Enteral Parenteral Flashcards
What is enteral nutrition?
Nutrition delivered through the GI system
What kind of diet is NPO?
Nothing by mouth
What foods are included in a clear liquid diet?
Water, Tea, Soda, Juice, Light colored jello, clear broth
Why would someone be on a clear liquid diet?
Before colonoscopy or introducing food after surgery
What foods are included in a full liquid diet?
Sherbert, Milkshake, Ice cream, tea, soda, anything that can become liquid at room temp
What is included in a soft diet?
Puree foods.
Foods that do not require chewing, for patients with poor dentation or difficulty swallowing (soft pasta, pudding, apple sauce, eggs, yogurt)
What kind of diet is “as tolerated”
Per the patient
What is a restrictive diet?
Very specific diet based on a patient’s medical condition. (i.e., cardiac with low fat and sodium, diabetic with low sugar and carbs, obese with restricted calories, renal low protein-sodium-and-potassium)
What does an NGT stand for?
Nasogastric tube
Purpose of placing an NGT?
Gastric decompression because there is air in stomach).
An NGT can also be used for: Suction, Irrigation, Gastric lavage, and gastric feeding
How do we know if an NGT is placed correctly?
Xray and “ready to use order” after CXR
How do we know our NGT is correctly in place once confirmed by xray?
Look for aspirate (gastric juices, feeding), observe for respiratory distress, confirm exit site markings. You can also insert air into the stomach & listen for sound or check the pH.
Who can insert an NGT?
Nurses, Providers, and students with supervision
If the pt is receiving feeding through an NGT, what does it mean to “check the residual?”
Pull back on the syringe and see if the gastric contents to see if patient is absorbing the tube feeding
What do we do with the residual if there is any?
We put it back. If we take it out, we are disrupting the pH and taking out electrolytes
What is a Salem pump
A NGT used for suctioning
What is the pigtail of the salem pump
The blue part of the salem sump for air. If we don’t have air, it can suck against the stomach lining causing irritation or an ulcer.
Is the salem pump for long term or short term use?
Short term, usually post surgery.
What is a levine tube?
An NGT used for tube feeding
What is a peg?
A percutaneous endoscopic gastrostomy tube, used for long term tube feeding.
Why is the peg used? Where is it located?
It creates access for bolus or continuous feeding. It enters through the abdominal wall, into the stomach and is held in place by a balloon.
What is a gastrojejunostomy tube? What can it help with?
A tube in the stomach and the jejunum. It decreases the risk for aspiration.
How is a gastrojejunostomy tube different from a peg?
lumens
gastrojejunostomy tube has 3 lumens as compared to 2 lumens in the peg
GJ has gastric, jejunum, and balloon
What is a kangaroo (patrol) pump used for?
Feeding, controls amount and rate
If using a bag with your kangaroo pump, how much tube feed can be placed in the bag?
Only 8 hours worth of tube feed.
How much medication can you add to the bag of tube feed?
None!!
You don’t know how much of medicine they’ll get.
How often is the tube feed bag changed?
Every 24 hours
What position should your patient be in when receiving tube feeding?
Minimally semi-fowlers (30-45 degrees)
Kids is 90 degrees.
At what point would tube feeding be held (amount)?
When the residual is 1.5 to 2 times the rate. The residual amount is still returned to the stomach
The tube feeding (continuous) is running at 40c/hr. The residual is 60. Do we hold the tube feed?
Yes. 40 x 1.5 = 60
The tube feeding is a hypertonic solution. What could this cause in the patient beginning tube feedings?
Hypertonic solutions will pull water into the lumen of the GI. That will cause diarrhea, gas, pain, discomfort, bloating.
Does diarrhea mean the patient can no longer receive tube feedings?
No, they may just need time to adjust or a change in tube feeding formula
What is a stopcock (lopez valve)
A device that allows access to NGT/PEG/G-J tubes without disconnecting the system.
What is a bolus tube feeding?
We give a feeding all at one time.
What point is a bolus tube feed held?
When the residual is 250cc to 500cc.
What is parenteral?
Delivered intravenously, not through GI tract.
What fluids are delivered parenterally?
IV fluids, electrolytes, nutrition, medication, blood products.
What is an example of an isotonic solution?
Lactated ringers (LR), an injection used to replace water and electrolyte loss in patients with low blood volume or low blood pressure
When is an isotonic solution used?
Most solutions are used to treat hypovolemia. i.e., A patient who was bleeding, who was vomiting, who has severe GI drainage, replacing fluid that is lost
What is an important mental note when using hypotonic solutions?
MONITOR CAREFULLY because they can cause intravascular fluid depletion and cardiovascular collapse.
What is an angiocath?
Device used to venous access. Peripheral IV.
What needs to be done to IV tubing before it can be used?
Prime it. Get the air out.
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 x 2.
Order reads infuse 1000cc over 8 hours. How many ccs per hour? How many drops per minute (15ggt/cc)
125cc / hour
125 cc x 15 / 60 minutes = 31.25 = 31 gtt.
