Enternal / Parental Flashcards
What is Enteral Nutrition?
Nutrition delivered through the GI tract
What foods are included in a clear liquid diet? why?
tea, soda, light colored jello, clear broth, water
- want to introduce foods slowly, esp post-operatively
What foods are included in a full liquid diet?
anything that can become liquid at room temp
What is included in a soft diet?
puree foods, foods that do not require chewing
What kind of diet is “as tolerated”?
whatever the pt can tolerate
What is a restrictive diet?
a specific diet
- ex. diabetic diet (low sugar, control carbs); lean diet
Cardiac diet:
low sodium, low fat
Diabetic diet:
low sugar, control carbs
What is an NGT?
nasogastric tube
What is the purpose of placing an NGT?
gastric decompression, gastric lavage, and gastric feedings
How do we know our newly placed NGT is in the correct place?
XRAY and “ready to use”
How do we know our NGT is in the correct place once confirmed by XRAY?
assess visual characteristics of aspirate, observe for respiratory distress, confirm exit site markings
Who can insert an NGT?
nurses, providers, and students (with supervision)
If the pt is receiving tube feeding through an NGT, what does it mean to “check the residual?”
Pull back the syringe to check gastric contents to see how much the pt is absorbing the tube feed and document
What is a Salem Sump?
an NGT used for suctioning
What is a pigtail?
blue port, used for air filtration to keep the NGT from adhering to the stomach mucosa
Is a Salem Sump used for short term or long term?
short term
What is a Levine?
an NGT used for tube feeding (sometimes white, sometimes red)
What is a PEG?
percutaneous endoscopic gastronomy tube - used for long term tube feeding - there’s a port for medication and for feeding
Where is the PEG located?
feeding through the abdomen to the stomach
What is a gastrojejuostomy tube? How is this different from a PEG?
- has three lumens (compared to two lumens in the PEG)
- creates the ability to tube feed the pt through the jejunal port while connecting the gastric port to suction
- long term
What is a Kangaroo (patrol) pump used for?
controls the amount and rate of tube feed administered to the pt
If using a bag with your kangaroo pump, how much time feed can be placed in the bag?
ONLY 8HRS - worth of tube feeding
How much medication can you add to the bag of tube feed?
you can NEVER add medication to atube feeding bag
How often is the tube feed bag changed?
every 24hrs
What position should your patient be in when receiving tube feeding?
mininally semi-fowlers (30-45 degrees)
- what the pt can tolerate
At what point would tube feed be held?
when the residual is 1.5-2 times the rate - residual amount is still returned to the stomach
The tube feed is running at 40cc/hr and the residual is 60. Do you 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 feeding?
cause osmotic gradient attracts water from the body into the lumen of the GI tract, causing:
Diarrhea, gas, pain, discomfort, bloating
Does diarrhea mean the pt can no longer receive tube feeding?
no, they may just need time to adjust or change the tube feeding formula
What is a stopcock (Lopez valve)?
a device that allows access to ngt/peg/g-j tube without disconnecting the system
What is a Bolus tube feeding?
a certain amount of tube feed administered all at once as opposed to continued feeding on a pump
At what point is a bolus tube feed held?
when the residual is 250cc-500cc
What is Parental?
delivered intravenously
What are some examples of fluids delivered parentally?
IV fluids, electrolytes, nutrition (NOT TUBE FEED), medication, blood products
What is an Isotonic solution?
Normal Saline (0.9% sodium chloride) - solutions that have the same osmolarity of the cells - most used to treat hypovolemia - used for hemorrhage, severe vomiting/diarrhea
What is a Hypotonic solution?
1/2 normal saline (0.45% sodium chloride) - osmotic pressure is less than the cells so fluid shifts into cells - use cautiously as can cause fluid depletion and cardiovascular collapse
What is a Hyptertonic solution?
3% or 5% sodium chloride - needs strict monitoring so infused in ICU secondary to increased risk for circulatory overload, hypertension, and pulmonary/cerebral edema - osmostic pressure is greater than the cells so fluid is pulled from the cells into the intravasuclar space
What is an Angiocath?
device used for venous access, peripheral IV
What needs to be done to the IV tubing before it can be used?
prime it; get 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 time 2
Order reads 1000cc over 8hrs, how many cc/hr? How many drips/drops per minute?
- drip factor: 15gtt/cc
1000cc/8hrs = 125cc/hr
- (125cc x 15)/ 60 minutes = 31.25 gtt/min; round to the nearest whole number so 31 gtt/min
If we are running an IV gavity, we time tape by placing tape along the side of the IV solution bag. Why would this be important?
to be sure the fluid is infusing at the prescribed rate; the correct volume in the correct time frame
IV complications: What can cause bruising?
