Nutrition and IV Therapy Essentials

Enteral Feeding and Medication management

• Enteral Feeding Definition: The delivery of nutrition or fluid via a tube directly into the gastrointestinal (GI) tract.

• Enteral Medication Administration Procedures:

  • Health providers must always check if medications can be crushed before doing so.

  • Each medication must be prepared separately; they should not be grouped together during the preparation phase.

  • Each medication must be dissolved separately in appropriate solvent.

  • Mixing Medications and Formulas: Medications should never be mixed directly with enteral feeding formulas.

  • Flushing Protocol: Before and after any drug is administered through the enteral tube, the line must be flushed with approximately $15\,\text{mL}$ of water.

Total Parenteral Nutrition (TPN)

• Definition and Terminology:

  • Total Parenteral Nutrition refers to the provision of nutrients through a route other than the gastrointestinal tract, specifically delivered intravenously (IV).

  • The terms "parenteral nutrition" (PN), "total parenteral nutrition" (TPN), and "hyperalimentation" are used synonymously in a clinical context.

• TPN Characteristics:

  • TPN solutions are hypertonic.

  • They are designed to encompass the total nutritional needs of the patient.

• Individualized Patient Composition: PN solutions are tailored to the individual and typically contain:

  • Amino acids

  • Carbohydrates

  • Electrolytes

  • Fats

  • Trace elements

  • Vitamins

  • Water

• Clinical Indications for TPN:

  • Inability to meet nutritional and metabolic demands through standard oral intake.

  • Cases where disease or surgical intervention necessitates bowel rest.

  • Eligibility requirements: PN is used if the patient is ineligible for Enteral Nutrition (EN) due to a nonfunctioning GI tract or intestinal failure.

• PN Safety and Maintenance:

  • Delivery Method: Always use a central catheter for administration.

  • Equipment: An infusion pump is mandatory for delivery to ensure accuracy.

  • Infection Control: Specific measures must be taken to prevent infections.

  • Monitoring: Healthcare staff must monitor the patient's blood sugar levels.

  • Maintenance: The IV tubing must be changed regularly according to protocol.

Intravenous (IV) Therapy

• Primary Objectives: IV therapy is used to correct or prevent disturbances in fluid and electrolyte balance.

• System Access: Provides direct access to the patient's vascular system.

• Potential Complications: The following risks are associated with IV therapy:

  • Risk of infection

  • Occlusion (blockage of the line)

  • Phlebitis (inflammation of the vein)

  • Infiltration (leakage of non-vesicant fluid into surrounding tissue)

  • Extravasation (leakage of vesicant or irritant medication into surrounding tissue)

Blood Transfusions

• Pre-Administration Protocol:

  • A "Type and crossmatch" is required to ensure compatibility.

  • Verification: The blood and patient identity must be checked by $2\,\text{RNs}$ (Registered Nurses).

• Patient Assessment: The patient's condition must be assessed before, during, and after the transfusion process.

• Transfusion Reactions:

  • One significant risk is a hemolytic transfusion reaction.

  • Timing: Many adverse reactions occur within the first $5-15\,\text{mins}$ of starting the infusion.

• Equipment and Fluids:

  • Tubing: Only specific blood tubing equipped with an in-line filter must be used.

  • Compatible Fluids: Blood must be infused with normal saline.

• Documentation: The volume of blood and saline infused must be documented in the patient's Intake and Output (I and O) records.