Chapter 25 Nutritional Support and IV Therapy Copyright

Chapter 25 Nutritional Support and IV Therapy Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc.

Reasons for nutritional support Ø Ø Ø Many persons cannot eat or drink because of illness, surgery, or injury. Chewing or swallowing problems Refusal to eat or drink Inability to eat enough to meet nutritional needs Food cannot pass from the mouth into the stomach or small intestines. Nutritional support or intravenous (IV) therapy Ø Ordered by the doctor to meet food and fluid needs Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 2

Enteral nutrition is giving nutrients into the gastrointestinal tract through a feeding tube. Nasogastric (NG) tube Ø Nasoenteral tube • Nasoduodenal tube • Nasojejunal tube Ø Gastrostomy tube (stomach tube) Ø Jejunostomy tube Ø Percutaneous endoscopic gastrostomy (PEG) tube Ø Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 3

The doctor orders: The type of formula Ø The amount to give Ø When to give tube feedings Ø A nurse gives formula through the feeding tube. Formula is given at room temperature. Tube feedings are given: At certain times (scheduled feedings, intermittent feedings) Ø Over a 24 -hour period (continuous feedings) • A feeding pump is used. Ø Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 4

Report the following observations at once: Ø Ø Ø Nausea Discomfort during the feeding Vomiting Distended abdomen Coughing Complaints of indigestion or heartburn Redness, swelling, drainage, odor, or pain at the ostomy site Fever Signs and symptoms of respiratory distress Increased pulse rate Complaints of flatulence Diarrhea Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 5

Aspiration is a major risk from tube feedings. Ø It can cause pneumonia and death. Aspiration can occur: During insertion Ø If the tube moves out of place Ø From regurgitation Ø To assist the nurse in preventing regurgitation and aspiration: Position the person in Fowler’s or semi-Fowler’s position before the feeding. • Follow the care plan and the nurse’s directions. Ø Maintain Fowler’s or semi-Fowler’s position after the feeding. • Follow the care plan and the nurse’s directions. Ø Avoid the left side-lying position. Ø Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 6

Persons with feeding tubes usually are NPO (nothing by mouth). Ø Dry mouth, dry lips, and sore throat can cause discomfort. Feeding tubes can: Irritate and cause pressure on the nose Ø Change the shape of the nostrils Ø Cause pressure ulcers Ø The following measures are common: Clean the nose and nostrils every 4 to 8 hours. Ø Secure the tube to the nose. Ø Secure the tube to the person’s garment at the shoulder area. Ø Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 7

You assist the nurse with tube feedings. Ø In some states and centers, nursing assistants give tube feedings and remove NG tubes. You are never responsible for inserting feeding tubes or checking their placement. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 8

Parenteral Nutrition (Total Parenteral Nutrition [TPN], Hyperalimentation) Parenteral nutrition is giving nutrients through a catheter inserted into a vein. This method is used when: The person cannot receive oral feedings or enteral feedings. Ø Oral or enteral feedings are not enough to meet the person’s needs. Ø TPN risks include infection, fluid imbalances, and blood sugar imbalances. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 9

Report the following signs and symptoms to the nurse at once: Ø Ø Ø Fever, chills, and other signs and symptoms of infection Signs and symptoms of sugar imbalances Chest pain Difficulty breathing, shortness of breath, or cough Nausea, vomiting, or diarrhea Thirst Rapid heart rate or an irregular heartbeat Weakness or fatigue Sweating Pallor or trembling Confusion or changes in behavior Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 10

Assisting with TPN The nurse is responsible for all aspects of TPN. Ø You assist the nurse by carefully observing the person. Ø You assist the nurse with the person’s basic needs and activities of daily living. Ø Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 11

Intravenous Therapy (IV Therapy, IV Infusion) Doctors order IV therapy to: Ø Provide fluids when they cannot be taken by mouth Ø Replace minerals and vitamins lost because of illness or injury Ø Provide sugar for energy Ø Give drugs and blood RNs are responsible for IV therapy. Peripheral and central venous sites are used. Ø Peripheral sites are away from the center of the body. Ø Central sites are close to the heart. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 12

IV equipment The solution container is a plastic bag. Ø A catheter or needle is inserted into a vein. Ø The IV tube or infusion tubing connects the IV bag to the catheter or needle. Ø Fluid drips from the bag into the drip chamber. Ø The clamp is used to regulate the flow rate. Ø The IV bag hangs from an IV pole (IV standard) or ceiling hook. Ø Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 13

The flow rate is the number of drops per minute (gtt/min). Ø Ø Ø The RN sets the clamp for the flow rate. Or an electronic pump is used to control the flow rate. • An alarm sounds if something is wrong. Tell the nurse at once if you hear an alarm. Never change the position of the clamp or adjust any controls on IV pumps. You can check the flow rate by counting drops in 1 minute or comparing the fluid line with the time line on the time tape. Tell the RN at once if: • No fluid is dripping. • The rate is too fast. • The rate is too slow. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 14

Assisting with IV therapy Your state and center may allow you to: • Change dressings at peripheral IV sites • Discontinue a peripheral IV Ø You are never responsible for: • Starting or maintaining IV therapy • Regulating the flow rate • Changing IV bags • Giving blood or IV drugs Ø Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 15

Quality of Life Persons needing nutritional support or IV therapy are often very ill. At all times, you must give quality care and protect the person’s rights. Sometimes decisions are made to stop nutritional support or IV therapy. Ø Talk to the nurse if you have problems with the decision. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc. , an affiliate of Elsevier Inc. Slide 16