Stomach Disorders: Vitamin B12 Deficiency and TPN/PPN Flashcards
Folic acid is also which vitamin?
• B9
Vitamin B9 and B12 are absorbed by the body due to what substance produced by the stomach?
• Intrinsic factor
Folic acid and VitB12 are important to…
• Erythropoiesis
A lack of B12 and folic acid causes the body to produce…
• Abnormally large red blood cells that cannot function properly (megaloblastic anemia)
Why does Vitamin B12 Deficiency make one weak, tired, lightheaded, SOB, or have pale skin?
• Lack of erythropoiesis leads to anemia and lack of oxygenation
What are the s/s of Vitamin B12 Deficiency?
- Weakness, tiredness, lightheadedness
- Heart palpitations and SOB
- Pale skin
- Beefy tongue
- Constipation, Diarrhea loss of appetite or gas
- Vision loss
What other vitamins and minerals are affected by lack of intrinsic factor besides vitamin B12
- Iron
- Calcium
- Folic acid
What foods contain vitamin B12?
- meat
- fish
- milk
- cheese
- eggs
What is the tx for Vitamin B12 Deficiency as a result of gastric surgery?
- Will need to be given via injection at first
- When sufficient, supplements will be needed
What is enteral feeding?
• Enteral administration is food or drug administration via the human gastrointestinal tract.
What is parenteral feeding?
• Nutrition or drug administration that occurs from routes outside the GI tract, such as intravenous routes
What is TPN?
- Total Parenteral Nutrition
- It is a method of getting nutrition into the body through the veins for patients who do not have a functioning GI tract or who have disorders requiring complete bowel rest
TPN is a long-term therapy for nutrition. What is the number 1 issue to continually assess for?
• Infection
What is PPN?
- Partial Parenteral Nutrition (aka Peripheral Parenteral Nutrition)
- Method used for clients that can take some oral nutrition, but not enough to meet the body’s needs
Through what route is TPN administered?
- Via PICC line in
- Subclavian vein or
- Jugular vein
Through what route is PPN administered?
• A peripheral IV port
What are the risks of inserting a PICC line?
- Veinous puncture through
- Lung puncture → pneumothorax
Why does is a central line needed for TPN?
• The vein is large enough to handle the nutrition mixture
What is the risk of administering a TPN mixture through a peripheral IV?
• Vascular collapse due to the viscosity (high osmolality) of TPN solution
What type of needle is used for TPN?
• ≥ 16 gauge
What is the insertion procedure for a PICC line?
- Pt = supine
- Have pt take a deep breath and then hold
- On hold, insert needle
- This is so the chest is still and reduces risk of pneumothorax
- Assess vitals for signs of infiltration or pneumothroax
- Confirm placement by x-ray
How is a TPN solution obtained and started?
- Doc confirms placement and gives TPN prescription
- Prescription is mixed per pt and can take around 6hrs to be delivered
- Get baseline vitals and weight
- Start feeding
- Document/Chart everything
How often is the TPN solution updated by the HCP?
• Daily
How are we monitoring glucose/electrolyte levels during TPN?
- Daily blood labs
- Finger sticks ever 4hrs
Why might a pt become hyper/hypoglycemic on TPN?
• Glucose levels provided are too high/low
What are we checking during TPN to monitor fluid balance?
- Check sodium and potassium levels
- Blood pressure
- Weight
What are normal potassium levels?
• 3.5 - 5.0
How can TPN affect the biliary system?
- Over time, the TPN solution can cause bile to become more viscous or “sludge”
- This can lead to cholelithiasis (gallbladder stones)
How can TPN affect the hepatic system?
• Over time, the pt can develop steatosis (fatty liver)
What clinical sign will indicate liver disease?
- Elevated LFT (Liver Function Tests)
- ALP, AST, ALT, GTT
What is the TPN concentration?
- Aminoacid: 4.25%
- Dextrose: 25-50%
- Fat: >20%
What is the PPN concentration?
- Aminoacid: 1.75-305%
- Dextrose: 5-10%
- Fat: ≤ 20%
Which is the used more commonly, PPN or TPN?
• TPN
What type of PICC line is used for TPN?
• Triple lumen
Why is a triple lumen PICC line used for TPN and what is its benefit to the pt?
- It allows for constant TPN administration through one lumen
- Can administer fluids or abx through another
- Can take blood samples from another
- Benefit to pt: less sticks
True or False
It is permissible to do a blood transfusion or administer blood products through the TPN PICC line.
- False, it will cause a coagulation issue
- A peripheral IV line must be used
TPN is indicated for patient conditions?
- GI tract cannot tolerate/process enteral feeding
- Post surgery and the bowel needs to rest for healing
Should patients with AIDS, cancer, malnutrition or clients receiving chemotherapy have TPN or PPN?
• Pending their GI tolerance/status, could be either
True or False
The TPN rate may be sped up or slowed down.
• False, TPN rate must remain constant
Why must the TPN rate remain constant?
• Varying the speed can cause coagulation issues putting the pt at risk for embolism
What do we do with the TPN feeding @ end of shift?
• Document unused and replace?
When must a dressing change be done for the PICC line?
• Unless otherwise indicated, weekly, using sterile technique
What are the complications of parenteral nutrition?
- Hyper/Hypoglycemia
- Electrolyte imbalance
- Fluid imbalance
- Biliary disease (cholelithiasis and sludge)
- Hepatic disease (steatosis, elevated LFT)
- Refeeding syndrome
What is a normal glucose levels?
• Between 70-140
What are low glucose levels?
- < 70 is low
- <55 requires immediate action
What are normal sodium levels?
• 135-145
