TPN + pancreatitis

Question 1

What is the difference between Enteral Nutrition and Parenteral Nutrition?

Answer 1

Enternal= into GI tract
Parenteral= outside the GI, directly into a vein

Question 2

What is the difference between peripherally infused parenteral nutrition(PPN) and TPN?

Answer 2

PPN is used for short-term, transitional nutrition
TPN is used for the long term and meets larger caloric nutrition needs

Question 3

What are the criteria for using TPN?

Answer 3

Loos weight
wasting of muscles
GI rest for more than 5 days
GI bleeding
Vomiting
surgery
cancer
burns

Question 4

How to prepar for TPN?

Answer 4

TPN orders are written daily(based on lab value)
Prepared by a pharmacist
Under a sterile technique

Question 5

How to deliver?

Answer 5

-second nurse to verify
-always use an infusion pump
-check a solution for cracking
-infusion immediately or refrigerate but take out for an hour to room temp
-lipid hung below
-never speed up the rate
-if the infusion is complete before the next TPN, may hang D10 prevents hypoglysemia

Question 6

Nursing management

a) monitor what values?
b) assess what things?

Answer 6

a) daily weight
daily electrolytes
blood sugar
b) catheter site every shift
change bag and tubing/ 24 hr
bowel sounds
fluid volume overload
respiratory distress (embolism)

Question 7

Complications/ infections

Answer 7

-change bag and tubing every 24hr
-chlorhexidine for cleaning
-sterile technique for a dressing change
-dressing change every 4 days
-use biopatch(not gauze)
-flush the TPN lumen when bag change
-flush lumen in not use every shift

Question 8

Complications
during insertion

Answer 8

pneumothorax
hemothorax
arrhythmia

Question 9

Transtion from TPN to PO

Answer 9

gradualy process
provider will gradually decrease rates and infusion
hyperinsulinemia
hypoglycemia

Question 10

a) What patient assessments are necessary prior to starting TPN?
b) What IV Fluid is more suitable for replacing an empty TPN bag?
c) What are the reasons for a sluggish flow?

Answer 10

a) weight, all electrolyte levels, lung sounds
b) 10% dextrose
c)

Question 11

3 enzymes that pancreas produce

Answer 11

Protease-protein
Lipase-fat
Amylase-carb
and insuline

Question 12

a) What is pancreatitis?
b) Risk factor?

Answer 12

a) progressive, continuous,irreversible damage
cell replaced with fibrotic tissue
systemic lupus erythematosus

b) Alcohol abuse!!
obstruction(gallstones, tumor,trauma)
inflammation of sphincter of oddi

Question 13

Pancreatitis
Pain

Answer 13

Pain in LUQ may radiate to the back
Heavy, gnawing feeling, burning, cramp
Sudden onset, or large meal or alcohol
Pain not relive by vomiting
onset may occur when recumbent(lay down)

Question 14

Pancreatitis
manifestations
other than pain

Answer 14

-Hypocalcemia d/t increase lipid in blood
-Malabsorption w/ weight loss
-Constipation
-Mild jaundice w/dark urine
-forthy urine
-steatorrhea(increase in fat excretion in the stools)
foul-smelling, fatty stool
-DM
-abdominal tenderness

Question 15

Endoscopic cholonagio
Pancreatography
a) Pre
b) Post

Answer 15

a) NPO
sedation
b)Gag reflex
Normal diet
Stool softner

Question 16

Intervention
acute exacerbation

Answer 16

NPO
NG tube(vomiting,pancreas rest)
Antibiotic
Nutrition support(enteral/parental nutrition)

Question 17

Medications

Answer 17

pancreas enzymes replacement
pancreas,zenpap,creon
Take with all meals and snacks
DO not crush or chew tablet
Check for steatprrhea(determined to effectiveness)

Question 18

Education

Answer 18

-low fat, high carb, high protein
-small frequent meals
-vitamin supplements(prevent further fat loss)
-No alcohol, spicy food, strong odor, coffee
-take replacement enzyme with meals and snacks
-monitor stools for fat to determine effectivness of pancreatic enzyme

Question 19

Complications

Answer 19

Pseudocyst formation
Bile duct or duodenal obstruction
Pancreatic ascites
Pleural effusion
Splenic vein thrombosis
Pancreatic cancer

Question 20

A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient’s plan of care?
a) Immediately start enteral feeding to prevent malnutrition.
b) Insert an NG and maintain NPO status to allow pancreas to rest.
c )Initiate early prophylactic antibiotic therapy to prevent infection.
d) Administer acetaminophen (Tylenol) every 4 hours for pain relief.

Answer 20

b
Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal.
Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status.
Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

Question 21

A nurse is reviewing the admission lab results of a pt who has acute pancreatitis. Which of the following findings should the nurse expect?
a) Decreased blood lipase level
b) Decreased blood amylase level
c) Decreased blood calcium levels
d) Increased blood glucose level

Answer 21

d
d/t pancreatic cell injury, which decreased in the release insulin.

Question 22

A nurse is preparing to administer pancrelipase to a pt who has pancreatitis. Which of the following actions should the nurse take?
a) Instruct the pt to chew the med before swallowing
b) Offer a glass of water following med administration
c) Administer the med 30 min before meals
d) Sprinkle the contents on peanut butter

Answer 22

b

Question 23

A nurse is completing an admission assessment of a pt who has pancreatitis. Which of the following findings should the nurse expect?
a) pain in the right upper quadrant radiating to right shoulder
b) report of pain being worse when sitting uprights
c) pain relieved with defecation
d) epigastric pain radiating to the left shoulder

Answer 23

d
will have severe burning epigastric pain that radiates to the back, left flank or left shoulder
being worse when lying down
c-relieved pain by fetal position
defeaction 排便

Question 24

A nurse is assessing a pt who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis?
a) generalized cyanosis
b) hyperactive bowel sounds
c) gray-blue discoloration of the skin around the umbilicus
d) wheezing in the lower lung field

Answer 24

c
cullen’s sing
a-jaundice
b-absent or decreased bowel sounds
d-diminished breath sounds,dyspnea,orthopnea

Question 25

A nurse is completing nutrition teaching for a pt who has pancreatitis. Which of the following statements by the pt indicates an understanding of the teaching? SATA
a) I plan to eat small,frequent meals
b) I Will eat easy-to-digest foods with limited spice
c) I will use skim milk when cooking
d) I plan to drink regular cola
e) I will limit alcohol intake to two drinks per day

Answer 25

a,b,c
c-low fat food is recommended
d-should be caffeine free
e-should ZERO alcohol