Total Parenteral Nutrition
Terms
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- Why would a client need to be given TPN ?
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GI tract is not usable
Severe disease states
Burns
Long or short term nutritional support - How is parenteral nutrition administered?
- intravenously such as through a central venous catheter into the superior vena cava.
- What type of solution is used when giving TPN?
- HYPERTONIC
- What does the parenteral nutrition solution consist of ?
-
glucose
protein hydrolsates
minerals
vitamins - The nurse knows that when using a small -bore tube that.....
- to leave the stylet or guide wire in place until placement is verified by x-ray
- What method for determining tube placement is least effective?
- auscultating the injected air.
- Why is a nasogastric tube taped to the client's nose?
- to avoid irritaion the nostril
- After insertion what does the nurse need to do to the nasogastric tube?
- clamp the end of the tube or hook it up to suction, and pin to clients gown
- What are the ways a nurse can verify tube placement?
-
initial x-ray examination
aspiration of gastric pH
ausculation of injected air
the graduated marks on the tube - Intermittent feeding
-
300-500 ml. several times a day
stomach is the preferred site
administered over 30 minutes - bolus intermittent feedings
-
given by syringe
delivered to the stomach
delivered rapidly
not recommended for long-term situation unless client tolerates them.
client monitored for distention - Continuous feedings
-
administered over 24 hour period
used with a pump
essential for small bowel feedings
used with small-bore gastric tubes or when gravity flow is insufficient to instill the feeding. - What temperature should tube feedings be ?
- room temperature
- Hot feedings can cause ?
- irritate the mucous membrane
- cold feedings can cause?
- cramping
- dumping syndrome
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nausea
vomiting
diarrhea
cramps
pallor
sweating
heart palpitations
increased heart rate
fainting after a feeding - What clients would experience a dumping syndrome?
- jejunostomy
- What causes the "dumping syndrome" in jejunostomy clients?
- results when hypertonic foods and liquids suddenly distend the jejunum. to make the intestinal contents isotonic, body fluids shift rapidly from the client's vascular system
- What should the nurse assess before administering tube feeding?
-
allergies to any food in the feeding.
bowel sounds before q feeding or q4-6 hours for continuous feedings.
correct placement
presence of regurgitation/feelings of fullness.
dumping syndrome
distention
diarrhea,constipation, flatulence
urine for sugar and acetone
hematocrit and urine specific gravity
serum BUN and sodium levels - Why is the hematocrit and urine specific gravity test done on a client receiving a tube feeding?
- both increase as a result of dehydration.
- Serum BUN and sodium levels are monitored in clients receiving tube feedings to assess?
- due to high protein and inadequate fluid intake the test are done to monitor the if the kidneys are able to excrete nitrogenous waste.
- When administering a jejunum or gastrostomy feeding the nurse must first?
-
remove the ostomy dressing
lubricate the feeding tube to be used
insert the tube 10-15cm or 4-6 cm.
or check the patency of a tube that is in place and determine placement. - common complications of enteral feedings?
-
aspiration
hyperglycemia
abdominal distention
diarrhea
fecal impaction - small bore tubes
-
silicone rubber feeding tube
decreases irritation to nose and throat
more difficult to insert
prevent regurgitation: less chance of aspiration. - gastric sump pump
- 2nd lumen to provide air vent
- Duo tube the nurse should assess for
-
nausea
vomiting
distention
pain - Ewald tube
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very large lumen 26-30 lumen
used for lavage- OD or other poisonous agents.
also used for diagnostic purposes - Canter tube and Baker tube
-
long single lumen rubber tube with a rubber bag attached to its distal tip.
contains 30ml. of mercury in the bag
usually inserted by a physician - Miller-Abbot Tube
-
long, double lumen rubber tube
inserted as NGT and the bag is inflated
used for a small bowel obstruction
both lumen openings must be clearly marked. - Reason for tube feeding obstructions
-
formulas w. large molecular size
re feeding partially digested gastric residual.
formula rates less than 50ml.hour
instilling crushed or hydorphilic medications into tube.
not flushing before/after feedings or medications - major danger of continuous tube feedings.
- aspiration