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MED SURG > TOPIC 7 - parenteral and enteral feeding > Flashcards

TOPIC 7 - parenteral and enteral feeding Flashcards

1
Q

enteral feedings are given to patients who

A

are unable to maintain or achieve adequate nutritional status

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2
Q

enteral feeding is administered through

A

a tube inserted into the stomach, duodenum, or jejunum in a balanced liquefied food

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3
Q

indications for enteral nutriton

A

patients who have a condition that impacts swallow ability, anorexia, facial fractures, head/neck cancer, neurologic or psychiatric conditions, chemo, critical illness, stroke

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4
Q

tube features for enteral nutrition

A

polyurethane or silicone tube
soft, flexible, radiopaque, placed in small intestine, decreased likelihood for regurgitation and aspiration

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5
Q

what is the benefit of placement into the small intestine

A

intestine decreases the chance of regurgitating gastric contents into the esophagus and subsequent aspiration. However, the patient can still aspirate gastric secretions if the stomach is not emptying properly

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6
Q

when is a stylet used

A

in a comatose patient because the ability to swallow is not essential during insertion. A complication that can result from using a stylet is increased risk for perforation

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7
Q

complications of nasogastric and nasointestinal tubes

A

clog easily, can be dislodged by vomiting or coughing, can be knotted or kinked in GI tract

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8
Q

gastrostomy and jejunostomy tubes (PEG( may be used for patients

A

who require tube feedings for an extended time

patient must have intact, unobstructed GI tract

can be placed surgically, radiologically, or endoscopically

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9
Q

placement of PEG tube

A

Using endoscopy, a gastrostomy tube is inserted through the esophagus into the stomach and then is pulled through a stab wound made in the abdominal wall. a retention disk and bumper then secure the tube

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10
Q

delivery options of enteral nutrition

A

continuous infusion by pump, cyclic feedings by pump, intermittent by gravity, intermittent by bolus by syringe

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11
Q

when are enteral feedings started

A

when bowel sounds are present, usually 24 hours after placement

PEG tubes are started 2 hours after insertion

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12
Q

interventions for preventing aspiration risk

A

ensure proper position of tube, maintain head of bed elevation, check gastric residual volume

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13
Q

client position for enteral feedings

A

sitting or lying with HOB at 30-45 degrees, remain elevated for 30-60 minutes for intermittent delivery

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14
Q

confirming tube placement

A

mark exit site of tube (observe for change in length)
check placement before each feeding/drug admin or every 8 hours with continuous feeds
check insertion length regularly

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15
Q

methods to check placement

A

aspiration of stomach contents
pH <5
xray

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16
Q

when to check GRV

A

every 4 hours during first 48 hours

increased volume leads to aspiration

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17
Q

site care

A

assess the skin around the tube daily

monitor bumper tension

apply a dressing until site is healed

after healed, wash with soap and water and protective ointment or skin barrier

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18
Q

why is skin at risk around gastrostomy and jejunostomy tubes

A

digestive juice irritates skin

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19
Q

protective ointments and skin barriers

A

zinc oxide, petroleum gauze, karava, stomahesive

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20
Q

checking tube patency

A

flush with 30ml water before and after each feeding, drug admin, and residual check

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21
Q

preventative measure for continuous feedings

A

occlusion alarm

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22
Q

misconnection

A

SAFETY ALERT
inadvertent connection between enteral feeding and nonenteral feeding system

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23
Q

admin of feedings pump vs intermittent

A

pump: gradually increase over 24-48 hrs
intermittent: usually 200-500 mL per feed

24
Q

nursing considerations

A

daily weights, assess bowel sounds, I+O, initial glucose checks, label with data and time started

25
Q

how often is pump tubing changed

A

every 24 hours

26
Q

complications of enteral nutrition

A

vomiting, dehydration, diarrhea, constipation

27
Q

potential problems of gastrostomy or jejunostomy feedings

A

skin irritation
pulling out of tube

28
Q

parenteral nutrition administers …

A

directly into the bloodstream

29
Q

minimum caloric intake

A

1200-1500 a day

30
Q

parenteral nutrition indications

A

chronic severe diarrhea and vomiting, complicated surgery or trauma, GI obstruction, intractable diarrhea, severe anorexic, severe malabsorption, short bowel syndrome, GI tract abnormalities

used when ingestion, digestion, and absorption is impaired

31
Q

composition of parenteral nutrition

A

base contains dextrose and protein in the form of amino acids
electrolytes, vitamins, and trace elements
IV fat emulsion is added

32
Q

trace elements

A

Zinc, copper, chromium, manganese, selenium, molybdenum, and iodine

33
Q

fat emulsion side effects

A

vomiting, shivering, fever, chills

34
Q

lipids should be cautioned in patients with

A

disturbance in fat metabolism, in danger of fat embolism, allergy to eggs

35
Q

methods of parenteral administration

A

central - used for long term support
peripheral - used for short term therapy

36
Q

central parenteral nutrition

A

catheter tip lies in SVC
subclavian or jugular vein
PICCs

37
Q

peripheral parenteral nutrition indications

A

protein and caloric deficiency
risk of central catheter is too great
supplement inadequate oral intake

38
Q

difference in peripheral vs central tonicity

A

central : large vein can handle high tonicity (20-50%)
peripheral : up to 20%

39
Q

solutions administered to prevent hypoglycemia

A

10, 20, or 5% dextrose solution

used when a PN bag empties before the next solution is available

40
Q

complications of PN

A

refeeding syndrome : fluid retention and electrolyte imbalance
hypophosphatemia

41
Q

conditions that predispose patients refeeding syndrome

A

long standing malnutrition, chronic alcoholism, N/V/D, chemo, major surgery

42
Q

metabolic problems of PN

A

Hyperglycemia, hypoglycemia, prerenal azotemia, fatty acid deficiency, electrolyte disturbances, hyperlipidemia, mineral deficiencies

43
Q

mechanical problems of PN

A

insertion problems
dislodgment, thrombosis of great vein, phlebitis

44
Q

nursing management of PN

A

vitals every 4-8 hours, daily weights, glucose checks every 4-6 hours, monitor for hyper or hypoglycemia

45
Q

signs and symptoms of hyperglycemia

A

thirst, polyuria, confusion, elevated BS, blurred vision, dizziness, N/V, and dehydration

46
Q

signs and symptoms of hypoglycemia

A

sweating, hunger, weakness, tremors

47
Q

maintain glucose :

A

110-150

48
Q

management of increased glucose

A

maintain accurate infusion rate, never increase or decrease flow rate by more than 10%, never stop PN abruptly unless it is replaced by another glucose source, infusion pump must be used, need to periodically check volume infused

49
Q

labs to monitor daily

A

hyper or hypokalemia, hypophosphatemia, hypomagnesemia, BUN, CBC, liver enzymes

50
Q

air embolus

A

difficulty breathing or respiratory failure, chest pain, heart failure, stroke, pneumothorax, hemothorax, hydrothorax, hemorrhage

51
Q

main symptoms of air embolus

A

SOB and cyanosis

52
Q

local vs systemic manifestations of infection and septicemia

A

local : erythema, tenderness, exudate at catheter insertion site
systemic : fever, chills, nausea, vomiting, malaise

53
Q

if no other cause of infection can be identified what is suspected

A

catheter related infection

54
Q

diagnostics for infection status

A

blood and catheter cultures
xray : to check pulmonary status

55
Q

what caloric intake should be met before discontinuation

A

60% caloric needs

MED SURG (30 decks)

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