Med Surg: Enteral nutrition and care of feeding ports Flashcards
What are the objective of enternal nutrition and feeding ports?
Understand why total enteral nutrition is important
Who is most likely to recieve TEN
Known the difference paths of administration
Understanding the difference between types of feeding
Complications
Methods of maintenance and care of enteral nutrition
What patients are most likely to receive TEN?
pts can eat, but not maintain adequate nutrition by oral intake
permanent neuromusclular impairment and cannot swallow
Critically ill and cannot eat
When is TEN contraindicated?
Significant hemodynamic compromise
- diffuse peritonitis
- severe acute or chronic pancreatitis
- intestinal obstruction
- paralytic ileus
What is TEN?
Combination of carbohydrates, fats, vitamins and minerals
Prescription from the health care provider
Dietitian makes recommendations
What are the methods of administering TEN?
NG tube
Nasoduodenal tube (NDT): short term (4 weeks), safer for pt at risk for aspiration
Gastrosomy: stoma creasted from abdominal wall into stomach, placed endoscopically, PEG, PEG/J. low profile
Jejunostomy: used less often, bypass stomach: gastric disease, upper GI obstruction, abnormal gastric or duodenal emptying
What is tube feeding administration?
Bolus feeding: intermittent, manually or infusion
Continuous: similar to IV therapy, small amounts continuously given
Cyclic Feeding: Same as continuous, infusino stopped for specific time
What is assessment for tube feeding care?
Placement of tube
insertion site
clean nostril
check and record resiudal feeding
change feeding bag and tubing every 24-48 hours
What is intervention for tube feeding care?
Rotate tube 360 degrees each day
Dry sterile dressing
Replace tape
Secure to patient gown
Give frequent mouth care
Only add 4 hours worth of feeding at a time
Label feedings and dispose properly
HOB elevation during and 1 hour after
Monitor lab values
Monitor I&O and weight
How to care and maintain feeding tube?
Flush tube with 20-30 mL of water, 4 hours for intermittent, before and after each feeding, before and after drug administration
Clogged: use 30 mL water, apply pressure with 50 mL piston syringe
What is parenteral nutrition?
When pt cannot adequately use GI tract for nutitional purpose or unable to meet body requirements
Preneteral solution made of amino acids, glucose, fat vitamins, electrolytes, carbohydrates, minerals and proteins
IV therapy different from standard IV therapy. 600 calories per day
What is partial parenteral nutrition?
Short term therapy
Usually given through catheter or cannula in a PICC line or large distal arm vein
Indicated for use when pt able to each but unable to meet bodies nutrient needs
2 types IV solutions:
- IV fat lipids emulsions
- Amino acid dextrose: considered more stable so often mixed with vitamins, minerals and electrolytes, must be delivered by an in-line dilter
What is total parenteral nutrition?
long term therapy
used for intensive nutritional support
delivered through either a PICC line, central veins or internal jugular veins
TPN provides calories needed and protects the bodies proteins from breakdown for energy requirement
Administered by an infusion pump at a controlled rate
What are complications of TPN?
fluid imbalance
Hyperglycemia
Dehydration
Hypovolemic shock
Cardiac or renal dysfunction exacerbation
CHF
pulmonary edema
What complications should you monitor for in TPN?
taking daily weights
charting intake and output while receiving parenteral nutrition
Serum glucose/electrolyte values
Changes/adnormalities
What is the care and maintenance of total parenteral nutrition?
Check each solution bag for accuracy by comparing physicians and pharmacist’s perscription request
Monitor the IV pumps hour rate for accuracy of solution delivered
Monitor the patients weight daily
Monitor glucose and serum electrolytes daily
Document and report all fluid and electrolyte imbalances and complications
Monitor patients I&O
Assess IV site for infiltration or signs of infection
Change tubing of IV every 24 hours
Change the IV site dressing every 48-72 hours
