IV Therapy Chapter 12 NSG Flashcards
Nutrition Screening:
Assessment
Overall health and diet history Anemia Anorexia Burns Trauma Organ failure Cancer Immunodeficiency Energy Requirements Physical examination Necessary to determine if need Energy requirements Basal metabolic rate Digestion activity
Indicate nutrition
Electrolytes
Albumin
Protein
Assessment issues with nutrition
BMI Delayed wound healing Grip strength Strength Muscle function Respiratory skeletal Brittle skin, hair and nails
Nutritional support candidates
Patients with GI disturbances affecting absorption of nutrients
May intake but not absorb
Cardiac patients Pediatric patients Anorexia patients Trauma patients Need and increase of nutrients to help in the healing process Prevent further deterioration
Peripheral Parenteral Nutrition is used to?
nourish patients who either are already malnourished or have the potential for developing malnutrition and who are not candidates for enteral nutrition. Have to meet a specific criteria Good peripheral access Able to intake large amounts of fluids Up to 3000 mL daily
Advantages of Peripheral Parenteral Nutrition
Avoids the need for insertion and maintenance of a central line
Delivers less hypertonic solutions
Reduces the chance of metabolic complications
Increases calorie source, along with fat emulsions
Can add fat if needed
Can be changed per pt.
We do not admin any of these through the same line:
fluids,
meds
blood products
Disadvantages of Peripheral Parenteral Nutrition
Cannot be used in severely nutritionally depleted patients
Cannot be used in volume-restricted patients
Does not usually increase a patient’s weight
Risk of phlebitis
Not for pt. with poor line access (must have good access)
Have to be able to tolerate large amounts of fluids
What is in Total Parenteral Nutrition (TPN)
Two-in-one admixtures: dextrose and amino acids: Mineral's vitamins Amino acids Electrolytes
What is needed prior to administering Total Parenteral Nutrition (TPN)
Must have central venous access
Total Parenteral Nutrition (TPN) is used to do what?
Reverses starvation and adequately achieves tissue synthesis, repair, and growth
Growth and rejuvenation of tissues
Long term weeks to years. therapy
What are the Advantages of Total Parenteral Nutrition (TPN)?
Dextrose solution of 20% –70% can be administered
Because of central line
Beneficial for long-term use
Useful for patients with large caloric and nutrient needs
Provides calories; replaces essential vitamins, electrolytes and minerals
Promotes tissue synthesis
Allows bowel to rest and heal
Improves tolerance to surgery
Can add insulin to TPN
What are the Disadvantages of Total Parenteral Nutrition (TPN)?
May require a minor surgical procedure for insertion of central line
May cause metabolic complications
Giving patients high doses of dextrose, increased BGL; you have to monitor
We could create glucose intolerance
Correct imbalances but could also cause imbalances
Risk of pneumothorax during insertion
Radiographic verification of tip placement of central line needed
Poor absorption of nutrients
Poor Gi function
may receive vitamin K weekly as supplement
MUST verify tip placement 1st before admin. by having an x-ray for verification
Full barrier precautions when inserting catheter
Sterile and aseptic technique
What is in Total Nutrient Admixture (TNA)?
Three-in-one solutions of dextrose, amino acids, and fat emulsions in one bag.
Proteins can be added ; synthetics and amino acids.
Individualized generally per pt. requirements.
How long should Total Nutrient Admixture (TNA) be infused depending on Provider and labs?
Infuses over 24 hours, then change bag
Total Nutrient Admixture (TNA) should use what to be given? For what reason?
Administer through special filter- 1.2-micron filter.
due to fat emulsion the risk of particulate matter.
Risk of catheter occlusions from fat deposits
Fats can occlude catheter
What are the Advantages of Total Nutrient Admixture (TNA)?
Dextrose solution of 20% –70% can be administered
Because of central line
Beneficial for long-term use
Useful for patients with large caloric and nutrient needs
Provides calories; replaces essential vitamins, electrolytes and minerals
Promotes tissue synthesis
Allows bowel to rest and heal
Improves tolerance to surgery
Can add insulin to TNA
Cost effective
Nursing time saved because multiple infusions are not needed.
