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Adult Health I Test IV > Therapeutic Procedures > Flashcards

Therapeutic Procedures Flashcards

1
Q

why are therapeutic procedures performed?

A

Can be performed for maintenance of nutritional intake and tx of GI obstructions, obesity, and other disorders

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2
Q

potential dz that may indicate need for enteral feedings

A
  • Inability to eat due to a medical condition (comatose, intubated)
  • Pathologies that cause difficulty swallowing or inc risk of aspiration (stroke, advanced Parkinson’s dz, multiple sclerosis)
  • Inability to maintain adequate oral nutritional intake and need for supplementation due to inc metabolic demands (cancer therapy, burns, sepsis)
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3
Q

client presentation that may indicate need for an enteral feeding

A
  • Malnutrition: dec prealbumin, dec transferrin or total iron binding capacity
  • Aspiration pneumonia
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4
Q

list possible complications of enteral feedings

A
  • overfeeding
  • diarrhea
  • aspiration pneumonia
  • refeeding syndrome
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5
Q

explain overfeeding as a complication of enteral feedings

A
  • results from infusion of a greater quantity of feeding than can be readily digested, resulting in abdominal distention, n/v
  • Nursing actions:
    • Check residual Q4-6 hour
    • Follow protocol for slowing or withholding feedings for excess residual volumes
    • Check pump for proper operation and ensure feeding infused at correct rate
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6
Q

explain diarrhea as a complication of enteral feedings

A
  • occurs secondary to concentration of feeding or its constituents
  • Nursing Actions:
    • Slow rate of feeding & notify HCP
    • Confer with dietitian
    • Provide skin care and protection
    • Evaluate for c. diff if diarrhea continues, esp if it has a foul odor
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7
Q

explain aspiration pneumonia as a complication of enteral feedings

A
  • can occur secondary to aspiration of feeding
  • Can be life threatening
  • Tube displacement is primary cause
  • Nursing actions:
    • Stop feeding
    • Turn client to side and suction
    • Administer O2 if indicated
    • Monitor V/S for elevated temp
    • Auscultate breath sounds for inc congestion and diminishing breath sounds
    • Obtain CXR
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8
Q

explain refeeding syndrome as a complication of enteral feedings

A
  • occurs when enteral feeding is started in a client who is in a starvation state and whose body has begun to catabolize protein and fat for energy
  • Nursing Actions:
    • Monitor for new onset of confusion or seizures
    • Assess shallow respirations
    • Monitor for inc muscular weakness
    • Obtain serum electrolytes
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9
Q

TPN

A
  • hypertonic IV bolus soln
  • Purpose is to prevent or correct nutritional deficiencies and minimize the adverse effects of malnourishment
  • Usually administered thru a central line or PICC line
  • Contains complete nutrition, including calories in a high conc (10-50%) of dextrose, lipids/essential fatty acids, protein, electrolytes, vitamins, trace elements
    • Std IV bolus therapy: no more than 700 calories/day
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10
Q

PPN

A
  • Partial parenteral nutrition or peripheral parenteral nutrition (PPN): less hypertonic, intended for short term use, and administered in a large peripheral vein
    • Usual dextrose is 10% or less
    • Risks include phlebitis
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11
Q

indications for TPN

A
  • any condition that:
    • Affects the ability to absorb nutrition
    • Has a prolonged recovery
    • Creates a hypermetabolic state
    • Creates a chronic malnutrition
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12
Q

potential dx that may indicate a need for TPN

A
  • Chronic pancreatitis
  • Diffuse peritonitis
  • Short bowel syndrome
  • Gastric paresis from DM
  • Severe burns
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13
Q

client presentation that may indicate a need for TPN

A
  • Weight loss >10% of body weight and NPO or unable to eat/drink for more than 5 days
  • Hypermetabolic state
  • Muscle wasting, poor tissue healing, burns, bowel dz disorders, acute kidney failure
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14
Q

