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GI PP 4
Nutritional Supplements
| Question | Answer |
|---|---|
| Enteral Nutrition | Feeding tubes are used for those with: Abnormal esophageal or stomach peristalsis Altered anatomy secondary to surgery Depressed consciousness Impaired digestive capacity |
| Enteral Formulation Group: Polymeric | Ensure, Ensure-Plus, Isocal, Osmolite, Sustacal, Jevity, others Preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; cause fewer GI problems |
| Enteral Formulation Group: Polymeric | Most closely resemble normal dietary intake |
| Enteral Formulation Group:Impaired Glucose Tolerance | Glucerna Contains proteins, carbohydrates, fat, sodium, potassium Used in patients with impaired glucose tolerance (e.g., diabetic patients) |
| Parenteral Nutrition | Also known as total parenteral nutrition (TPN) or hyperalimentation; can give R insulin through TPN port IVP only, no other medications |
| Parenteral Nutrition | Formulations vary according to individual patient nutritional needs Amino acids Carbohydrates Lipids Trace elements |
| Peripheral total parenteral nutrition | Temporary, short term (less than 2 weeks) Dextrose concentration generally less than 10% |
| Central total parenteral nutrition | Long-term use (over 2 weeks) Dextrose concentrations may be 10% to 50%, but are commonly 25% to 35% |
| Peripheral TPN:Adverse Effects | Phlebitis is the most devastating adverse effect Can lead to loss of a limb Fluid overload |
| Central TPN | Delivered through a large central vein Subclavian Internal jugular Long-term use (more than 2 weeks) |
| Central TPN | Disadvantages are the risks associated with central line insertion, use, and maintenance Higher risk for infection, catheter-induced trauma, metabolic alterations |
| Implications | Ensure that a complete nutritional assessment is taken, including a dietary history, weekly and daily food intakes, and weight and height measurements |
| Implications | Monitor for signs of lactose intolerance – for tube feedings Cramping Diarrhea Abdominal bloating Flatulence |
| Implications | Monitor blood glucose levels with a glucometer Monitor for hyperglycemia Headache, dehydration, weakness Monitor for hypoglycemia Cold, clammy skin, dizziness, tachycardia, tingling of the extremities |
| Implications | Monitor for fluid overload while on TPN Weak pulse Hypertension Tachycardia Confusion Decreased urine output Pitting edema |
| Implications | If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels If TPN must be discontinued abruptly, then infuse 5% to 10% glucose to prevent hypoglycemia |
| Implementation | If the volume aspirated is more than the volume delivered over the previous 2 hours (of continuous feeding), the nurse should return the aspirate, hold the feeding, and contact the prescriber while keeping the head of the patient's bed elevated. |
| Implementation | For intermittent bolus feedings, if the residual amount is more than 50% of the volume previously infused, the nurse should return the aspirate, withhold the feeding, and contact the prescriber. |
| Implementation | Average tube feeding is 75 ml/hour |
| Implementation | Usually the initial rate is 50 mL/hr at one-half strength, but this may be increased per patient tolerance to a rate ordered by the physician or appropriate health care provider. |
Created by:
codzep
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