IV Therapy Chapter 12 NSG

Question 1

Nutrition Screening:

Assessment

Answer 1

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

Question 2

Indicate nutrition

Answer 2

Electrolytes
Albumin
Protein

Question 3

Assessment issues with nutrition

Answer 3

BMI
Delayed wound healing
Grip strength
Strength
Muscle function 
Respiratory
skeletal
Brittle skin, hair and nails

Question 4

Nutritional support candidates

Answer 4

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

Question 5

Peripheral Parenteral Nutrition is used to?

Answer 5

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

Question 6

Advantages of Peripheral Parenteral Nutrition

Answer 6

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

Question 7

Disadvantages of Peripheral Parenteral Nutrition

Answer 7

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

Question 8

What is in Total Parenteral Nutrition (TPN)

Answer 8

Two-in-one admixtures: 
dextrose and 
amino acids:
Mineral's vitamins
Amino acids
Electrolytes

Question 9

What is needed prior to administering Total Parenteral Nutrition (TPN)

Answer 9

Must have central venous access

Question 10

Total Parenteral Nutrition (TPN) is used to do what?

Answer 10

Reverses starvation and adequately achieves tissue synthesis, repair, and growth
Growth and rejuvenation of tissues
Long term weeks to years. therapy

Question 11

What are the Advantages of Total Parenteral Nutrition (TPN)?

Answer 11

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

Question 12

What are the Disadvantages of Total Parenteral Nutrition (TPN)?

Answer 12

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

Question 13

What is in Total Nutrient Admixture (TNA)?

Answer 13

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.

Question 14

How long should Total Nutrient Admixture (TNA) be infused depending on Provider and labs?

Answer 14

Infuses over 24 hours, then change bag

Question 15

Total Nutrient Admixture (TNA) should use what to be given? For what reason?

Answer 15

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

Question 16

What are the Advantages of Total Nutrient Admixture (TNA)?

Answer 16

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.

Question 17

What are the Disadvantages of Total Nutrient Admixture (TNA)?

Answer 17

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

Question 18

Cyclic TPN Therapy is infused over? given when?

Answer 18

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

Question 19

Cyclic TPN Therapy has Risk of?

Answer 19

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

Question 20

Cyclic TPN Therapy includes what Advantages?

Answer 20

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

Question 21

What are the Disadvantages Cyclic TPN Therapy?

Answer 21

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

Question 22

Name the Key Points in Nutrition Support Administration.

Answer 22

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

Question 23

Nutrition Support Administration complications can include?

Answer 23

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.

Question 24

Before discontinuation of parenteral or enteral nutritional support what should happen?

Answer 24

there should be another type of nutrition to replace it.

Is pt. ready to increase to an oral diet.