Parenteral Nutrition/tube Feeding

Front 1

why a tube
brunner

Back 1

decompression of the stomache by removing gas and fluid.
to lavage: flush with water or other fluids
to diagnose gi motility and other disorders
to administer medications and feedings
to compress a bleeding site
to aspirate gastric content for analysis

Front 2

why a tube pp

Back 2

decompress, daignose, aspirate/lavage, treatment, meds and feeding

Front 3

types of tube: NG tube levin/sump

Back 3

goes from the nose down into the stomach, single lumen, low intermittent suction to avoid erosion or tearing of the stomache linin,

Front 4

NG TUBE

Back 4

nose through to the stomache, often before or during surgery or at the bedside. NG tubes may be used to administer meds for up to 4 weeks, give feedings or remove fluid and gas from the upper g.i. tract. -levin and gastric sump

Front 5

gastric sump-

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radioopaque tube, ng tube, has a blue port that vents the larger suction drainage tube, low suction, suction lumen is irrigated as prescribed to maintain patency, blue vent should be kept above the patients waist to prevent reflux of gastric content

Front 6

to remove fluid and gas from the upper g.i. tract

Back 6

decompression

Front 7

all purpose feedings

Back 7

ensure 470, jevity 310 and osmolite 300 mOsm/kg

Front 8

high calorie feeds

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ensure plus 600 mOs/kg Magnical 590 mOs/kg

Front 9

high nitrogen

Back 9

ensure hn and osmolite hn

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special needs

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Pulmocare-copd, cystic fibrosis or resp. failure
Glucerna-diabetes
Nepro-dialysis
Suplena-reduced kidney function-low protein

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complications of tube feeding

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diarrhea, distention, infection,irritation, aspiration, nausea,fluid overload, clogged tube, constipation and anxiety

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nursing consideration

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correct tube insertion, check proper placement, monitor, managing and comfort

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to correct proper placement

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xray, ph, auscultation and aspiration

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total parenteral nutrition

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amino acids/dextrose and fats, total nutrient admixture

Front 15

routes of tpn

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parenteral/central

Front 16

xray

Back 16

most accurrate method to verify tube placement,
costly,

Front 17

measuring length of tube-placement assesment

Back 17

ease of use-only indicates changes in position not location

Front 18

gastric ph

Back 18

1-5

Front 19

intestinal ph

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6-7

Front 20

nursing considerations for tpn

Back 20

assess
infection
sepsis,
clotted lines
air embolism
hyper/hypoglycemia

Front 21

indications for parenteral nutrition

Back 21

the inability to ingest adequate oral food or fluids within 7 days.

Front 22

assessment of tube

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each shift nurse measures length
visual assessment of aspirate color
ph of aspirate
air auscultation

Front 23

aspirate color of stomache content

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gloudy and green, tan, off white or brown

Front 24

intestinal aspirate is

Back 24

clear and yellow to bile colored

Front 25

clearing tube obstruction

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digestive enzymes mixed with sodium bicarb, endoscopic or cytology brushes

Front 26

feeding tube is irrigated

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every 4 to 6 hours

Front 27

monitoring potential complications

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fvd-dry leathery skin and mucus membranes, decreased urinary output, measure i/o's emesis, ng drainage and diarrhea

Front 28

assesment

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auscultation of lung sounds and monitor vital signs

Front 29

before removing the tube the nurse

Back 29

may intermittently clamp it for a trial period of several hours to ensure the patient does not experience nausea vomiting or distention

Front 30

dumping syndrome

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patient has a feeling of fullness, nausea, diarrhea, causing dehydration, hypotension, tachycardia

Front 31

polymeric formulas are

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protein, carbohdrtes and fats in a high molecular weight form.

Front 32

chemically define formulas

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earsier to absorb nutrients.

Front 33

tube feeding is detemined by

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location of the tube in the gi tract, patient tolerance, convenience and cost.

Front 34

bolus feedingcna be administered

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by gravity inot the stomach, through a large syringe, bolus of 300-500 ml mequire 10-15 minutes to complete

Front 35

raising or lowering the syringe above the abdominal wall

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regulate the rate flow.

Front 36

amount given is determined by

Back 36

the patients reactions. patient feels full, it may be desirable to give smaller amount more frequentlyly

Front 37

the intermittent gravity drip

Back 37

requireds administering feeding over 30 minutes at designated intervals. This method is commonly used when pt. is at home.

