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Nursing Fundamentals > TPN, NG tubes, Colostomy, catheter, trach, hypoxia > Flashcards

TPN, NG tubes, Colostomy, catheter, trach, hypoxia Flashcards

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1
Q

when is parental nutrition used?

A

when GI system is not functioning or when client can’t consume enough calories orally

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2
Q

what is TPN

A

it provide complete nutrition and is also used when caloric needs are very high
anticipated duration of therapy is greater then 7 days
solution is hypertonic (10% dextrose)

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3
Q

where can TPN be administered?

A

in a central vein

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4
Q

what is PPN

A

nutritionally complete solution
there is limited nutritional value because it is administered into peripheral vein
short term nutritional therapy and fewer calories
the solution is isotonic (less than 10% dextrose)

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5
Q

what are the different components of parenteral nutrition solutions?

A

amino acids
dextrose (10 - 50%)
electrolytes
vitamins and trace minerals

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6
Q

is PN medical or surgical asepsis?

A

surgical asepsis

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7
Q

what condition would a higher concentration of dextrose be prescribed for?

A

client of fluid restrictions

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8
Q

what condition is controlled through a lower-dextrose concentration

A

hyperglycemia

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9
Q

what vitamin can be added to a PN solution

A

K

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10
Q

how are lipids added to PN?

A
  • piggy back

- given intermittently

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11
Q

why would additional piggybacks in PN solution be contraindicated?

A

hyperlipidemia
hepatic disease
allergy to soybean oil, eggs or safflower oil

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12
Q

what does lipid emulsion provide for PN

A
  • needed calories when the dextrose concentration has to be decreased due to fluid restrictions
  • increases calories w/o increasing osmolality
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13
Q

what should the nurse evaluate before starting PN?

A 
weight
BMI
nutritional status
diagnosis
lab tests
education over PN
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14
Q

why is an electronic infusion device used with PN?

A

accidental overload of a solution

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15
Q

what should the nurse constantly assess throughout PN therapy?

A 
I & O
daily weight
vital signs
labs
evaluation of underlining conditions
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16
Q

intervention for hyperglycemia on PN

A

insulin (following glucose check)

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17
Q

should you increase the flow rate for PN to catch up?

A

No

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18
Q

what can a rapid administration cause?

A 
dehydration
hypovolemic shock
seizures
coma
death
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19
Q

how often should the PN bag and tubing be changed

A

every 24 hours

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20
Q

what is cracking of a TPN solution? can you still administer this solution?

A

if the Ca or Phosphorous content is too high
there is a layer of fat on top of the solution

NO - do not administer

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21
Q

complications from PN therapy include what?

A

infection and sepsis
metabolic complications
mechanical complications of the actual placement of the tube

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22
Q

what are different metabolic complications from TPN?

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A

hyperglycemia, kalemia
hypoglycemia, phosphatemia, calcemia, albuminemia
dehydration
fluid overload

23
Q

what are different mechanical complications from TPN?

Study These Flashcards
A 
catheter misplacement
pneumothorax
subclavian artery puncture
catheter embolus
air embolus
24
Q

how should PN be discontinued?

25
when should PN be discontinued?
asap to avoid complications | not until clients oral intake is 60% or more of estimated caloric requirement
26
Indication for GI intubation
- To decompress the stomach and remove gas and fluid - To lavage the stomach and remove ingested toxins - to diagnose disorders of GI motility and other disorders - To administer medications and feedings - to treat an obstruction - to compress a bleeding site - to aspirate gastric contents
27
Assessing who needs a GI tube
- surgical pts - ventilated pts - neuromuscular impairment - pts who are unable to maintain adequate oral intake to meet metabolic demands
28
Assessment for GI placement
assess - gag reflex - mental status - bowel sounds - medical hx (nosebleeds, nasal surgery, deviated septum, anticoagulation therapy)
29
Critical aspects of NG, NE placement
- pt in sitting or high-Fowler's - Measure tube (nose, ear, xiphoid) +8-10 cm for NE - Lube (water-soluble) - Hyperextend neck - Insert tube - Tuck neck, drink water, swallow - Confirm placement!! - Tape in place
30
Critical aspects of NG tube removal
- pt in sitting or high-Fowler's - Clear tube of secretions by injecting 10 mL of air - have pt hold breath - discard :)
31
What are the relative pH for gastric and intestinal contents?
- gastric greenish-brown pH 1 - 4 (up to 6 w/antacids) | - intestinal yellow-green pH 4 - 7.0
32
What you monitor when pt receiving enteral nutrition?
- tube placement - skin condition - blood glucose - BUN - electrolytes
33
How do you check placement of NG tube?
- radiographic verification (chest x-ray) - aspiration of stomach contents - Measuring of pH of the aspirate - injecting air into the feeding tube
34
If unable to aspirate...
- advance tube in case it's above fluid level - If intestinal placement withdraw 5-10cm - Have pt lie on left side, wait 10-15min, attempt again
35
What are the s&s of hypoxia
- dyspnea - tachypnea - pallor - cyanosis of the nails, lips or skin - confusion - restlessness - apprehension - dizzyness - fatigue - decreased LOC - tachycardia - changes in BP
36
Common causes of hypoxia
- Hypoventilation - decreased Hgb - decreased inspired O2 concentrations
37
Interventions for hypoxia
- sit pt up, orthopneic position - deep breathing - incentive spirometry - abdominal or diaphragmatic breathing
38
what are the s&s of central cyanosis?
``` -observed in the tongue oral mucosa conjunctiva of the eye around the lips ```
39
what are the characteristics of normal bowel sounds
high-pitched | 5-35 gurgles every minute
40
What are the characteristics of hyperactive bowel sounds?
very high-pitched | more frequent than normal
41
What are the characteristics of hypoactive bowel sounds?
low-pitched infrequent noises quiet indicates decreased peristalsis
42
How long must bowel sounds be absent before you can determine absence?
3-5 minutes
43
What type of foods that increase peristalsis?
``` High fiber foods (25-30g fiber/day) yogurt (bacteria) fruits vegetables legumes whole-grains spicy foods (sometimes) WATER ```
44
What types of foods slow peristalsis?
``` carbohydrates lean meats simple sugars carbonated beverages processed foods (salt) low-fiber foods ```
45
How do supplements affect peristalsis?
Vitamin C - softens stool Calcium - causes constipation magnesium - loosens stool
46
s&s of paralytic ileaus
- persistent abdominal pain - cramping - firm, distended abdomen - absent bowel sounds - failure to pass flatus - abdominal x-ray shows distention
47
prevention of paralytic ileus
- increase activity as soon as tolerated - take precaution to prevent hypokalemia - maintain adequate tissue perfusion - administer gastrointestinal stimulants if ordered
48
treatment of paralytic ileus
withhold all oral intake | insert NG tube and maintain suction as ordered.
49
foods that may cause gas or odor
``` asparagus cabbage beans broccoli cauliflower radishes brussel sprouts peas melons carbonated beverages beer eggs fish garlic nions ```
50
foods that may help control odor or gas
yogurt parsley cranberry juice buttermilk
51
High-fiber foods that may cause blockage
``` raw or minimally cooked veggies/fruit stringy foods (celery) foods w/ tough skins or membranes (like citrus) foods with seeds mushrooms nuts shrimp lobster ```
52
foods that may cause loose stools
``` fried foods highly seasoned foods beer raw fruits and veggies onions licorice baked beans larged meals milk chocolate caffeine ```
53
foods that may alleviate diarrhea
``` bananas applesauce cheese creamy peanut butter starchy foods ```

Nursing Fundamentals (24 decks)

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