prep and ongoing care for a client w/ TPN

A
  • Preparation of client:
    • Determine client readiness for TPN
    • Obtain daily labs including electrolytes
  • Ongoing care:
    • Flow rate is gradually inc and dec to allow body adjustment (no more than a 10% hourly inc in rate)
    • Never stop abruptly
      • Can alter blood glucose significantly
    • Assess V/S Q4-8 hours
    • Follow sterile procedures to minimize risk of sepsis
      • TPN is prepared by pharmacy using aseptic technique w/ a laminar flow hood
      • Change tubing and solution bag (even if not empty) Q24 hours
      • Filter added to tubing to collect particles from soln
      • Do not use line for other IV bolus soln
      • Do not add anything to soln due to risk of contamination and incompatibility
      • Use sterile procedures (including mask) when changing central line dressing
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15
Q

interventions for TPN

A
  • Check capillary glucose Q4-6 hr for at least the first 24 hours
  • Clients receiving TPN frequently need supplemental regular insulin until the pancreas can inc its endogenous production of insulin
  • Keep dextrose 10% in water at the bedside in case the solution is unexpectedly ruined or the next bag is not available
    • Minimizes risk of hypoglycemia
  • If bag is unavailable and administered late, do not attempt to catch up by inc the infusion rate b/c the client can develop hyperglycemia
  • Older adults have inc incidence of glucose intolerance
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16
Q

list complications of TPN

A
  • metabolic: hyperglycemia, hypoglycemia, vitamin deficiencies
  • air embolism
  • infection
  • fluid imbalance
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17
Q

metabolic complications with TPN

A
  • hyperglycemia, hypoglycemia, vitamin deficiencies
  • Nursing actions:
    • Daily lab tests are prescribed and results obtained before a new soln is prepared
    • Fluid needs are typically replaced w/ a separate IV bolus to prevent fluid vol excess
    • Monitor for hyperglycemia
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18
Q

air embolism as a complication of TPN

A
  • pressure change during tubing changes can lead to an air embolism
  • Nursing actions:
    • Monitor for manifestations: sudden onset of dyspnea, chest pain, anxiety, hypoxia
    • Clamp catheter immediately and place client on his left side in trendelenburg position to trap air
    • Administer O2 and notify HCP so trapped air can be aspirated
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19
Q

infection as a complication of TPN

A
  • Conc glucose is the medium for bacteria growth
  • Nursing actions:
    • Observe central line for signs of infection: erythema, tenderness, exudate
    • Change sterile dressing Q48-72 hr
    • Change IV tubing per protocol (Q24 hr)
    • Observe for fever, inc WBC, chills, malaise
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20
Q

fluid imbalance as a complication of TPN

A
  • TPN is hyperosmotic soln which poses risk for fluid shifts and places client at risk for inc fluid vol excess
  • Older adults more vulnerable
  • Nursing actions:
    • Assess lungs for crackles and monitor for resp distress
    • Monitor daily weight and I&O
    • Use controlled infusion pump to administer at prescribed rate
    • Do not speed up infusion to catch up
    • Gradually inc flow rate until prescribed infusion rate is achieved
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21
Q

paracentesis

A
  • Performed by inserting a needle or trocar thru the abdominal wall into the peritoneal cavity
  • Therapeutic goal: relief of abdominal ascites
  • Usually performed w/ U/S as a safety precaution
  • Once drained, ascitic fluid can be sent for lab culture
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22
Q

indications for paracentesis

A
  • Potential dx:
    • Abdominal ascites:
      • Abnormal accumulation of protein rich fluid in the abdominal cavity most often caused by cirrhosis
        • Result is inc abdominal girth and distention
  • Client presentation:
    • Compromised lung expansion, inc abdominal girth, rapid weight gain
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23
Q

preprocedure nursing actions for a paracentesis

A
  • Determine client’s readiness for procedure
    • Variables: age, acute/chronic dz can influence ability to tolerate and recover from procedure
  • Assess labs: serum albumin, protein, glucose, amylase, BUN, creatinine
  • Informed consent
  • Have client void and insert indwelling catheter
  • Position client in an upright position: either on the edge of the bed with feet supported or a high Fowler’s position in the bed
    • If they have ascites, typically more comfortable sitting up
  • Review baseline V/S, record weight, and measure abdominal girth
  • Administer sedation
  • Administer IV bolus fluids or albumin, prior to or after paracentesis, to restore fluid balance
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24
Q

