Pancreatitis, TPN, NG and enteral tube therapy Flashcards
(51 cards)
Hard to manage, having no relief, cannot be stopped, even with medication and prolonged
Intractable
Why can we not administer a central TPN solution through a peripheral route?
Due to the high osmolarity of the solution (33% dextorse) is that it will blow the peripheral vein very rapidly - large molecule size
Can diabetics receive TPN?
Yes, we just have to offest the glucose by giving more insulin
What do we start patients on when they receive TPN?
Insulin
a person receiving TPN will become diabetic for the limited time they receive TPN; they will stop taking insulin when they stop TPN
What may occur as a result of long term PTN?
Stomach may atrophy
Does the person ever get hungry when given TPN?
No, but may miss taste of food
How is TPN administered?
Through PICC (peripherally inserted central catheter) line or Hickman
Where does the catheter for the PICC line/central line sit in?
Superior vena cavaq
PICC line insertion/clean is a ______ procedure.
This requires that we wear _____.
sterile
masks
How can we get a patient on TPN to produce saliva? Why is that important?
Pt can have gum, or suck on a mint
May use a mouthcare tray - diluted to swish and spit
They will have bad breath without saliva
Describe the two lumen central line.
Red is for taking blood out
white is for feed
A central line in the chest is called what?
Hickman’s
What is the third lumen for?
Blue - for drugs
Nurses hate it when doctor’s put a central line here. Why?
Why is it used?
Jugular vein - compromising to comfort as patient cannot turn their neck
used in emergency stuations, or if the other sites are compromised
(happens with dialysis patients)
TPN administration:
- Before administration we check the bag. What do we check for?
- Administered via pump to prevent _______
- Monitor blood glucose ____ for 24 hours, then ____ if levels are normal
- Monitor for allergy to ______; often occurs within first ____ minutes - fever, shaking, chills, SOB, chest pain or back pain
- Prevent catheter related infection - strict ______ when accessing ports and changing dressings (_____ worn by patient and nurse!)
- change the solution and tubing for lipid containing solutions ______
- solutions should be ______ until administration
check bag for:
- expiry date, appearances, leaks or tears, correct ingredients
bolusing q6h, OD lipids, 30 minutes asepsis - masks q24hrs refrigerated
Why is the pump essential when giving TPN?
If it ran by gravity and were to open really quick - person may get atrial fibrillation and cardiac arrest
When a large amount of fluid is administered rapidly to a patient (too rapidly)
blousing
Why do we see flank pain in lipid allergy?
Get lysis and clots which clog up the kidneys
In LHSC, at what frequency do we change IV tubing?
Why do we change lipid tubing q24hrs?
q72hours
q24hrs for lipid as it coats the inside of the tubing
Before administering the TPN solution we should warn the patient that it will be ____.
cold
IF extravasation occurs, it is often dramatic from a central line - very red, inflammed. What must we do?
Stop the IV, dress the area and do NOT USE IT FOR ANYTHING
Delivery of nutrition through a feeding tube, placed in the stomach of small intestine. It is used when a client is not able to ingest food but is still able to digest food and absorb nutrients.
Enteral nutrition
For the following conditions, describe whether the person would receive enteral nutrition or TPN.
A -Chronic Diarrhea or vomiting B - Pancreatitis C - Comatose state D - GI obstruction E - Oral, head and neck surgeries F - Severe malabsorption G - Confused clients H - Short bowel syndrome I - Intractable diarrhea J - Impaired swallowing or gag reflex (e.g. stroke) K - Sepsis L - Receiving mechanical ventilation M - GI obstruction
A - TPN B - TPN C - EN D - TPN E - EN F - TPN G - EN H - TPN I - TPN J - EN K - TPN L - EN M - TPN
What are the advantages of enteral feeding over parenteral feeding?
EN nutrients are absorbed in the proximal small bowel, promoting distal bowel rest
Prevents GI mucosal atrophy
Less invasive, fewer complications
Less expensive
