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32 Cards in this Set

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Why would a client need to be given TPN ?
GI tract is not usable
severe malnutrition
bowel disease disorder
acute renal failure
hepatic failure
metastatic cancer
Severe disease states
Burns
major surgeries
How is parenteral nutrition administered?
intravenously such as through a central venous catheter into the superior vena cava.
Why would a client need to be given TPN ?
GI tract is not usable

Severe disease states

Burns

Long or short term nutritional support
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
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
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