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32 Cards in this Set

  • Front
  • Back
What is TPN
IV delivery of nutritional hypertonic soln
Indications for TPN
Chronic diarrhea/vomitting
complicated surgery/trauma
GI obstruction
GI anomalies/fistulae
hypermetabolic state (sepsis)
malnourished
pancreatitis
#1 nursing diagnosis with TPN?
risk for infection
How is TPN administered?
(line? if you infuse too fast? stop too fast?)
PICC line, peripheral
central line - long term
both superior to vena cava
infuse too fast = inc temp, N/V
stop too fast = hypoglycemia
Preparation of TPN
-by pharmacist/trained tech
-aseptic
-nothing added after prep by pharmacy
-Isotonic IV verified by xray
-site covered by sterile dressing
-only good for 24 hr
**must be on pump, check q4hr
-min calorie = 1200-1500/day
Complications of TPN
-hyperglycemia, hypoglycemia, hyperosmolar/hyperglycemic state (r/t glucose in TPN)
-Essential fatty acid deficiency (hyperlipidemia)
-prerenal azotemia (uremia, waste in blood)
-line sepsis
-air embolus
-GI complication
-fatty liver (inc LFTs)
Composition of TPN
base soln = dextrose 25%
amino acids
fat emulsion
electrolytes
sometimes others
-each bottle individually made
Gastric Sump "Salem Sump"
use: decompress stomach
-pigtail used to vent - keep above pt waist
-inject air after use/ irrigation
Medium tubes
J-tubes
use: enteral feeds
Harris Tube
use: suction/irrigation
mercury weighted, Y tube outside
Cantor tube
larger, has mercury wt
-ends at duodenum (check w/ flouroscopy)
Insertion of tubes: nasogastric
-pt sit upright
-measure length
-lube tube
-breath thru mouth
-x ray before starting feedings or aspirate (ph 0-4)
-secure tube
-check placement q shift
intestinal tube insertion
NO tape
pt lies on rt side then left side in 2 hr rotation

if around the clock, use pump

meds ok in enteral tube if you dilute in H2O
care of tubes
-provide oral/nasal hygeine
-cotton swabs
-monitor output of NG tube (minus irrigation soln)
Complications of tube feedings
-fluid vol deficit
-pulmonary
-monitor glucose levels
-monitor wt (AM)
-irritation of mucus membranes
Contraindications of tube feedings
-ileus or hypomotility
-severe diarrhea
- high output fistula
-acute pancreatitis
PEG tubes
- radiologically placed
- fewer risks, lower cost, less sedation needed
Tube feeding: nursing care
-replace q4hr hanging
-store room temp
-pt wt
-HOB up
-watch labs
-irrigate 30-50ml saline before/after meds
-1 ml food, 2 ml water
TMJ/TMD
misalignment of jaw, clicking, pain radiates

surgery to fix: jaw wired; NG tube to prev vomitting

liquid diet
Oral cancer: esophagel d/os
-dysphagia
-achalasia: diff. swallowing, failure to relax. Dx barium swallow
Cancer of oral cavity
Bx suspicious lesion lasting 2 weeks
GERD s/s
dyspepsia, dysphagia, regurg, adynophagia (painful swallowing), esophagitis, hypersalivation
GERD tx
med: reglan
diet: low fat, high fiber.
surgery: fundoplication *risk of aspiration
GERD management
diet restricions
no eating 2 hr before sleep
lose wt if obese
lifestyle: no smoking/alcohol
Hiatal hernia s/s
like GERD
Hiatal hernia management/tx
diet: sm freq meals, low fat, high protein
lifestyle: risk of aspiration; watch amt of antacids
Tx same as for GERD; surgery last resort
Neck dissection
r/t cancer
removal of cervical nodes
*post-op airway #1
Neck dissection nursing care
-auscultate trachea (stridor/noisy?)
-JP drain, must be deflated
-they get TPN usually
-possible nerve injury
-incl facial/cranial nerves
-NO valsalva
-pressure packs bedside (stop bleeding)
-ruptured carotid = tachypnic, low BP
BMI
25-29.9 overweight
30< obese
40< severely obese
anorexia labs
increased BUN, iron def, anemia, hypokalemia
INH (med)
avoid cheese (swiss), fish (tuna), tyramine, sweating, chills, lightheadedness
coumadin
avoid vit K (green tea, green leafy veg, dairy)