If we are running an IV to gravity, we “time tape” by placing tape along the side of the IV solution bag. Why is this important?
To be sure the fluid is infusing at the prescribed rate; correct volume in the correct amount of time.
IV Complications, what can cause bruising?
“Blown vein,” or improper insertion/removal technique
IV Complications, what is infiltration?
Fluid goes into surrounding tissue
IV Complications, what is phlebitis?
Inflammation of the vein caused by to large of a catheter, IV left in too long, irrigation fluid infusion, poor veins.
IV Complications, what are signs an IV site is infected?
Redness, swelling, discharge, red streaking, N/V
IV Complications, what is fluid overload?
Too much fluid is infused too quickly. Can result in HTN, edema, dyspnea, heart issues
What is an air embolism for IV complications
Air entering the cardiovascular system from too much air in IV tubing, placement of a central line
What is a maintenance fluid?
Continuous fluid at a prescribed rate, to maintain homeostatic fluid status.
What is a bolus?
A large amount of fluid in a short amount of time. Pumps can be set to 999cc/hr or run “wide open.” Sometimes called a fluid challenge.
*kids are based on weight
What is a keep vein open order?
10cc to 20cc per hour to keep IV from clotting.
What is a banana bag/osler bag?
Patients who have deficiency in vitamins and minerals. The bag is yellow in color and contains vitamins and minerals in an isotonic solution
What is an infusion pump?
Regulates infusion of IV fluids
What does it mean when an infusion pump says occlusion fluid side, what does that mean?
Problem exists above the pump
What is IV push?
Pushing meds into the line
What do we do before and after an IV push?
Flush the site
What is a triple lumen central line?
Short term central line allowing infusion of 3 incompatable fluids or any 3 fluids simultaneously
If an IV is in the external jugular vein, is it a central line?
No it’s a peripheral line
If an IV is in the internal jugular vein, is it a central line?
Yes
What are the similarities of a hickman and groshung?
Both are long term tunneled central catheters
How is the groshung different from hickman
Groshung does not use heparin as a flush to keep it patent
What is a dacron sheath?
Cuff around the central line that acts as an anchor for the central line and a barrier against microorganisms
Is a picc a central line?
Yes. a long term central catheter, threaded into the superior vena cava
Can a nurse place a picc?
Yes, a picc nurse can
What does TPN/CPN stand for?
Total parenteral nutrition/Complete parenteral nutrition
What is the concentration of dextrose and protein in CPN/TPN?
greater than 10% dextrose and/or greater than 5% protein (concentrated)
Where can TPN/CPN be administered? (what type of insertion site)
ONLY Central line
(PICC and Hickman)
Complications of TPN/CPN and PPN?
If dextrose is too high it can lead to infection.
+ fluid overload, hyperglycemic.
For example, fluid overload can look like crackles in lungs and SOB.
What IV fluids should be on hand should TPN/CPN need to be stopped?
10% dextrose (D10W)
Why do pts with TPN/CPN started on finger sticks?
To monitor hyperglycemia secondary to high concentrations of dextrose
What does PPN stand for? Where can it be administered? (what type of insertion site)
Peripheral/Partial Parenteral nutrition. Goes through peripheral line or central line (PIVCs and Midlines)
What is the concentration of dextrose and protein in PPN?
less than 10% dextrose and/or less than 5% protein concentration
A hemorrhaging pt is brought into the ED. What blood products will they receive?
Whole blood for quick volume replacement for lost colume.
What are PRBs
Packed red blood cells have 50% less volume than whole blood. Increases O2 carrying capacity of blood without the volume. Mostly contains RBCs with some WBCs and platelets remaining. Very little plasma
Why would a patient receive PRBs
When a patient is at risk for fluid overload possibly due to chronic condition.
Treats anemia and moderate blood loss and increases the oxygen carrying capacity
What timeframe does blood transfusion need to be completed
4 hours
FFP
Fresh frozen plasma; given when clotting is a concern
What is the most life threatening blood transfusion traction
Hemolytic blood transfusion
What is gastric lavage?
Gastric lavage, also known as stomach pumping, is a medical procedure that involves removing the contents of the stomach through a tube.
Your patient is having a difficult time with NGT tube insertion. As the nurse, what can you do to help them?
When inserting can ask patient to take sips of water to help guide
After placing an NG tube, what is an appropriate patient position?
Keeping the head of the bed between 30 – 45 degrees
Is the gastrojejunostomy tube used for long term or short term use?
It is long term.
Explain the importance of the 3 ports of a gastrojejunostomy tube?
Feed through the J, suction through the G.
G-port (Gastric decompression), Jport (Jejunal feed), and balloon port.
What amount of fluid do you use to flush a G-J (gastrojejunostomy) tube?
30 to 50 cc
How long do feed bags take to expire
24 hours
How much aspiration is too much?