preprocedure client edu for a paracentesis

A
  • Explain procedure
  • Local anesthetics will be used at insertion site
  • May be pressure or pain w/ needle insertion
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25
intraprocedure nursing actions for paracentesis
* Monitor V/S * Adhere to std precautions * Label lab specimens and send to lab * b/w 4-6 L fluid is slowly drained from the abdomen by gravity * Nurse must monitor amount and notify of complications
26
postprocedure nursing actions for paracentesis
* Maintain pressure at insertion site for several minutes. Apply a dressing to a site * If insertion site leaks after a few min, dry sterile gauze should be applied and changed as often as necessary * Check V/S, record weight, and measure abdominal girth * Document and compare to preprocedure measurements * Monitor V/S and insertion site * Monitor temp every 4 hr for minimum 48 hr * fever=bowel perforation * Assess I&O Q4 * Administer medication * Diuretics such as spironolactone and furosemide can be prescribed to control fluid volume * Potassium supplements can be necessary when a loop diuretic such as furosemide has been administered * Administer IV bolus fluids or albumin * Assist client into a position of comfort with HOB elevated to promote lung expansion * Document color, odor, consistency, and amt removed; site of insertion; evidence of leakage at insertion site; manifestations of hypovolemia; and changes in mental status * Continue monitoring of serum albumin, protein, glucose, amylase, electrolytes, BUN, and creatinine levels
27
postprocedure client edu for paracentesis
* Avoid alcohol, maintain a low sodium diet, take meds, monitor puncture site for bleeding or fluid leakage * Report changes in mental and cognitive status due to change in F&E balance * Change positions slowly to dec risk of falls related to hypovolemia from removal of ascitic fluid
28
list complications of paracentesis
* hypovolemia * bladder perforation * peritonitis
29
hypovolemia as a complication of paracentesis
* albumin levels can drop dangerously low b/c the peritoneal fluid removed contains a large amount of protein * Removal of this protein rich fluid can cause shifting of intravascular volume, resulting in hypovolemia * Nursing Actions: * Preventive measures include: slow drainage of fluid and administration of plasma expanders, such as albumin, to counter albumin losses * Monitor for hypovolemia: tachycardia, hypoTN, pallor, diaphoresis, dizziness
30
bladder perforation as a complication of paracentesis
* Manifestations: * Hematuria * Low or no urine output * Suprapubic pain or distention * Symptoms of cystitis * Fever * Nursing actions: if suspected, notify HCP * Client edu: inform client to report any manifestations
31
peritonitis as a complication of paracentesis
* Can occur as a result of injury to the intestines during needle insertion * Manifestations: * Sharp, constant abdominal pain * Fever * n/v * Diminished or absent bowel sounds * Nursing actions: notify HCP * Client edu: report any manifestations
32
3 types of pharmacological therapies for weight loss
* Orlistat * Larcaserin * Phentermine-topiramate
33
Orlistat
* prevents digestion of fats * ADRs: oily discharge, reduced food and vitamin absorption, dec bile flow
34
Larcaserin
* stimulates serotonin receptors in the hypothalamus in the brain to curb appetite * ADRs: HA, dry mouth, fatigue, nausea
35
Phentermine-topiramate
* suppresses appetite and induces feeling of satiety * ADRs: dry mouth, constipation, nausea, change in taste, dizziness, insomnia, numbness and tingling of extremities * Contraindications: hyperthyroidism, glaucoma, taking MAOI
36
Restrictive Bariatric Surgery
* such as laparoscopic adjustable gastric band (LAGB) or laparoscopic sleeve gastrectomy (LSG) * Limit the amount of food eaten at one time due to dec volume capacity * Weight loss is often regained after a period of time unless the client adheres to stringent weight loss protocols and lifestyle modifications
37
explain the difference b/w LAGB and LSG
* LAGB: involves placement of adjustable band at the proximal portion of the stomach to restrict stomach volume to 10-15 mL * LSG: involves removal of portion of the stomach that secretes ghrelin (hormone that stimulates feelings of hunger) * Up to 85% of stomach is removed
38
vertical banded gastroplasty
* involves creation of new, smaller stomach pouch using staples to dec its functional size
39
malabsorption surgery
