the nurse give the flush?
5CC over 2 minutes, same as medication
67
What is a triple lumen central line?
A short-term central line allowing infusion of three incompatible fluids or any three fluids simultaneously
68
If an IV is in the external jugular vein, is this considered a central line?
No, this is a peripheral line. Internal jugular would be a central line
69
What are Hickman and Groshung?
Both are long-term tunneled central catheters
70
How is a Groshung CVAD different from a Hickman CVAD?
Both are long term tunneled central line catheters but the Groshung doesn't use heparin as a flush to keep it patent
71
What is a dacron sheath?
A cuff around the central line that acts as an anchor for the central line and a barrier against microorganisms
72
What is TPN/CPN
Total parenteral nutrition/complete parenteral nutrition
73
Is a PICC considered a central line?
Yes, a PICC is a long-term central catheter placed in the arm and threaded up into the superior vena cava
74
Can a nurse place a PICC line?
Only specially trained PICC nurses can place it at bedside
75
Where do we infuse TPN/CPN?
Through a central line
76
What IV fluid should be on hand should the TPN/CPN need to be stopped abruptly?
D10W
77
What is the concentration of dextrose and protein in CPN/TPN?
>10% dextrose and/or >5% protein
78
Why are patients receiving TPN/CPN started on finger sticks?
To monitor possible hyperglycemia secondary to high concentrations of dextrose
79
What is PPN?
Peripheral parenteral nutrition/partial parenteral nutrition
80
What is the concentration of dextrose and protein in PPN?
<10% dextrose and/or <5% protein
81
A hemorrhaging patient is brought into the ED. What blood product will they receive?
Whole blood for quick volume replacement
82
IV Infusions: Whole blood
- 500mL bag
- Volume replacement in case of hemorrhage or shock
- Inlcudes all blood components (RBCs, WBCs, plasma, platetels)
83
IV Infusions: PRBs
- Packed red blood cells
- For blood transfusions
- 50% less volume than whole blood (250mL-500mL)
- Treats anemia and moderate blood loss (e.g. GI bleed)
84
On a general medical/surgery unit, in what timeframe does a blood transfusion need to be completed?
Within 4 hours
85
IV Infusions: Platelets
- 50-70mL bag
- Used before invasive procedure to assist with clotting
- Does not need to be patient compatible
- Shorter tubing used to prevent clotting in tubes
- Used in cases of bleeding secondary to thrombocytopenia or bone marrow supression
- Administer 15-30 minutes once received (fragile and easily destroyed)
86
IV Infusions: FFPs
- Fresh, frozen plasma
- 200-250mL
- increased clotting factors V, VII, IX, X
- Infuse immediately after thawing
- MUST be ABO compatible with patient
- Used for bleeding secondary to liver disease and hemophilia
87
IV Infusions: Albumin
- 25mL-50mL bottles
- Not to be infused >1mL/min
- Improved volume and CO
- Balances effects of diuretics and increases voiding
- Increased oncotic pressure in bloodstream
- No ABO compatibility required
87
Why would a patient receive albumin?
To treat low blood volume and pull fluid back into the cardiovascular system from surrounding tissue
88
How is blood transfusion tubing different from regular primary tubing?
There is a separate tubing for blood and saline, both come together to merge into a filter (prevents clotting)
89
ABO Compatibility: Type A
Antigen present: A
Antibodies Present: B
Can receive: A, O
90
ABO Compatibility: Type B
Antigen present: B
Antibodies Present: A
Can receive: B, O
91
ABO Compatibility: Type AB
(Universal Recipient)
Antigen present: AB
Antibodies Present: None
Can receive: A, B, AB, O
92
ABO Compatibility: Type O
(Universal Donor)
Antigen present: None
Antibodies Present: A, B
Can receive: O
93
Blood Transfusion: Nursing Responsibilities
ID, consent form, IV size, VS (at least 15 min before transfusion), premed, blood requirements/order/signature, explanation, gloves, document
94
Blood transfusion complication: Febrile reaction
- Minor reaction
S/S: fever, chills, HA
- Stop transfusion
- Meds: antipyretic (Tylenol)
- Continue transfusion
95
Blood transfusion complication: Allergic reaction
- Minor reaction
- Stop transfusion
- S/S: flushing, wheezing, rash with itching/hives
- Meds: antihistamines/antipyretic
96
Blood transfusion complication: Hemolytic reaction
- DANGEROUS
- Risks: RBC destruction, ↓ oxygen, capillary destruction, (possible) death
- S/S: flushing, fever, chills, HA, low back pain, dyspnea, hypotension, blood in urine, rigors, tachychardia
- Occurs with mislabeled transfusions
97
Nursing interventions for hemolytic reaction
- STOP TRANSFUSION
- Infuse NS (dilute blood)
- VS
- Urine sample
- Return blood
- Inform physician
- Stay with patient
- Document
98
Blood transfusion complication: TACO reaction
- Transfusion associated circulatory overload
- Due to volume rather than blood
- Age/system related
- S/S: HTN, bounding pulse, JVD, dyspnea, restlessness, confusion
99
Nursing interventions for TACO reaction
- Slow infusion (stop if severe)
- Monitor I&O
- Diuretics (↓ circulating volume; given if safe)
