Chapter 12

NPO p MD

NPO past midnight

NPO x meds

NPO except for meds

clear liquid diet

water/ coffee/ tea, broth, popsicles and jello, sports drinks, no pulp lemonade

don’t do clear liquids for longer then…

8 to 24 hrs

full liquid diets

foods that are liquid at room temp

dysphagia

thickened liquids are better, don’t go into the airway

levels of thickened liquids

thin → nectar thick → honey thick → pudding thick

pureed diet

blended (can pass through a strainer)

mechanically altered diet

softened and easily chewed

advanced diet

no hard, dry, sticky, or crunchy foods

8 common types of allergies

milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soy

enteral nutrition

can’t eat but gut works, tube feedings

nasogastric

greatest risk of aspiration

long term tube feedings

gastrostomy and jejunostomy

less aspiration risk…

the farther down the tube is placed

volvulus

intestines loop around themselves, can happen with PEGs

Which client would benefit from a Nasogastric Tube?

a. A client who had a stroke that failed their swallow evaluation         

b. A client with Congestive Heart Failure

c. A client preparing for surgery that is delayed 24 hours.

d. A client with a Platelet count of 50,000

a. A client who had a stroke that failed their swallow evaluation         

method of administration continuous

on a pump, over 12 - 24 hrs, check residual and flush every 4 hrs

method of administration intermittent

on a pump, 4 - 6 times a day in equal portions, resembles normal pattern of intake

method of administration bolus

large volume over short time, food goes in tube by gravity

what method of administration increases aspiration risk and may cause dumping syndrome?

bolus

normocaloric formula

1 - 1.5

hypercaloric formula

1.5 - 2

polymeric formula

requires a normally functioning GI tract

special formulas

elemental and specialty

elemental formula

hydrolyzed, partially functioning GI system

specialty formula

specific for disease state

refeeding syndrome

getting fed too much too soon

formula administration considerations

room temp (don’t microwave), bed at 30 - 45 degrees, hand hygiene

bed height for continuous

stays elevated

bed height for intermittent

head of bed stays up for an hour

Your client has a PEG tube, and you are about to administer a tube feeding using the feeding pump. You note that the last feeding tube hanging on the pole is labeled Aug 16 and today's date is Aug 18. Which nursing action is correct.

A. Continue to administer the feeding because the tubing is good for 4 days

B. Change the adapter cap at the end of the tubing

C. Notify the MD for further orders

D. Immediately discard the tubing and open a new package of tubing before proceeding with the feeding

D. Immediately discard the tubing and open a new package of tubing before proceeding with the feeding

**feeding tube is good for 24 hours**

total volume of feeding

= mL of H2O + mL of formula

water needed to make the ordered strength

Total Volume – mL of formula

parenteral nutrition

GI tract cannot be used, central and peripheral IVs

what balance does parenteral nutrition cause?

positive nitrogen balance

CPN (central) or TPN (total)

central line (hyperosmolar solution), long term, critically ill

PPN (peripheral)

peripheral line (isotonic solution), short term, fewer cals (watered down)

parenteral components carbohydrates

dextrose concentration 5-70%

parenteral components amino acids

proteins

parenteral components fats

density (10%, 20%, 30%), monitor triglyceride levels, ask about allergies (contains eggs)

PPN isotonic

no more than 10% dextrose

no more than 5% amino acids

A nurse is caring for a group of clients on a medical-surgical nursing unit. The nurse recognizes that which of the following clients would be likely candidates for parenteral nutrition? Select All That Apply

a. A 55-year-old with persistent nausea and vomiting from chemotherapy.

b. A 44-year-old client with ulcerative colitis.

c. A 59-year-old client who had an appendectomy.

d. A 25-year-old client with a Hirschsprung’s Disease (birth defect effecting large intestine.

e. An 18-year-old client with persistent abdominal distention following PEG tube feedings.

A, B, D, E

remove TPN from refrigerator when?

30 mins before administration

if TPN is cracking (oil separating)…

do not give, send back to pharmacy

slowing or speeding up TPN rate?

can slow down rate without permission, can’t increase the rate

if you run out of formula…why…

must have D5NS on hand, sugar may bottom out

what is the most common side effect in tube feeding?

hyperglycemia

refeeding syndrome explained…

everything drops during starvation, once eating again insulin shoots up, hypophosphatemia happens

how do we transition patients back? (1 of 2)

parenteral → enteral

don’t want to go long periods of time without using GI

how do we transition patients back? (2 of 2)

enteral → by mouth

assess swallowing ability, want them to be hungry and wanting food again, oral intake increases/ tube feeding volume decreases

when do you discontinue tube feeding for oral intake?

when oral intake consistently exceeds two-thirds

Nurse Russell is preparing to give a total parenteral nutrition using a central line. Place the following steps for administration in the correct order?

1. Connect the tubing to the central line.
2. Regulate the electric infusion pump at the ordered rate.
3. Maintain aseptic technique when handling the injection cap.
4. Check the solution for cloudiness, particles, or a change in color.
5. Prime the IV tubing through an infusion pump.
6. Select and flush the correct tubing and filter.

4, 6, 5, 3, 1, 2