TPN, NG tubes, Colostomy, catheter, trach, hypoxia Flashcards
when is parental nutrition used?
when GI system is not functioning or when client can’t consume enough calories orally
what is TPN
it provide complete nutrition and is also used when caloric needs are very high
anticipated duration of therapy is greater then 7 days
solution is hypertonic (10% dextrose)
where can TPN be administered?
in a central vein
what is PPN
nutritionally complete solution
there is limited nutritional value because it is administered into peripheral vein
short term nutritional therapy and fewer calories
the solution is isotonic (less than 10% dextrose)
what are the different components of parenteral nutrition solutions?
amino acids
dextrose (10 - 50%)
electrolytes
vitamins and trace minerals
is PN medical or surgical asepsis?
surgical asepsis
what condition would a higher concentration of dextrose be prescribed for?
client of fluid restrictions
what condition is controlled through a lower-dextrose concentration
hyperglycemia
what vitamin can be added to a PN solution
K
how are lipids added to PN?
- piggy back
- given intermittently
why would additional piggybacks in PN solution be contraindicated?
hyperlipidemia
hepatic disease
allergy to soybean oil, eggs or safflower oil
what does lipid emulsion provide for PN
- needed calories when the dextrose concentration has to be decreased due to fluid restrictions
- increases calories w/o increasing osmolality
what should the nurse evaluate before starting PN?
weight BMI nutritional status diagnosis lab tests education over PN
why is an electronic infusion device used with PN?
accidental overload of a solution
what should the nurse constantly assess throughout PN therapy?
I & O daily weight vital signs labs evaluation of underlining conditions
intervention for hyperglycemia on PN
insulin (following glucose check)
should you increase the flow rate for PN to catch up?
No
what can a rapid administration cause?
dehydration hypovolemic shock seizures coma death
how often should the PN bag and tubing be changed
every 24 hours
what is cracking of a TPN solution? can you still administer this solution?
if the Ca or Phosphorous content is too high
there is a layer of fat on top of the solution
NO - do not administer
complications from PN therapy include what?
infection and sepsis
metabolic complications
mechanical complications of the actual placement of the tube
what are different metabolic complications from TPN?
hyperglycemia, kalemia
hypoglycemia, phosphatemia, calcemia, albuminemia
dehydration
fluid overload
what are different mechanical complications from TPN?
catheter misplacement pneumothorax subclavian artery puncture catheter embolus air embolus
how should PN be discontinued?
gradually
when should PN be discontinued?
asap to avoid complications
not until clients oral intake is 60% or more of estimated caloric requirement
Indication for GI intubation
- To decompress the stomach and remove gas and fluid
- To lavage the stomach and remove ingested toxins
- to diagnose disorders of GI motility and other disorders
- To administer medications and feedings
- to treat an obstruction
- to compress a bleeding site
- to aspirate gastric contents
Assessing who needs a GI tube
- surgical pts
- ventilated pts
- neuromuscular impairment
- pts who are unable to maintain adequate oral intake to meet metabolic demands
Assessment for GI placement
assess
- gag reflex
- mental status
- bowel sounds
- medical hx (nosebleeds, nasal surgery, deviated septum, anticoagulation therapy)
Critical aspects of NG, NE placement
- pt in sitting or high-Fowler’s
- Measure tube (nose, ear, xiphoid) +8-10 cm for NE
- Lube (water-soluble)
- Hyperextend neck
- Insert tube
- Tuck neck, drink water, swallow
- Confirm placement!!
- Tape in place
Critical aspects of NG tube removal
- pt in sitting or high-Fowler’s
- Clear tube of secretions by injecting 10 mL of air
- have pt hold breath
- discard :)
What are the relative pH for gastric and intestinal contents?
- gastric greenish-brown pH 1 - 4 (up to 6 w/antacids)
- intestinal yellow-green pH 4 - 7.0
What you monitor when pt receiving enteral nutrition?
- tube placement
- skin condition
- blood glucose
- BUN
- electrolytes
How do you check placement of NG tube?
- radiographic verification (chest x-ray)
- aspiration of stomach contents
- Measuring of pH of the aspirate
- injecting air into the feeding tube
If unable to aspirate…
- advance tube in case it’s above fluid level
- If intestinal placement withdraw 5-10cm
- Have pt lie on left side, wait 10-15min, attempt again
What are the s&s of hypoxia
- dyspnea
- tachypnea
- pallor
- cyanosis of the nails, lips or skin
- confusion
- restlessness
- apprehension
- dizzyness
- fatigue
- decreased LOC
- tachycardia
- changes in BP
Common causes of hypoxia
- Hypoventilation
- decreased Hgb
- decreased inspired O2 concentrations
Interventions for hypoxia
- sit pt up, orthopneic position
- deep breathing
- incentive spirometry
- abdominal or diaphragmatic breathing
what are the s&s of central cyanosis?
-observed in the tongue oral mucosa conjunctiva of the eye around the lips
what are the characteristics of normal bowel sounds
high-pitched
5-35 gurgles every minute
What are the characteristics of hyperactive bowel sounds?
very high-pitched
more frequent than normal
What are the characteristics of hypoactive bowel sounds?
low-pitched
infrequent noises
quiet
indicates decreased peristalsis
How long must bowel sounds be absent before you can determine absence?
3-5 minutes
What type of foods that increase peristalsis?
High fiber foods (25-30g fiber/day) yogurt (bacteria) fruits vegetables legumes whole-grains spicy foods (sometimes) WATER
What types of foods slow peristalsis?
carbohydrates lean meats simple sugars carbonated beverages processed foods (salt) low-fiber foods
How do supplements affect peristalsis?
Vitamin C - softens stool
Calcium - causes constipation
magnesium - loosens stool
s&s of paralytic ileaus
- persistent abdominal pain
- cramping
- firm, distended abdomen
- absent bowel sounds
- failure to pass flatus
- abdominal x-ray shows distention
prevention of paralytic ileus
- increase activity as soon as tolerated
- take precaution to prevent hypokalemia
- maintain adequate tissue perfusion
- administer gastrointestinal stimulants if ordered
treatment of paralytic ileus
withhold all oral intake
insert NG tube and maintain suction as ordered.
foods that may cause gas or odor
asparagus cabbage beans broccoli cauliflower radishes brussel sprouts peas melons carbonated beverages beer eggs fish garlic nions
foods that may help control odor or gas
yogurt
parsley
cranberry juice
buttermilk
High-fiber foods that may cause blockage
raw or minimally cooked veggies/fruit stringy foods (celery) foods w/ tough skins or membranes (like citrus) foods with seeds mushrooms nuts shrimp lobster
foods that may cause loose stools
fried foods highly seasoned foods beer raw fruits and veggies onions licorice baked beans larged meals milk chocolate caffeine
foods that may alleviate diarrhea
bananas applesauce cheese creamy peanut butter starchy foods