“blown vein” or improper insertion/removal technique
IV complications: What is infliltration?
IV fluid goes into surrounding tissue, needle may slip out of the vein or perforate vein; pain/burning/soft swelling
IV complications: What is Phlebitis?
inflammation of the vein
- caused by too large of a catheter in a small vein, IV in too long, irritating fluid infusion, poor veins, site is red, warm, hard
IV complications: What are the signs of infection at the IV Site?
Redness, pain, warm, pus (purulent)
IV complications: What is fluid overload?
too much fluid is infused or is infused too quickly - can result in HTN, edema, dyspnea, heart issues
IV complication: What is an air embolism?
air entering the cardiovascular system from too much air in IV tubing, placement of a central line can increase risk
IV orders: What is maintenance fluid?
fluid administered to pt, at a prescribed rate, to attain homeostasis fluid status
IV Orders: What is a fluid bolus?
large amount of fluid in a short amount of time - the pump can be set to 999cc/hr or un “wide open” - sometimes called a fluid challenge
- not applicable to children (pediatrics)
IV orders: What is KVO?
keep vein open - 10-20cc/hr
- to keep IV from clotting
What is a banana bag/olser bag?
yellow in color; contains vitamins and minerals in an isotonic solution
What is an infusion pump?
Regulates infusion of IV fluids
What does it mean when the pump says occlusion fluid side?
A problem exists above the pump - a problem in the bag
What does it mean when the pump says occlusion patient side?
a problem exists below the pump
What is a piggyback tubing?
also called secondary tubing, used to connect a second bag of fluid to the primary line
What does “IV Push” mean?
pushing a medication into the IV line (NEVER push potassium)
What do we do before and after an IV push medication is administered?
flush with normal saline
What is the importance of the IV push chart?
Provides information about medication
When flushes the IV line, how much and what rate should the nurse give?
the same amount at which the medication was given - volume (ex. 5cc over 2. minutes)
What is a triple lumen central line?
A short-term central line that allows the infusion of three incompatible fluids or any three fluids simultaneously
If an IV is in the external jugular bein, is this considered a central line?
no, this is a peripheral line
What are Hickman and Groshung? How is the groshung different?
both are long term tunneled central catheters
- the Groshung does not use heparin as a flush to keep it patent
How do we know these central lines are in the correct position?
XRAY
What is a Dacron Sheath?
it is a cuff around the central line that acts as an anchor for the central line and a barrier against microorganisms
Is a PICC considered a central line?
is a long term central catheter placed in the arm and threaded up into the superior vena cava
Can a nurse place a PICC line?
yes, by a specially trained PICC nurse - verified by XRAY
What is TPN/CPN?
Total Parental Nutrition/Coplete Parental Nutrition (may be used interchangeably)
What is the concentration of dextrose and protein in CPN/TPN?
> 10% dextrose and/or >5% protein
Where do we infuse TPN/CPN?
through a central line
What are the possible complications of CPN/TPN?
infection, fluid overload, hyperglycemia
What fluid should be on hand should TPN/CPN need to be stopped abruptly?
D10W
Why are patients receiving TPN/CPN started on finger sticks?
to monitor possible hyperglycemia secondary to high concentrations of dextrose
What is PPN?
Partial Parental Nutrition / Peripheral Parental Nutrition
What is the concentration of PPN?
<10% dextrose and/or <5% protein
A hemorrhaging patient is brought inot he ED. What kind of blood product will they receive?
Whole blood for quick volume replacement - includes RBCs, WBCs, Plasma, and Platelets
What are PRBs and how do they differ from whole blood?
PRBs have 50% less volume than whole blood - increase O2 carrying capacity of blood without the volume - mostly contain RBCs with some Wbcs and platelet remaining - very little plasma
Why might a pt be on PRB instead of whole blood?
when pt is at risk for fluid overload
Why would a pt receive platelets or FFPs?
when clotting is a concern
Why would a patient receive albumin?
to treat low blood volume and pull fluid back into the cardiovascular system
What are the symptoms of febrile blood transfusion reactions?
fever, chills, headaches
How is a febrile blood transfusion reaction treated?
transfusion paused and antipyretic administered - infusion may then be restarted
What is the most life-threatening blood transfusion?
hemolytic blood transfusion
What are the signs of hemolytic blood transfusion?
flushing, fever, chills, headache, low back pain, dyspnea, hypotension, blood in urine, rigors, tachycardia
How is hemolytic blood reaction treated?
stop the infusion, infuse NS, take frequent vital signs, get a urine sample for lab, return unused blood to the blood bank, inform provider, stay with the patient, DO NOT restart infusion
