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Clients with Health Challenges - N3600 > Pancreatitis, TPN, NG and enteral tube therapy > Flashcards

Pancreatitis, TPN, NG and enteral tube therapy Flashcards

1
Q

Hard to manage, having no relief, cannot be stopped, even with medication and prolonged

A

Intractable

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2
Q

Why can we not administer a central TPN solution through a peripheral route?

A

Due to the high osmolarity of the solution (33% dextorse) is that it will blow the peripheral vein very rapidly - large molecule size

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3
Q

Can diabetics receive TPN?

A

Yes, we just have to offest the glucose by giving more insulin

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4
Q

What do we start patients on when they receive TPN?

A

Insulin
a person receiving TPN will become diabetic for the limited time they receive TPN; they will stop taking insulin when they stop TPN

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5
Q

What may occur as a result of long term PTN?

A

Stomach may atrophy

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6
Q

Does the person ever get hungry when given TPN?

A

No, but may miss taste of food

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7
Q

How is TPN administered?

A

Through PICC (peripherally inserted central catheter) line or Hickman

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8
Q

Where does the catheter for the PICC line/central line sit in?

A

Superior vena cavaq

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9
Q

PICC line insertion/clean is a ______ procedure.

This requires that we wear _____.

A

sterile

masks

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10
Q

How can we get a patient on TPN to produce saliva? Why is that important?

A

Pt can have gum, or suck on a mint
May use a mouthcare tray - diluted to swish and spit
They will have bad breath without saliva

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11
Q

Describe the two lumen central line.

A

Red is for taking blood out

white is for feed

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12
Q

A central line in the chest is called what?

A

Hickman’s

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13
Q

What is the third lumen for?

A

Blue - for drugs

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14
Q

Nurses hate it when doctor’s put a central line here. Why?

Why is it used?

A

Jugular vein - compromising to comfort as patient cannot turn their neck
used in emergency stuations, or if the other sites are compromised
(happens with dialysis patients)

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15
Q

TPN administration:

  • Before administration we check the bag. What do we check for?
  • Administered via pump to prevent _______
  • Monitor blood glucose ____ for 24 hours, then ____ if levels are normal
  • Monitor for allergy to ______; often occurs within first ____ minutes - fever, shaking, chills, SOB, chest pain or back pain
  • Prevent catheter related infection - strict ______ when accessing ports and changing dressings (_____ worn by patient and nurse!)
  • change the solution and tubing for lipid containing solutions ______
  • solutions should be ______ until administration
A

check bag for:
- expiry date, appearances, leaks or tears, correct ingredients

bolusing
q6h, OD
lipids, 30 minutes
asepsis - masks
q24hrs
refrigerated
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16
Q

Why is the pump essential when giving TPN?

A

If it ran by gravity and were to open really quick - person may get atrial fibrillation and cardiac arrest

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17
Q

When a large amount of fluid is administered rapidly to a patient (too rapidly)

A

blousing

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18
Q

Why do we see flank pain in lipid allergy?

A

Get lysis and clots which clog up the kidneys

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19
Q

In LHSC, at what frequency do we change IV tubing?

Why do we change lipid tubing q24hrs?

A

q72hours

q24hrs for lipid as it coats the inside of the tubing

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20
Q

Before administering the TPN solution we should warn the patient that it will be ____.

A

cold

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21
Q

IF extravasation occurs, it is often dramatic from a central line - very red, inflammed. What must we do?

A

Stop the IV, dress the area and do NOT USE IT FOR ANYTHING

22
Q

Delivery of nutrition through a feeding tube, placed in the stomach of small intestine. It is used when a client is not able to ingest food but is still able to digest food and absorb nutrients.

A

Enteral nutrition

23
Q

For the following conditions, describe whether the person would receive enteral nutrition or TPN.

A -Chronic Diarrhea or vomiting
B - Pancreatitis
C - Comatose state
D - GI obstruction
E - Oral, head and neck surgeries
F - Severe malabsorption
G - Confused clients
H - Short bowel syndrome
I - Intractable diarrhea
J - Impaired swallowing or gag reflex (e.g. stroke)
K - Sepsis
L - Receiving mechanical ventilation
M - GI obstruction
A 
A - TPN
B - TPN
C - EN
D - TPN
E - EN
F - TPN
G - EN
H - TPN
I - TPN
J - EN
K - TPN
L - EN
M - TPN
24
Q

What are the advantages of enteral feeding over parenteral feeding?

