NURS3804 Chapter 14: Nutritional Support

What are benefits of nutritional support?

- restores intestinal motility

- maintains GI function

- reduces movement of bacteria

- improves wound healing

- decreases incidence of infection

- decreases length of hospital stay

- improves general health

What are requirements for oral feeding?

- patient can swallow

- functioning GI tract

What are requirements for enteral nutrition?

- patient may have swallowing difficulties

- functioning GI tract

What are requirements for parenteral nutrition?

- vascular access

- patient has nonfunctioning GI tract

What are the different types of enteral nutrition support?

- gastrostomy (G) tube

- nasogastric (NG) tube

- nasojejunal (NJ) tube

- jejunostomy (J) tube

- nasoduodenal (ND) tube

- duodenostomy tube

- oral supplements

What are types of enteral nutritional solutions?

- polymeric

- modular formulas

- elemental/monomeric

- specialty formulas

What are the methods for enteral nutrition delivery?

- continuous infusion pump

- intermittent infusion by gravity

- intermittent bolus by syringe

- cyclic feedings by infusion pump

What are complications of enteral nutrition?

- dehydration

- aspiration pneumonitis

- diarrhea

What should be monitored when a patient is receiving enteral nutrition?

- blood chemistry

- BUN

- creatinine

- electrolytes

- glucose

- triglycerides

- serum proteins

- I&O

- weight

How can the nurse ensure safety when a patient is receiving enteral nutrition?

- elevate HOB 30-45 degrees

- assess bowel sounds

- check gastric residual

- confirm placement of newly inserted tube before feeding

How often should gastric residual be checked when a patient is receiving intermittent feedings?

before each feeding

How often should gastric residual be checked when a patient is receiving continuous feedings?

q 4-6 hrs

What is the best way to verify placement of a newly inserted feeding tube?

x-ray

What are nursing implications when administering medications via enteral feedings?

- ensure drug is able to be crushed

- validate with pharmacist that drug dissolves in 15 mL of water and can be absorbed enterally

- prepare each medication separately

- flush tube before and after medication delivery with water

Which medications can not be crushed?

- extended release

- enteric coated

What are indications for total parenteral nutrition (TPN)?

- bowel obstruction

- prolonged paralytic ileus

- inflammatory bowel disease

- severe pancreatitis

- patient needs bowel rest

- severe trauma

- severe malnutrition

What nutrients are in total parenteral nutrition (TPN)?

- amino acids

- carbohydrates

- fats

- vitamins

- electrolytes

- trace elements

- water

What are complications of total parenteral nutrition (TPN)?

- pneumothorax

- hemothorax

- air embolism

- infection

- hyperglycemia

- hypoglycemia

- hypervolemia

What is the Valsalva maneuver?

- used to prevent air embolism during dressing, cap, and tubing changes of a central line

- patient is instructed to turn their head in the opposite direction of the insertion site

- patient is then instructed to take a deep breath, hold it, and bear down

- this increases intrathoracic venous pressure

What are nursing implications for total parenteral nutrition (TPN)?

- monitor lab results

- check for signs and symptoms of overhydration

- monitor I&O

- monitor for signs of infection

- check blood glucose

- monitor flow rate of TPN

How often should parenteral nutrition solutions be changed?

q 12-24 hrs

How often should parenteral nutrition tubing be changed?

q 24 hrs