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z_NUR411_Medsurge: UNIT 2 > Stomach Disorders: Vitamin B12 Deficiency and TPN/PPN > Flashcards

Stomach Disorders: Vitamin B12 Deficiency and TPN/PPN Flashcards

1
Q

Folic acid is also which vitamin?

A

• B9

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2
Q

Vitamin B9 and B12 are absorbed by the body due to what substance produced by the stomach?

A

• Intrinsic factor

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3
Q

Folic acid and VitB12 are important to…

A

• Erythropoiesis

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4
Q

A lack of B12 and folic acid causes the body to produce…

A

• Abnormally large red blood cells that cannot function properly (megaloblastic anemia)

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5
Q

Why does Vitamin B12 Deficiency make one weak, tired, lightheaded, SOB, or have pale skin?

A

• Lack of erythropoiesis leads to anemia and lack of oxygenation

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6
Q

What are the s/s of Vitamin B12 Deficiency?

A
  • Weakness, tiredness, lightheadedness
  • Heart palpitations and SOB
  • Pale skin
  • Beefy tongue
  • Constipation, Diarrhea loss of appetite or gas
  • Vision loss
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7
Q

What other vitamins and minerals are affected by lack of intrinsic factor besides vitamin B12

A
  • Iron
  • Calcium
  • Folic acid
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8
Q

What foods contain vitamin B12?

A
  • meat
  • fish
  • milk
  • cheese
  • eggs
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9
Q

What is the tx for Vitamin B12 Deficiency as a result of gastric surgery?

A
  • Will need to be given via injection at first
  • When sufficient, supplements will be needed
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10
Q

What is enteral feeding?

A

• Enteral administration is food or drug administration via the human gastrointestinal tract.

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11
Q

What is parenteral feeding?

A

• Nutrition or drug administration that occurs from routes outside the GI tract, such as intravenous routes

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12
Q

What is TPN?

A
  • 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
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13
Q

TPN is a long-term therapy for nutrition. What is the number 1 issue to continually assess for?

A

• Infection

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14
Q

What is PPN?

A
  • 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
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15
Q

Through what route is TPN administered?

A
  • Via PICC line in
  • Subclavian vein or
  • Jugular vein
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16
Q

Through what route is PPN administered?

A

• A peripheral IV port

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17
Q

What are the risks of inserting a PICC line?

A
  • Veinous puncture through
  • Lung puncture → pneumothorax
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18
Q

Why does is a central line needed for TPN?

A

• The vein is large enough to handle the nutrition mixture

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19
Q

What is the risk of administering a TPN mixture through a peripheral IV?

A

• Vascular collapse due to the viscosity (high osmolality) of TPN solution

20
Q

What type of needle is used for TPN?

A

• ≥ 16 gauge

21
Q

What is the insertion procedure for a PICC line?

A
  • 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
22
Q

How is a TPN solution obtained and started?

A
  • 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
23
Q

How often is the TPN solution updated by the HCP?

A

• Daily

24
Q

How are we monitoring glucose/electrolyte levels during TPN?

A
  • Daily blood labs
  • Finger sticks ever 4hrs
25
Q

Why might a pt become hyper/hypoglycemic on TPN?

A

• Glucose levels provided are too high/low

26
Q

What are we checking during TPN to monitor fluid balance?

A
  • Check sodium and potassium levels
  • Blood pressure
  • Weight
27
Q

What are normal potassium levels?

A

• 3.5 - 5.0

28
Q

How can TPN affect the biliary system?

A
  • Over time, the TPN solution can cause bile to become more viscous or “sludge”
  • This can lead to cholelithiasis (gallbladder stones)
29
Q

How can TPN affect the hepatic system?

A

• Over time, the pt can develop steatosis (fatty liver)

30
Q

What clinical sign will indicate liver disease?

A
  • Elevated LFT (Liver Function Tests)
    • ALP, AST, ALT, GTT
31
Q

What is the TPN concentration?

A
  • Aminoacid: 4.25%
  • Dextrose: 25-50%
  • Fat: >20%
32
Q

What is the PPN concentration?

A
  • Aminoacid: 1.75-305%
  • Dextrose: 5-10%
  • Fat: ≤ 20%
33
Q

Which is the used more commonly, PPN or TPN?

A

• TPN

34
Q

What type of PICC line is used for TPN?

A

• Triple lumen

35
Q

Why is a triple lumen PICC line used for TPN and what is its benefit to the pt?

A
  • 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
36
Q

True or False
It is permissible to do a blood transfusion or administer blood products through the TPN PICC line.

A
  • False, it will cause a coagulation issue
  • A peripheral IV line must be used
37
Q

TPN is indicated for patient conditions?

A
  • GI tract cannot tolerate/process enteral feeding
  • Post surgery and the bowel needs to rest for healing
38
Q

Should patients with AIDS, cancer, malnutrition or clients receiving chemotherapy have TPN or PPN?

A

• Pending their GI tolerance/status, could be either

39
Q

True or False
The TPN rate may be sped up or slowed down.

A

• False, TPN rate must remain constant

40
Q

Why must the TPN rate remain constant?

A

• Varying the speed can cause coagulation issues putting the pt at risk for embolism

41
Q

What do we do with the TPN feeding @ end of shift?

A

• Document unused and replace?

42
Q

When must a dressing change be done for the PICC line?

A

• Unless otherwise indicated, weekly, using sterile technique

43
Q

What are the complications of parenteral nutrition?

A
  • Hyper/Hypoglycemia
  • Electrolyte imbalance
  • Fluid imbalance
  • Biliary disease (cholelithiasis and sludge)
  • Hepatic disease (steatosis, elevated LFT)
  • Refeeding syndrome
44
Q

What is a normal glucose levels?

A

• Between 70-140

45
Q

What are low glucose levels?

A
  • < 70 is low
  • <55 requires immediate action
46
Q

What are normal sodium levels?

A

• 135-145

z_NUR411_Medsurge: UNIT 2 (25 decks)

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