* includes Roux en Y gastric bypass (RNYGB) or simply gastric bypass * Interfere with the absorption of food and nutrients from the GI tract * Most maintain 60-70% of weight loss even 20 yrs postprocedure * RNYGB: involves restricting stomach capacity to 20-30 mL * Bypasses the majority of stomach and duodenum * Section of jejunum is anastomosed to smaller section of the stomach, bypassing majority of stomach
40
indications for bariatric surgery
* Diagnosis: hx of morbid obesity w/ unsuccessful attempts at nonsurgical weight loss * Client presentation: BMI greater than 40 or BMI greater than 35 w/ comorbidities
41
preprocedure nursing actions for bariatric surgery
* Express emotions about eating behaviors, weight, and weight loss to identify psychosocial factors related to obesity * Ensure the client understands needed diet and lifestyle changes * Prepare for postop course and potential complications * Arrange for availability of bariatric bed and mechanical lifting device to prevent client/staff injury * Assess pertinent labs: CBC, electrolytes, BUN, creatinine, A1C, iron, B12, thiamine, folate * SCDs
42
postprocedure nursing actions for bariatric surgery
* Monitor for leak of anastomosis: inc back, shoulder, abdominal pain; restlessness; tachycardia; oliguria * Notify provider * Notify provider for suspected NG tube displacement * NG tube is typically sutured in place following stomach surgery * Do not attempt to manipulate the tube * Monitor for development of complications that are at inc risk due to obesity: atelectasis, thromboemboli, skin fold breakdown, incisional hernia, peritonitis * Assess airway and O2 sats * Maintain client in semi Fowler’s position for lung expansion * Monitor for bowel sounds * Apply an abdominal binder as prescribed to prevent dehiscence * Ambulate client ASAP * Resume fluids as prescribed: first fluids can be restricted to 30 mL and inc in frequency and volume * Provide 6 small meals a day when client can resume oral nutrients * Observe for dumping syndrome: cramps, diarrhea, tachycardia, dizziness, fatigue
43
postprocedure client education for bariatric surgery
* Teach client limitations regarding liquids or pureed foods for the first 6 wks as well as the volume that can be consumed (often not to exceed 1 cup * Walk for at least 30 min daily * Teach client that overeating can dilate the surgically created pouch causing weight to be regained * Take vitamins/mineral
44
complications of bariatric surgery
* dehydration * malabsorption/malnutrition
45
dehydration as a complication of bariatric surgery
* Warn client that excessive thirst or conc urine can be an indication of dehydration and the surgeon should be notified * Work with the client to establish goals and schedule for adequate daily fluid intake
46
malabsorption/malnutrition as a complication of bariatric surgery
* b/c bariatric surgeries reduce size of stomach or bypass portions of intestinal tract, fewer nutrients are absorbed/ingested * Nursing actions: * Monitor for tolerance to inc amounts of food/fluids * Dietary management referral * Encourage client to consume meals in low Fowler’s position and to remain in this position for 30 min after eating to delay stomach emptying and minimize dumping syndrome * Client edu: * Eat 2 servings of protein/day * Eat only nutrient dense foods * Avoid empty calories like colas and fruit juice
47
NG decompression
* required if client has an intestinal obstruction * An NG tube is inserted, then suction as applied to relieve abdominal distention * Tx continues until obstruction is removed or resolves * Obstruction can be mechanical (tumors, adhesions, fecal impaction) or functional (paralytic ileus)
48
indications for NG decompression
* Potential dx: any disorder that causes a mechanical or functional obstruction (surgery, trauma, GI tract infection, condition in which peristalsis is absent) * Client Presentation: * Vomiting: begins w/ stomach contents and continues until fecal material is also being regurgitated * Bowel sounds absent (paralytic ileus) or hyperactive/high-pitched (obstruction) * Intermittent, colickly abdominal pain and distention * Hiccups * Abdominal distention
49
postprocedure nursing actions/client edu for NG decompression
* Nursing Actions: * Assess and maintain proper function of NG tube and suction equipment * Maintain accurate I&O * Assess bowel sounds and abdominal girth * Return of flatus * Encourage repositioning and ambulation to help inc peristalsis * Monitor tube for displacement: dec in drainage, inc n/v/distention * Assess labs: electrolytes, Hct * Oral care and care of nares * Client edu: * Maintain NPO status
50
complications of NG decompression
