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. |