Final review 3 Flashcards
preventing refeeding - check for what? (refeed the electrolytes)
Identify individuals at risk (just check elctrolytes before starting)
Correct depleted electrolytes before refeeding
enteral complications = Gastrostomy or jejunostomy tubes
Gastrostomy or jejunostomy tubes
Skin irritation around tube
Skin assessment and care
Tube dislodgement
Teach patient/family about feeding administration, tube care, and complications
Fistulas -entero-cutaneous
Infections: skin, fasciitis, peritonitis
Abdominal wall or intraperitoneal bleeding and bowel perforation
Obstruction or erosion of gastric wall
Gastric mucosa hypertrophy
Parenteral Nutrition - indications (when it’s needed) (Parents need IVs if they’re vomiting, gi problems, malnurished, panceatitis)
Indications:
Chronic or intractable diarrhea and vomiting
Complicated surgery or trauma
Post GI surgery
GI obstruction
GI tract anomalies and fistulae
Sepsis
Severe malnutrition
Malabsorption
Pancreatitis
Parenteral Nutrition - composition (parents are composed of everything but carbs)
Composition
Base solutions contain dextrose and protein in the form of amino acids
Prescribed electrolytes, vitamins, and trace elements are added to customize patient need
IV fat emulsion is added to complete the nutrients
Central Parenteral Nutrition: what is it made of? (the central parent says no more than 25% dextrose on halloween)
very concentrated sugar
Base Solution 20-25% dextrose
Peripheral Parenteral Nutrition: what is the base solution? (Perry is less than 20% dextrose)
Base solution must be < 20% dextrose
Through peripherally inserted catheter
Parenteral Nutrition: Complications (parents get hyper and hypo lips)
Hyperglycemia and hypoglycemia
Fluid, electrolyte, and acid base imbalances
Hyperlipidemia when lipids used
Phlebitis
Infection and bacteremia
nursing management/care - vital signs, weight, glucose, how often to check? parenteral
Vital signs every 4 to 8 hours
Daily weights
Regular blood glucose monitoring
Check initially every 4 to 6 hours
Parenteral Nutrition: Nursing Management/Care - assess for what and how often to change dressing? (change parents every week)
Assess central access site
Site assessment for phlebitis
Dressing change every 7 days or as needed
Use sterile technique with dressing changes
Infusion pump must be used
Parenteral - Pan culture when (and what culture) (parents dip)
infection is suspected
Perform DTTP blood cultures when systemic infection is suspected
starvation - liver (liver loses pap, fluid shifts, bye Na!)
Liver function impaired
Protein synthesis diminished
Low albumin leads to ↓ plasma oncotic pressure
Fluid shifts from vascular space into interstitial space
Na+/K+ pump fails due to deficiency in calories and proteins
Malnutrition: Nursing Management of Imbalanced Nutrition < Body Requirements = not eating enough. Just eat small meals w/ weed
Daily calorie count
High-protein, high-calorie foods or feedings
Multiple, small feedings
Supplements
Appetite stimulants such as Megace and Marinol (weed)
diabetes leading cause of (blind me with kidney disease and amputation)
Leading cause of
Adult blindness
End-stage kidney disease
Nontraumatic lower limb amputations
oral hypoglycemics - hold when? and monitor what labs?
Hold med if patient is undergoing surgery or radiologic procedure with contrast medium
24-48 before procedure and at least 48 hours after
Monitor serum creatinine
Contraindications
Renal, liver, cardiac disease
Excessive alcohol intake
nutritional therapy DM - when is meal consistency important?
Meal plan is based on individual’s usual food intake and is balanced with insulin and exercise patterns
Day-to-day consistency important for patients using conventional, fixed insulin regimens
When 60% of caloric needs met orally, then***
you can discontinue PN or EN nutrition
albumin helps keep (al loves water)
fluid in cells. Once this protein is gone, fluid starts leaking into interstitial fluid.