What are the Disadvantages of Total Nutrient Admixture (TNA)?
May require a minor surgical procedure for insertion of central line.
May cause metabolic complications.
Giving patients high doses of dextrose, increased BGL; you have to monitor
We could create glucose intolerance
Correct imbalances but could also cause imbalances
Risk of pneumothorax during insertion
Radiographic verification of tip placement of central line needed
Poor absorption of nutrients
Poor Gi function
may receive vitamin K weekly as supplement
MUST verify tip placement 1st before admin. by having an x-ray for verification
Full barrier precautions when inserting catheter
Sterile and aseptic technique
Increased risk of bacterial and candida infections due to lipid emulsions
Must use 1.2 micron filter – filters out larger particles and clots
Built in infusion set
Catheter occlusion
Cyclic TPN Therapy is infused over? given when?
C-TPN usually infused over a 12 – 18 hour period, versus 24 continuous hours
Pt may do night or morning
Often infused while patient is sleeping
Cyclic TPN Therapy has Risk of?
sepsis-associated central line increases due to increased manipulation of line
Because it is not continuously hooked up;
and
Line is used and stopped often
Cyclic TPN Therapy includes what Advantages?
events or treats hepatoxicity induced by continuous TPN
Prevents or treats EFAD (essential fatty acid deficiency) that can occur in nonfat TPN bags
Improves quality of life by encouraging normal daytime routines
Can do when sleeping
Have normal daytime routine
What are the Disadvantages Cyclic TPN Therapy?
Must observe for symptoms of hypoglycemia and dehydration
Sepsis associated with central line manipulation
Hyperglycemia during peak C-TPN flow rate
Not continuous dextrose so BGL can drop
Increasing dextrose so increases risk
Pt may not feel good at all
Routine BGL q 6 hrs.
Sliding scale of insulin even tough not DM pt. due to dextrose/glucose
And dehydration monitored
Should be standard orders to prevent hypoglycemia or hyperglycemia
Name the Key Points in Nutrition Support Administration.
Assessment prior to initiation
Ascertain correct placement of central line with radiographic verification
Strict attention to sterile technique
Check the PPN or TPN solution to ensure correct nutrients are included as ordered
Tramped process they are medications.Maintain sterile technique when manipulating solution or administration set
Check vitals
Monitor blood sugar every 6 hours
Maintain strict I and O
Daily serial weights
½ lb. a day is the goal for wt. gain.
Initially TPN should be stared slowly, increasing at a rate of 25 ml/h increments until desired rate of infusion is achieved
Container of TPN must not infuse beyond a 24-hour period of time
ALWAYS Use a pump
Change administration sets every 72 hours for 2-in-1 admixtures, every 24 hours for TNA
Avoid rapidly replacing lagged TPN solutions
Never play catch up, always go by infusion rate
Contains dextrose and electrolytes
Administer insulin as ordered to maintain serum glucose in the designated range, Based on BGL.
Use central line bundle for insertion and maintenance of CVC
Occlusive transparent dressing Use appropriate filters for each separate solution
170 Micron filter
Sterile dressing should be done every 48 – 72 hours if nontransparent occlusive dressing is used; every 4 – 7 days with transparent dressing
Observe for signs and symptoms of hypophosphatemia, hypokalemia, hypomagnesemia, and hypernatremia
Nutrition Support Administration complications can include?
Mechanical or technical complications (catheter related)
Infectious and septic complications
Catheter-related sepsis (CR-BSI).
Metabolic complications
-Altered glucose metabolism: rebound hypoglycemia
-Altered glucose metabolism: hyperglycemia
-Essential fatty acid deficiency (EFAD)
-Electrolyte imbalances
Nutrition altered
- Refeeding syndrome
- –If the body is not used to having adequate nutrients it will have a hard time adapting to having the necessary nutrients
- –Not getting nutrients so body slows down
Altered vitamin balance
-Disease processes can vitamin requirements so must assess for vitamin deficiencies.
Before discontinuation of parenteral or enteral nutritional support what should happen?
there should be another type of nutrition to replace it.
Is pt. ready to increase to an oral diet.
