General Knowledge Flashcards
indications for EN
EN: situations in which normal eating is unsafe because of high risk for aspiration: altered mental status, swallowing disorders, impaired gag reflex, dependence on mechanical ventilation, esophageal conditions (strictures or dysmotility), delayed gastric emptying.
Conditions that interfere with normal ingestions or absorptions of nutrients or create hypermetabolic states (surgical resection of oropharynx, proximal intestinal obstruction or fistula, pancreatitis, burns, severe pressure injuries.
Conditions in which disease or treatment-related symptoms reduce oral intake: anorexia, nausea, pain, fatigue, SOB, depression.
types of gastronomy devices–peds
Shorter, MICK-EY
types of gastronomy devices–adults
PEG/G or J tubes
how does tube placement in peds differ from tube placement in adults
The distance from nose to ear to mid-umbilicus better predicts insertion length for gastric tube placement in neonates and children than traditional form nose to ear to xiphoid.
Assessment and care of a gastronomy (G) tube
inspect site for signs of impaired skin integrity: redness, swelling, drainage
sx/sx of infection, injury, tightness of tube.
factors to document of an enteral feeding
Record amount and type of feeding, infusion rate (or continuous feeding), time of infusion (or bolus method), GRV measurements, position of feeding tube, patient’s response to the tube feeding, patency of tube, condition of skin at tube site.
record volume of formula and any additional water on I and O form.
nursing management of parenteral nutrition
Monitor for Catheter-related bloodstream infection. Other complications include pneumothorax, air embolism, localized infection, catheter related sepsis, hyperglycemia, hypoglycemia.
Prevention includes making sure proper training is completed about insertion and removal, taper slowly, using sterile technique. continuing assessment of insertion site.
Outcomes wanted: ideal weight gain (0.5 and 1 kg/week), blood glucose levels maintained for desired glucose range. CVAD is patent, site is free of swelling, redness, pain, or inflammation. Patient is afebrile, patient and family caregiver can discuss purpose and steps for care.
commercial feeding products and home use considerations
need a home nutrition therapy team, home safety and physical nutritional and psychological needs assessment, patients or family need to learn how to perform catheter site care, dressing changes, techniques for connecting and disconnecting PN solutions and infusion pump management.
Make sure commercial feeding products meet patients nutritional needs.
when is a J tube indicated vs. a G tube
A J tube is indicated for when the patient has a higher risk of regurgitation and aspiration: severely delayed gastric emptying, pancreatitis.
Indications for (T)PN
used when the GI tract is not sufficiently functional
What is in TPN
protein, glucose, electrolytes, lipids
What do you monitor with TPN
glucose
if you hang a new bag of TPN what rate must you infuse it in
the same rate
Why does TPN go through the brown lumen (shortest)
shortest outside=longest and most direct inside
gets to the heart faster so can be absorbed in the RA to the bloodstream
Does TPN play well with others
NO, it is incompatible with anything
