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26 Cards in this Set

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1. List five conditions which may necessitate parenteral nutrition for a patient: (text, p. 263)
• GI trauma
• pancreatitis
• ileus
• inflammatory bowel disease
• GI tract malignancy
• GI hemorrhage
• paralytic ileus
• GI obstruction
• short-bowel syndrome
• GI fistula
• severe malabsorption
• CANNOT absorb food from GI tract
2. Name three reasons it is important to provide for the nutritional needs of patients: (text, p. 264)
• provide energy
• maintain body tissues
• aid body processes (growth, cell activity, enzyme production, temp. regulation)
risks of PN
• catheter infection
• hyperglycemia
• hypokalemia
• must have CV access
• expensive
TPN vs PPN
TPN long term, need central access (high dextrose conc)
PPN for 1-3 weeks, lower dextrose conc; not for use if liver disorders, malnutrition/fat metabolism disorders
3. List four situations which may increase a patient’s metabolic activity: ( text, p. 266)
• fever
• burns
• trauma
• disease/stress
4. Describe how the body fights starvation: ( text, p. 267)
glycogenolysis: mobilizes and converts glycogen to glucose
adipose tisssue: takes up stored energy
gluconeogenesis: body taps ts store of essential visceral/somatic proteins = negative nitrogen balance
PEM
protein energy malnutrition (protein calorie malnutrition)
iatrogenic - inadequate protein/poor calorie intake during hospitalization
Kwashiorkor - severe protein deficiency without a calorie deficit; usually with kids
marasmus - prolonged and gradual wasting
5. What four steps should the nurse take to complete a nutritional assessment? ( text, pp. 268-272)
• dietary history - changes/decreased amount of food intake
• physical assessment
• anthropometric measurements
• review pertinent diagnostic tests - visceral protein status, lean body mass, vitamin/mineral balance
Elements of parenteral nutrition
dextrose - calories
amino acids - protein
fats - lipid emulsions, calorie needs
electrolytes/minerals - based on serum chemistry profile/metabolic needs
vitamins -ensure normal body functions
micronutrients - trace elements; normal metabolism
water - fluids, electrolyte balance
TPN solutions
hypertonic
3 L bag
glucose balance important
slow infusion rate, increase gradually
abrupt stop can cause hypoglycemia
PPN solutions
slightly hypertonic
lipid emulsions
either continuous or cyclical administration
6. List three different methods through which TPN may be infused: (text, pp. 276-277)
PICC line (very conc. must go into central circulation)
CV access device
implanted port
long term = tunneled catheter/implanted port
8. List the key steps in maintaining a TPN infusion: (text, pp. 280- 281)
check order
label container
maintain flow rate as prescribed - monitor often
change tubing/filter/container q24hrs
IV site care/dressing changes
record vitals q4-8 hrs
record glucose levels
I&O, daily weight
monitor lab results/serum triglyceride levels
mouth care
document findings/interventions
10.List three catheter related complications of parenteral nutrition and nursing interventions to deal with those complications: (text, p. 286)
clotted cath
dislodged cath
cracked/broken tubing
pneumothorax
sepsis
clotted cath
interrupted flow rate
reposition cath, t-PA to clear
dislodged cath
wet dressing, bleeding
sterile gauze pad + antimicrobial ointment on site + pressure
cracked/broken tubing
risk of air embolism
padded hemostat above break= keep air out
pneumothorax
trauma to pleura during insertion of CV access device
dyspnea, chest pain, cough, diminished breath sounds, sweating/cyanosis
unilateral chest movment
chest tube insertion, chest tube suctioning
sepsis
fever, chills, red/indurated area around catheter
remove cath/culture tip, antibiotics
11.List five metabolic complications of parenteral nutrition and nursing interventions to deal with those complications: (text, pp. 286-287)
hyper & hypoglycemia (blood sugar) & hyperosmolar hyperglycemia nonketotic syndrome
hyper & hypokalemia - formula makpeup, loss in GI Tract, renal disease (+)
hypomagnesemia - not enough in solution
hypophosphatemia - insulin therapy
hypocalcemia - too little calcium, vitamin D deficiency, pancreatitis
metabolic acidosis - increased serum Cl, decrease serum bicarb level
liver dysfunction
12.List three mechanical complications of parenteral nutrition and nursing interventions to deal with those complications: (text, p. 287)
air embolism
venous thrombosis
extravasation
phlebitis
air embolism
apprehension, chest pain, techycardia, hypotension, cyanosis, seizures, loss of consciousness, cardiac arrest
clamp cath, trendelenburgs on left side, O2, CPR
thrombosis
swelling at cath site, swelling of extremity/face on same side as cath
pain at insertion site/along vein, malaise, fever, tachycardia
notify practitioner, heparin, venous flow study
extravasation
swelling around insertion site/pain
stop infusion, chest x-ray for cardiopulmonary abnormalities
phlebitis
pain, tenderness, redness, warmth at site & along vein
gentle heat @ site, elevate site
too fast infusion
nausea, headache, lethargy, heart failure (fluid overload)
check rate, check pump