Renal diet (Renal needs a low pump)
(low K and Na diet)
NPO vs strict NPO
what labs to assess during a nurtritonal assessment? (PLAITHs are my labs)
Nutritional lab studies: albumin, prealbumin, transferrin, Hg, Fe, blood glucose, lipid panel
For patients with nutritional deficit: oral feeding
High-calorie supplements
Milkshakes
Ensure, Glucerna for DM patients, Nepro for renal failure patients
Consult dietician
residual hold order
Depending on order: usual residual with hold order is >250- 400mL
how often to change enteral bags? (change the entry every12-24 hour life)
changed every 12-24h
Wear gloves when hanging feeding
how is parenteral different than crystalloid? (krystal doesn’t like vitamins)
*Different from crystalloid solutions in that crystalloids do not contain amino acids or vitamins
where is central parenteral infused? (central access central line)
May only be infused via central access due to the risk of thrombophlebitis caused by hypertonic solution of TPN
when are PICCs used? (only long haul use piccs)
Peripherally inserted central catheters (PICCs) - For longer term nutrition support
what labs to check for parenteral feeding? (Electra is a parent?)
Check labs: Electrolytes, BUN, Creatinine, CBC, liver function enzymes
parenteral feeding? how often to replace solution? (parents need to be fed every 24 hrs)
MUST replace solution and tubing every 24 hours even if bag hanging is not empty
if parenteral feeding bag is not available?
If solution is not available, hang D10W to prevent hypoglycemia
Tubing with filter is required for TPN
Do not abruptly discontinue TPN (total parenteral nutrition)
Decrease rate by half for one hr then stop. Check blood sugar in an hr.
Hallmark of refeeding syndrome (refeeding makes me lose phosphate)
Hypophosphatemia
enteral feeding complications - Diarrhea (diarrhea at 4 and 8) How much can you hang at once?
Do not hang more than 4° (4 hours) worth of modular formula and 8° (8 hours) vol of pre-packaged formula; change system Q 12-24°
enteral - Intermittent - how much is usually given to patient? (intermittently 500)
by gravity or syringe
Vol usually 200 to 500 mL per feeding
Remember to flush with 30mL water before after feeding so tube does not clog
when to use peripheral parenteral nutrition? (PPN perry is a short parent)
Short-term
When lower protein and calorie content is required
parenteral pan culture - differential (the difference in infection from the catheter or the blood)
Differential time to positivity
Differentiates infection likely source from catheter or blood
parenteral - Systemic Infection (s/s)
High risk associated with TPN
Fever, chills
Nausea/vomiting
Malaise
parenteral pan culture - Samples must be drawn when? (peter pan in 15 min)
no more than 15 min apart and collect same amount of blood for each sample
parenteral pan culture - If the sample from catheter grows bacteria < 2hrs before peripheral sample, then
the likely source of infection is from catheter
refeeding - how to initiate? (I was refed at 25 for 3 days in the morning)
Initiate nutrition support at approximately 25% of the estimated goal and advance over 3-5 days to the goal rate
Serum electrolytes and vital signs monitored carefully after initiation
parental nutrition causes what? (only parents have issues with gallbladder, liver, and blood clots)
Gallbladder and liver disease
Thrombosis
indications for enteral (enter the burn victim with deficiencies in vitamins and brains, and psycho on chemo)
Burn victims
Nutritional deficiencies
Neurologic conditions
Psychiatric conditions
Chemotherapy
central parenteral nutrition - where is the catheter? (central downtown is in the jugular)
Tip of catheter lies in superior vena cava where vesicant and irritant solutions are safe to be administered
Central catheter to internal jugular vein to superior vena cava
what types of insulin have the most flexibility with diet?
rapid-acting insulin, multiple daily injections, or insulin pump
Intraoperative Phase: (nurse intra-operating room)
ntraoperative Phase: Role of the scrub nurse and circulating nurse; anesthetics
pre op - allergies (LISBA)`
latex, iodine, shellfish, bannana, avacado (all from same tree family)
antibiotics (and find out what the exact reaction is), tape allergies,
pre op - Geriatric Considerations
cognitive decline so have family there, decreased kidney functions, confusion, not following direction