Front 38

continuous feeding

Back 38

is the delivery of feeding incrementally over long periods. it is assoc. with reduced rates of aspiration, distention, nausea,vomiting and diarrhea.

Front 39

continuous feeding

Back 39

is the delivery of feeding incrementally over long periods.

Front 40

associated with reduced rate of aspiration, distention, nausea, vomiting and diarrhea.

Back 40

continuous feeding

Front 41

continuous feeding

Back 41

is typically administered inot the small intestine

Front 42

feeding rates vary according to

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the caloric density of the formula and the energy needs of the patient.

Front 43

the overall goal of feeding is to

Back 43

achieve a positive nitrogen balance and weight maintenance or gain without producing discomfort or diarrhea.

Front 44

cyclic feeding

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is when the infused feeding is given over 8-18 hours.

Front 45

cyclic feeding may be infused at night

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to avoid interuptting the patients lifestyle

Front 46

bolus

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a feeding administered into the somach in large amounts and at various intervals

Front 47

central venous access device

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a device designed and used for long term administration of meds and fluids into central veins

Front 48

periodic infusion of feeding given over a short period

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8-18 hours

Front 49

rapid emptyng of the stomach contents inot the small intestine causing sweating weakness and diarrhea.

Back 49

dumping syndrome

Front 50

duodenum

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the first part of the small intestine, which arises from the pylorus of the stomach and extends to the jejunum

Front 51

nutritional formula feedings introducedj through a tube directly into the gi tract

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enteral nutrition

Front 52

surgical creation of an opening into the stomach for the purpose of aministering foods and fluids

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gastrostomy

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an oil in water emulsion of oils, egg phospholipids and glycerin

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intravenous fat emulsion

Front 54

2nd part of the small intestine which extends from the duodenum to the ileum

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jejunum

Front 55

flushing the stomach with water or other fluids with a gastic tube to clear it

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lavage

Front 56

oragastric

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wide bore tube inserted through the mouth to get rid of gastric content

Front 57

senstaken blakemore tube

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is used to treat bleeding esophogeal varices

Front 58

nasoenteric tubesw

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nasally interted feeding tubes placed in the duodenum

Front 59

labs to monitor with ng tube

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bun and creatinine, 24 hour fluid balance, reports negative fluid balance, output greater than intake, increased ng out put .

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condition requiring enteral therapy

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preop bowel prep. gi problems (fistula, short bowel syndrome, mild pancreatitis, crohn's disease, ulcerative colitis, non specific maldigestion or malabsorptio, radiation, chemo, surgery, injury severe illness, stroke head injury, neurologic disorder neoplasm, burns, trauma, multiple fractures, sepsis, aids, organ transplant, chronic illness, psychiatric or neurologic disorder, face, orthopharyngeal trauma, resp failure.

Front 61

signs and symptoms of ng tube complications

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coughing during admin of foods or meds, difficulty cleaing the airway, tachypnea, and fever.

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nasoduodenal or nasojejunal feeding

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is indicated when the esophagus and stomach need to be bypassed or the patient is at risk for aspiration

Front 63

to ensure patency and to decrease the chance of bacterial growth, crusting or occlusion of the tube at least 30-50 ml of water or normal saline is administered in each of the following instances

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before and after each dose of medication and tube feeding, after checking for gastric residuals and gastric ph, every 4-6 hours with continuous feedings, if the tube feeding is dicontinued or interrupted for any reason. when the tube is not being used where a minimum of twice daily flushing is recommended.

Front 64

if excessive residual volumes more than 200 ml occur twice

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the nurse notifies the physician

Front 65

the tube is flushed with 30-50 ml of water

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after medication administration, and is recorded as intake.

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an open system

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is packaged as a liquid or powder to be mixed with water

Front 67

in the open system the feeding container

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is hung on a pole and the tubing with the open system is changed every 24 hours

Front 68

to avoid bacterial contamination

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the amount of feeding formula in the bag should never exceed what should be infused in a 4 hour period.

Front 69

closed delivery system

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used a prefilled sterile container that is spiked with enteral tubing

Front 70

stool with enteral feeding

Back 70

is expected to be pasty an unformed.