A

EN nutrients are absorbed in the proximal small bowel, promoting distal bowel rest
Prevents GI mucosal atrophy
Less invasive, fewer complications
Less expensive

25
Q

What are the different ways that EN may be administered?

A

Intermittent
Continuous

Bolus (J and G tube only)
Gravity flow
Pump

Open - bag and tubing
Closed - pre-filled container with tubing

26
Q

EN formulas are made up of both _____ and _________, along with ______, which can make up to 85% of the formula

A

macro, micronutrients

water

27
Q

Nutrients that can provide fuel or energy.

What are the different types?

A

Macronutrients

Carbs, proteins, lipids

28
Q

Micronutrients required for metabolic processes to occur adequately. They cannot be manufactured by the body and are thus ingested.

A

Vitamins

29
Q

What are the two vitamin types. Which vitamins fit in which category?

A

Fat-soluble - ADEK

Water-soluble - B and C (BC is next to water)

30
Q

Micronutrients required for cell functioning, including the development and health of bone and RBCs.

A

minerals

31
Q

What are the five major minerals?

A

Calcium, phosphorus, potassium, sodium and magnesium

32
Q

The body is unable to store _____-soluble vitamins and thus they must be supplied daily by one’s diet.

A

water (i.e. vitamins B and C)

33
Q

EN route used for clients who require feeding on a short-term basis (less than __ weeks) and is inserted through the nose and stomach.

A

NG tube

less than 6 weeks

34
Q

Longer than an NG tube and is placed in the upper small intestine. it is used for clients at high risk for ______.

A

Nasointestinal tube

aspiration risk

35
Q

Placed through the abdominal wall into the stomach. Used for long-term feeding.

A

Gastrostomy (G) tube

36
Q

Used for clients who require long-term feeding and is placed through the abdominal well into the jejunum.

A

Jejunostomy (J) tube

37
Q

Opened cans of EN formula should be used within what time frame?

A

24 hours.

38
Q

Generally, reconstituted milk products should not be kept at room temperature for longer than _______.
Ensure tube-feeding formula is at _____ ______. Explain this last point.

A

4 hours
room temperature
- cold formula causes gastric cramping and client discomfort
- i.e. take it out 30 minutes before administration; or immerse in warm water for 15 minutes before administration

39
Q

When administering EN we raise the bed, how high and why?

A

Raise to high-fowler’s if they can tolerate it, or at least 30-45°.
This is essential to decrease aspiration risk.

40
Q

What do we listen for before commencing EN feeding?

A

Auscultate bowel sounds

41
Q

What are two potential adverse outcomes of EN feeding due to incorrect placement?

A

NG or NI tube in the lung

pulomonary aspiration of gastric contents

42
Q

What are the ways in which NG or NI tube placement is verified?

A

X-ray is the most reliable method - done whenever a tube is first inserted into a client

Measure the length of the tube by noting the mark at the exit of the nares and comparing to previous measures

Aspirate gastric contents to measure pH and observe characteristics of the aspirate

43
Q

Describe the colour of aspirate when verifying tube placement.

A

Gastric ontents are usually green, off-white to tan, or clear and colourless
Intestinal fluid is usually dark to golden yellow
Pleural fluid is PALE YELLOW

44
Q

What pHs do we look for when verifying tube placement?

A

Gastric pH - 1-4 (a client with continuous tube feeding may have a pH of 5+)
Intestinal pH - 6+
pleural fluid - 7+

45
Q

How long do we wait to test placement of NG tube after administering meds?

A

1 hour

46
Q

When do we check gastric residual volume (GRV)?

A

Before each feeding for intermittent feeding, and q4-6h initially for continuous feedings

47
Q

When do we flush the feeding tube?

A

Following a bolus or intermittent feeding, or q4h throughout continous feeding (usually a 30 mL sterile water flush)

48
Q

At what frequency are closed EN systems changed?

What about open systems?

A

q24h for closed

generally q24h for open too

49
Q

How long should a client stay upright after EN feeding?

A

30-60 minutes

50
Q

Skin care EN tube:

  • cleanse tube insertion site with ______ _____ and apply a dry gauze if drainage is present
  • a well established tube site can be cleansed with _____ and _____, and if there is no drainage it may be left open to the _____.
A

normal saline
soap and water
air

51
Q

What is the most important complication to consider for enteral therapy?

A

Aspiration

Clients with Health Challenges - N3600 (22 decks)

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