If you aspirate 1.5-2x the hourly rate, hold feed
A 68-year-old male with a history of stroke and dysphagia is receiving enteral tube feeding at a rate of 50 mL/hour via a nasogastric tube. During a routine check, the nurse aspirates 90 mL of gastric residual volume (GRV). Do you hold the feed?
The aspirated volume (90 mL) is 1.8 times the hourly rate (50 mL × 1.5 = 75 mL threshold).
Since the residual exceeds the 1.5-2x hourly rate guideline, the nurse holds the feed and notifies the healthcare provider.
What is the purpose feeding pumps?
Controls the rate at which we deliver feed.
Do we flush feeding pumps?
Flush to make sure it stays patent (unobstructed)
Tube feeds are hypertonic, what does this mean? What is a complication?
Fluid shifts into the intestines, therefore can cause diarrhea.
T/F the patient can be supine when a feeding pump is in use.
No, the head of the bed has to be up. Roughly 30 to 45 degrees to decrease aspiration and vomiting.
Who is an ideal candidate for parenteral nutrition?
For patients who cannot tolerate the GI system.
What nutritional support is given through parenteral nutrition?
proteins, carbs, fats, electrolytes (e.g. potassium), vitamins, minerals
What type of solution concentration is CPN or TPN?
Very hypertonic solution
Nursing Responsibilities for patients receiving TPN/CPN and PPN?
(think about the complications and what to monitor)
Glucose checks because high levels of dextrose
Monitor I & Os
Check label on bag against medication order
Your patient is receiving TPN. You know they are at an increased risk of infection because…
a) There are low levels of dextrose in the solution
b) There are high levels of dextrose in the solution
c) There are low levels of sodium in the solution
d) There are high levels of potassium in the solution
b) There are high levels of dextrose in the solution
What are IV isotonic solutions?
Isotonic: infusing normal saline (0.9% sodium chloride). Osmotic pressure is the same so cells stay the same.
What are IV hypotonic solutions?
Hypotonic – ½ Normal Saline (0.45% sodium chloride). Osmotic pressure is less than the cells, so cells swell.
What are IV hypertonic solutions?
Hypertonic – 3% sodium chloride, 5% sodium chloride. Osmotic pressure is greater than the cells, so cells shrink.
What setting are hypertonic solutions given and do they need to be monitored?
Given in ICU with intense monitoring because it is the most dangerous.
Who should NOT be ordered with hypertonic solutions?
anyone we are worried about fluid overload in
If a patient is experiencing infiltration, how will they describe it?
Burning and swelling
If a patient is experiencing phlebitis, what does the site of insertion look like?
Site is red, warm, hard.
S/S of air embolism
chest pain, dyspnea, hypotension, C.A.
What blood transfusions require ABO compatibility?
autologous blood transfusions
Whole blood
PRBs
What blood transfusions do not require ABO compatibility?
Platelets
FFPs
Albumin
Autologous blood transfusion
The reinfusion of blood taken from a person back into that same person.
What is a whole blood transfusion?
Refers to the mixture of both plasma and formed elements.
Used to replace volume.
What are FFPs (fresh frozen plasma)
Rapid volume replacement for slow active bleed, increases clotting factors, no platelets.
Albumin
Increases the plasma colloid osmotic pressure to maintain and improve peripheral edema, cardiac output, treat shock, chronic liver failure, and burns
Your patient is having a transfusion reaction to packed red blood cells. What are you going to do?
a) Notify physician, stop infusion, check vital
signs, infuse normal saline, get urine sample
b) Continue infusion and administer PRN Tylenol
c) Slow the infusion, notify physician, take vital signs, administer PRN Tylenol
d) Stop infusion, check vital signs, infuse normal saline, notify physician, get urine sample
d) Stop infusion, check vital signs, infuse normal saline, notify physician, get urine sample
Which patient scenarios match the expected fluid and/or blood products? SATA
a) A patient with a gun shot wound and severe bleeding – ordered LR and 0.9% sodium chloride
b) A patient with fluid overload needing a blood transfusion - ordered whole blood
c) A patient with CHF needing a blood
transfusion – ordered PRBC
a) A patient with a gun shot wound and severe bleeding – ordered LR and 0.9% sodium chloride
c) A patient with CHF needing a blood
transfusion – ordered PRBC
A patient with COPD is learning about pursed-lip breathing. What is the primary purpose of this technique?
a) To help strengthen the intercostal muscles to
allow for easier respirations
b) Increase oxygen intake per breath
c) Prevent alveolar collapse
d) Reduce the need for inhaled medications
c) Prevent alveolar collapse
Following cardiac catheterization, which nursing actions are a priority? (SATA)
a) Check peripheral pulses + bleeding
b) Immobilize limb for 6 hours
c) Administer a diuretic to assist with I/O’s
d) Monitor urine output
e) Elevate the affected limb above the heart
a) Check peripheral pulses + bleeding
b) Immobilize limb for 6 hours
d) Monitor urine output
All of the following require ABO compatibility except:
a) PRBs
b) FFPs
c) Whole blood
d) An autologous blood transfusion
b) FFPs
