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32 Cards in this Set
- Front
- Back
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What is TPN
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IV delivery of nutritional hypertonic soln
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Indications for TPN
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Chronic diarrhea/vomitting
complicated surgery/trauma GI obstruction GI anomalies/fistulae hypermetabolic state (sepsis) malnourished pancreatitis |
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#1 nursing diagnosis with TPN?
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risk for infection
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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 |
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Preparation of TPN
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-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 |
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Complications of TPN
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-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) |
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Composition of TPN
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base soln = dextrose 25%
amino acids fat emulsion electrolytes sometimes others -each bottle individually made |
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Gastric Sump "Salem Sump"
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use: decompress stomach
-pigtail used to vent - keep above pt waist -inject air after use/ irrigation |
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Medium tubes
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J-tubes
use: enteral feeds |
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Harris Tube
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use: suction/irrigation
mercury weighted, Y tube outside |
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Cantor tube
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larger, has mercury wt
-ends at duodenum (check w/ flouroscopy) |
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Insertion of tubes: nasogastric
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-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 |
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intestinal tube insertion
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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 |
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care of tubes
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-provide oral/nasal hygeine
-cotton swabs -monitor output of NG tube (minus irrigation soln) |
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Complications of tube feedings
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-fluid vol deficit
-pulmonary -monitor glucose levels -monitor wt (AM) -irritation of mucus membranes |
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Contraindications of tube feedings
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-ileus or hypomotility
-severe diarrhea - high output fistula -acute pancreatitis |
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PEG tubes
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- radiologically placed
- fewer risks, lower cost, less sedation needed |
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Tube feeding: nursing care
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-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 |
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TMJ/TMD
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misalignment of jaw, clicking, pain radiates
surgery to fix: jaw wired; NG tube to prev vomitting liquid diet |
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Oral cancer: esophagel d/os
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-dysphagia
-achalasia: diff. swallowing, failure to relax. Dx barium swallow |
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Cancer of oral cavity
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Bx suspicious lesion lasting 2 weeks
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GERD s/s
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dyspepsia, dysphagia, regurg, adynophagia (painful swallowing), esophagitis, hypersalivation
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GERD tx
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med: reglan
diet: low fat, high fiber. surgery: fundoplication *risk of aspiration |
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GERD management
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diet restricions
no eating 2 hr before sleep lose wt if obese lifestyle: no smoking/alcohol |
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Hiatal hernia s/s
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like GERD
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Hiatal hernia management/tx
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diet: sm freq meals, low fat, high protein
lifestyle: risk of aspiration; watch amt of antacids Tx same as for GERD; surgery last resort |
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Neck dissection
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r/t cancer
removal of cervical nodes *post-op airway #1 |
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Neck dissection nursing care
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-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 |
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BMI
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25-29.9 overweight
30< obese 40< severely obese |
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anorexia labs
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increased BUN, iron def, anemia, hypokalemia
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INH (med)
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avoid cheese (swiss), fish (tuna), tyramine, sweating, chills, lightheadedness
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coumadin
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avoid vit K (green tea, green leafy veg, dairy)
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