* F&E imbalance: * Nursing actions: * Monitor for F&E imbalance: * metabolic acidosis: low obstruction * Metabolic alkalosis: high obstruction * Monitor I&O * Skin breakdown: assess nasal skin for irritation
51
ostomies
* surgical opening from inside of body to the outside and can be located in many places * Can be permanent or temporary * A stoma is artificial opening created * Types: * Ileostomy: opening into ileum * Frequent, liquid stools * Colostomy: opening into large intestine * Ascending colon: more liquid stools * Transverse colon: more formed stools * Sigmoid colon: near normal stool
52
indications for an ostomy
* Ileostomy: when entire colon must be removed due to dz * Crohn’s dz, UC * Colostomy: when a portion of the bowel must be removed (cancer, ischemic injury), or requires rest for healing (diverticulitis, trauma)
53
preprocedure nursing actions/client edu for an ostomy
* Nursing actions: * Determine client’s readiness: visual acuity, manual dexterity, cognitive status, cultural influences, support system * Referral for wound ostomy nurse * Client edu: * Instruct client and support person about care/mgmt of ostomy
54
postprocedure nursing actions for an ostomy
* Assess type and fit of ostomy appliance * Monitor for leak (which is a risk for skin integrity) * Fit ostomy appliance based on: type/location of ostomy, visual acuity and manual dexterity of client * Assess peristomal skin integrity and appearance of stoma * Should be pink and moist * Apply skin barriers and creams (adhesive paste) to peristomal skin and allow to dry before applying new appliance * Evacuate stoma output: output should be more liquid and more acidic the closer the ostomy is to proximal small intestine * Empty ostomy bag when it is ¼-½ full of drainage * Assess for F&E imbalances (esp with new ileostomy) * Evaluate ability of client to perform care
55
postprocedure client edu for ostomies
* Teach about dietary changes and ostomy appliances that can help manage flatus and odor * Cause odor: fish, eggs, asparagus, garlic, beans, dark green leafy veggies * Help dec odor: buttermilk, cranberry juice, parsley * Cause gas: dark green leafy veggies, beer, carbonated beverages, dairy, corn, chewing gum, skipping meals, smoking * Help dec gas: yogurt, crackers, toast * Instruct the client to avoid high fiber foods for first 2 mos, chew food well, inc fluid intake, and evaluate for evidence of blockage when slowly adding high fiber foods * Proper appliance fit and maintenance prevent odor when ouch is not open * Filters, deodorizers, or a breath mint can minimize odor when pouch is open * Provide time for client to talk about feelings
56
what are the 2 complications of ostomies?
* stomal ischemia/necrosis * intestinal obstruction
57
stomal necrosis/ischemia as a complication of ostomies
* stomal appearance should be pink or red and moist * Signs of stomal ischemia are pale pink or bluish purple color and dry appearance * If stoma appears black or purple in color, indicates impairment of blood flow * Nursing actions: * Obtain V/S, O2 sats, lab results * Client edu: * Watch for stomal necrosis
58
intestinal obstruction as a complication of ostomies
* Nursing actions: * Monitor and record output * Assess for manifestations of obstruction: * Abdominal pain * Hypoactive or absent bowel sounds * Distention * n/v * Client edu: * Note indications of intestinal obstruction
59
compare normal post op output of ileostomy, transverse colostomy, and sigmoid colostomy
* ileostomy: * More than 1000 mL/day * Can be bile colored and liquid * transverse colostomy: * Small semi-liquid w/ some mucus 2-3 days after surgery * Blood can be present in the first few days after surgery * sigmoid colostomy: * Small to moderate amounts of mucus w/ semi-formed stool 4-5 days after surgery
60
compare post op changes in output of ileostomy, transverse colostomy, and sigmoid colostomy
* ileostomy: * After several days to weeks, the output decreases to approx 500-1000 mL/day * Becomes more paste like as the small intestine assumes the absorptive function of the large intestine * transverse colostomy: * After several days to weeks, output becomes more stool-like, semi-formed, or formed * sigmoid colostomy: * After several days to weeks, output resembles semi-formed stool
61
compare pattern of output of ileostomy, transverse colostomy, and sigmoid colostomy
* ileostomy: * constinuous output * transverse colostomy: * resume pattern similar to pre op pattern * sigmoid colostomy: * resume pattern similar to pre op pattern

Adult Health I Test IV (10 decks)

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