Front 71

possible causes of diarrhea

Back 71

malnutrition
medication therapy
c-diff
dumping syndrome

Front 72

aspiration pneumonia

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occurs when regurgitated stomach contentor enteral feedings from an improperly position feeding are instiled inot the pharynx or the trachea or when oral secretions are aspirated

Front 73

preventing aspiration

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feeding tubes placed beyond the pylorus, the pts. head should be elevated to 30-45 degrees. the position should be maintained atleast an hour after completion of intermittent tube feeding and is maintained for all times for patients recieving continuous feeding

Front 74

causes of diarrhea

Back 74

hyperosmolar feedings
rapid infusion/bolus feedings
cold formula
medications especially antibiotics

Front 75

therapuetic and preventive intervention for diarrhea

Back 75

***** fluid balance and electrolyte levels report findings. implementchanges in tube feeding formula or rate, review medications
prevention:
appropriate rate of infusion, avoid multiple meds and pro motility medications

Front 76

nausea vomiting causes

Back 76

change in formula or rate
inadequate gastric emptying

Front 77

prevention of nausea and therapuetic interventions

Back 77

Review medications, check residuals, if greater than 200 ml reinstill and recheck, repair if residual is consistenly high.

Front 78

gas, bloating and cramping causes

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air in tube, excess fiber

Front 79

gas bloating and cramping interventions

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notify dr. if persitent, keep tubing free of air

Front 80

constipation cause

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lack of fiber, inadequate fluid intake/dehydration, opioid use

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constipation intervention

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check fiber and water content, report findings, admin adequate amount of hydration as flushes, consider cathartic

Front 82

aspiration pneumonia cause

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improper tube placement, vomiting with aspiration of tube feeding, flat in bed

Front 83

intervention of aspiration pneumonia

Back 83

***** respiratory status and notify DR.
keep head of bed elevated

Front 84

promoting coping ability

Back 84

nurse reinforces an optimistic approach by identifying indicators of progress (daily weight trends, electrolyte balance, absence of nausea and diarrhea

Front 85

for a pt. to be considered for tube feeding at home

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be medically stable and successfully tolerating 60% to 70% of feeding regimine, be capable of self care or have a caregiver willing to assume the responsibility
have access to supplies and interest in learning how to admin tube feeding at home.

Front 86

before discharge, nurse provides info on

Back 86

equipment needed, formula purchase and storage, admin of the feeding frequency, quantity, rate of instillation.

Front 87

tube is guided down the esophagus into stomach through a small abdominal incision and endoscope inserted via the pts. mouth and upper gi tract. a mushroom cath. tip secure against the stomach wall

Back 87

peg tube

Front 88

feeding with a jejunostomy or gastrostomy

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at first admin as a slow hourly infuion of 10-20 ml hourly or small bolus volumes of 30-60 ml

Front 89

providing skin care for a gastrostomy

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washes the area around the tube with soap and water daily, removes any encrustation, rinses the area well with water and pats dry. assess for breakdown, irritation, excoriation and presence of drainage or gastric leakage.

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most common complications of gastrostomy

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wound infection or cellulitis at the exit site, bleeding and dislodgement. any signs of infrection are promptly reported to the dr. bleeding needs to be reported promtly, dislodgement reported promptly. tract can close within 4-6 hours

Front 91

When highly concentrated dextrose is administered

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calorie requirements are satisfied and the body uses amino acids for protein synthesis rather than energy

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high flow sub-clavian vein

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is used for pn feeding

Front 93

a total of 1 -3 liters of solutionis adminstered

Back 93

over a 24 hour period

Front 94

ivfe

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may be infused simultaneously with pn through a y connector close to the infusion site and should not be filtered

Front 95

500 ml of

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10% ivfe

Front 96

250 ml

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of 20% IVFE
admin over 6 to 12 hours 1-3 times a week

Front 97

pn infusion must be

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inspected for separation, oily apprearance or and precipitate if present do not use

Front 98

tna

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total nutrient admixture requires a special final filter 1.5 micron filter -three in one-mixed by pharmacy staff

Front 99

pn solutions are initiated

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slowly and advanced gradually each day to the desire rate as the pat. fluid and dextrose tolerance permits.

Front 100

standing orders for pn

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are for weighing the pt. monitor i's and o's, blood glucose and baseline periodic monitor of cbc, patelet cound, chemistry panel including serum carbon dioxide, magnesium, phophorus, and triglycerides

Front 101

the formulation of pn solution is calculated

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carefully each day to meet the complete nutritional needs of the individual patient

Front 102

PN solution may be admin

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either peripheral or central lines depending on the patient's cond. and anticpated length of therapy

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to supplement oral intak

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ppn may be prescribed through a peripheral vein, less hypertonic but not nutrionally complet low dextrose content.