Lecture 8 Flashcards
different types of IV fluids?
Ringer’s Lactate, Normal saline, 1/2 normal saline, D5W, D10W, D5W 1/2 NS
what does TKVO mean?
to keep vein open
what is the purpose of nutrition monitoring?
determine and measure amt of progress made for nutr intervention and whether nutr related goals/expected outcomes are being met
enteral nutrition related complications:
GI, metabolic, pulmonary, hydration, mechanical
nausea and vomiting happens in ____ % of pt on EN and ^ risk for _____
7-26; aspiration
possible etiologies of nausea/vomiting
delayed gastric emptying/gastroparesis, hypotension, hemodynamic instability, stress, sepsis, anesthesia/surgery, meds, very cold formula
interventions for nausea/vomiting?
room temp feeds, decrease rate of infusion, go back to continuous, change EN formula, liaise with team re meds
drugs that enhance GI motility via various mechanisms of action
prokinetic agents
common prokinetic agents
metclopromide, domperidone, erythromycin
various mechanisms of action that prokinetics work:
stim gut motility, esophageal peristalsis, strengthen lower esophageal sphincter pressure to promote gastric emptying
ab distension caused by:
GI ileus, bowel obstruction, constipation/obstipation, ascites, initial use of high fibre feed
interventions for ab distention:
testing to r/o obstruction or ileus (imaging with xray or CT), hold feeds if necessary (not necessary if intestinal appearance/fxn normal, no pain)
s/s of malabsorption:
wt loss, steatorrhea, diarrhea
interventions for malabsorption:
trial semi elemental formula, supplemental PN if unresponsive to EN
disease related malabsorption:
IBD, radiation enteritis, enteric fistulas, pancreatic insufficiency, short bowel syndrome
what is the osmolality of blood?
300
caused by incomplete absorption of fluid and electrolytes from lumen of GIT
diarrhea
sample definitions of diarrhea:
bristol stool chart 5-7, 3 loose stools/day for 2days, >500mL/24h, abnormal volume and consistency
etiologies of diarrhea
drugs, disease, infection, feeding formulas (hyperosmolar, lactose containing)
what does MOIST stand for?
motility, osmotic, impaction, secretory, trauma
decreased motility causes:
areas of stagnation–>bacteria overgrowth–>disrupt bile salt reabsorption, bile salts excessively enter colon
increased gut motility causes:
reduced contact time with the gut mucosa–>inadequate absorption of fluid/lytes
intraluminal presence of poorly absorbed osmotically active solute causes:
osmotic force pulls water/ions into lumen, exceeding absorptive capacity of bowel
the presence of a large amount of hard stool that is too large to pass and is thus retained in rectal vault
impactoin
meds that cause impaction:
narcotics/analgesics
overstimulation by luminal/circulating secretagogues leads to:
excess GI secretion which overwhelms GI absorptive ability
conditions associated with secretory diarrhea:
c difficile infection, intestinal resection, bile acid malabsorption, IBD, chronic infections, celiac sprue, small intestinal lymphoma, villous adenoma of rectum, Zollinger-Ellison syndrome, collagen vascular diseases, congenital defects, malignant carcinoid syndrome
how does trauma cause diarrhea?
structural disruption of intestinal epithelium barrier fxn leading to altered hydrostatic pressure in BV/lymphatic’s (lumen accumulates blood/pro/water/lytes/mucus)
what does CHIME stand for?
constipation, history, infection, meds, equipment
how to manage diarrhea nutritionally?
change formula type (intact protein–>peptides), add soluble/insoluble fibre (formula, modular, metamucil/pectin), consider PN
common causes of constipation?
dehydration, inadequate/excess fibre, meds, immobilization
interventions for constipation?
ensure hydration, switch to fibre rich formula, ensure pt is on bowel routine, mobilize pt, ^ water flushes
this is often forgotten in EN, but is very important:
oral care
these complications relate to hydration status, electrolyte imbalance, vit. and mineral status, glycemic control
metabolic
management strategies for pulmonary complications:
tube placement (chest or abdo xray), HOB 30-45 degrees, manage nausea and vomiting, GRVs
what is GRV threshold maximum?
250 mL
ins include __ and outs include ___
IVs, EN, free water, meds ; urine, stool, insensible losses, disease (ostomy, fistula, drains, paracentesis)
management strategies for hydration:
lab findings, assess ins and outs, physical assessment, include fluids/water in EN calculations
tube blockage caused by:
inadequate flushing, large amts of crushed meds and modulars
management for blockage:
routine water flushes, tube unclogging protocol (pancrealipase/NaHCO3 mix) , tube change
do NOT use these for flushes:
coke, cranberry juice
examples of irritation from tube:
sinusitis, nose bleeds, swallowing dysfunction, leakage/wound infection
managing irritation:
proper tube/wound care, tube changes as needed
