Chapter 28 Nutritional Support and IV Therapy Copyright

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Chapter 28 Nutritional Support and IV Therapy Copyright © 2017, Elsevier, Inc. All rights

Chapter 28 Nutritional Support and IV Therapy Copyright © 2017, Elsevier, Inc. All rights reserved.

Doctor’s Order • The doctor may order nutritional support or IV therapy to meet

Doctor’s Order • The doctor may order nutritional support or IV therapy to meet food and fluid needs for persons who: • Cannot eat or drink because of illness, surgery, or injury • Have problems eating or refuse to eat or drink • Cannot eat enough to meet their nutritional needs Copyright © 2017, Elsevier, Inc. All rights reserved. 2

Enteral Nutrition Copyright © 2017, Elsevier, Inc. All rights reserved. • Enteral nutrition is

Enteral Nutrition Copyright © 2017, Elsevier, Inc. All rights reserved. • Enteral nutrition is giving nutrients into the gastrointestinal (GI) tract through a feeding tube. • Gavage is the process of giving a tube feeding. • Tube feedings replace or supplement 3 normal nutrition.

4 Enteral Nutrition (Cont. ) • Common feeding tubes • Nasogastric (NG) tube—Feeding tube

4 Enteral Nutrition (Cont. ) • Common feeding tubes • Nasogastric (NG) tube—Feeding tube is inserted through the nose into the stomach. • Nasoenteral tube—Feeding tube is inserted through the nose into the small bowel. • Gastrostomy tube (stomach tube)— Doctor surgically creates an opening in the stomach and a tube is inserted. • Jejunostomy tube—Feeding tube is inserted into a surgically created opening in the jejunum of the small intestine. • Percutaneous endoscopic gastrostomy (PEG) tube—Doctor inserts the feeding tube with an endoscope. Copyright © 2017, Elsevier, Inc. All rights reserved.

Nasogastric Tube (NG Tube) Copyright © 2017, Elsevier, Inc. All rights reserved. 5

Nasogastric Tube (NG Tube) Copyright © 2017, Elsevier, Inc. All rights reserved. 5

Naso-enteral tube Copyright © 2017, Elsevier, Inc. All rights reserved. 6

Naso-enteral tube Copyright © 2017, Elsevier, Inc. All rights reserved. 6

Gastrostomy Tube Copyright © 2017, Elsevier, Inc. All rights reserved. 7

Gastrostomy Tube Copyright © 2017, Elsevier, Inc. All rights reserved. 7

Jejunostomy Tube Copyright © 2017, Elsevier, Inc. All rights reserved. 8

Jejunostomy Tube Copyright © 2017, Elsevier, Inc. All rights reserved. 8

Percutaneous endoscopic gastrostomy (PEG) tube Copyright © 2017, Elsevier, Inc. All rights reserved. 9

Percutaneous endoscopic gastrostomy (PEG) tube Copyright © 2017, Elsevier, Inc. All rights reserved. 9

Enteral Nutrition (Cont. ) • Formulas • The doctor orders the type of formula,

Enteral Nutrition (Cont. ) • Formulas • The doctor orders the type of formula, the amount to give, and when to give tube feedings. • Formula is given at room temperature. • Feeding times • Scheduled feedings (intermittent feedings) are given at certain times. • At least four feedings are given each day. • The nurse uses a syringe or a feeding bag. • Continuous feedings are given over 24 hours. • A feeding pump is used. Copyright © 2017, Elsevier, Inc. All rights reserved. 10

Enteral Nutrition (Cont. ) • Report the following observations at once: • Nausea •

Enteral Nutrition (Cont. ) • Report the following observations at once: • Nausea • Discomfort during the feeding • Vomiting • Distended (enlarged and swollen) 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 11

Enteral Nutrition (Cont. ) • Aspiration is a major risk from tube feedings. •

Enteral Nutrition (Cont. ) • Aspiration is a major risk from tube feedings. • Aspiration can occur: • During insertion • From tube movement out of place • From regurgitation • To help prevent 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. • Maintain Fowler’s or semi-Fowler’s position after the feeding. • Follow the care plan and the nurse’s directions. • Avoid the left side-lying position. Copyright © 2017, Elsevier, Inc. All rights reserved. 12

Enteral Nutrition (Cont. ) • Persons with feeding tubes usually are not allowed to

Enteral Nutrition (Cont. ) • Persons with feeding tubes usually are not allowed to eat or drink. • Dry mouth, dry lips, and sore throat can cause discomfort. • Feeding tubes can: • Irritate and cause pressure on the nose • Change the shape of the nostrils • Cause pressure ulcers • Assisting the nurse with tube feedings • In some states and agencies, nursing assistants give tube feedings and remove NG tubes. • You are never responsible for inserting feeding tubes or checking their placement. Copyright © 2017, Elsevier, Inc. All rights reserved. 13

Parenteral Nutrition Copyright © 2017, Elsevier, Inc. All rights reserved. • Parenteral nutrition is

Parenteral Nutrition Copyright © 2017, Elsevier, Inc. All rights reserved. • Parenteral nutrition is giving nutrients through a catheter inserted into a vein. • Often called total parenteral nutrition (TPN) or hyperalimentation • Nutrient solution is given directly into the bloodstream; nutrients do not enter the GI tract. • This method is used when: • The person cannot receive oral or enteral feedings. • Oral or enteral feedings are not enough to meet the person’s needs. 14

Parenteral Nutrition (Cont. ) • Report the following to the nurse at once: •

Parenteral Nutrition (Cont. ) • Report the following to the nurse at once: • Fever, chills, and other signs and symptoms of infection • Signs and symptoms of sugar imbalances • Chest pain • Difficulty breathing or shortness of breath • Cough • Nausea and vomiting • Diarrhea • Thirst • Rapid heart rate or an irregular heartbeat • Weakness or fatigue • Sweating • Pallor (pale skin) • Trembling • Confusion or behavior changes Copyright © 2017, Elsevier, Inc. All rights reserved. 15

Parenteral Nutrition (Cont. ) Copyright © 2017, Elsevier, Inc. All rights reserved. • Assisting

Parenteral Nutrition (Cont. ) Copyright © 2017, Elsevier, Inc. All rights reserved. • Assisting with TPN • The nurse is responsible for all aspects of TPN. • You assist the nurse by carefully observing the person. • You assist with the person’s basic needs and activities of daily living. 16

IV Therapy • Intravenous (IV) therapy (IV infusion) is giving fluids through a needle

IV Therapy • Intravenous (IV) therapy (IV infusion) is giving fluids through a needle or catheter inserted into a vein. • Doctors order IV therapy to: • Provide fluids when they cannot be taken by mouth. • Replace minerals and vitamins lost because of illness or injury. • Provide sugar for energy. • Give drugs and blood. • RNs are responsible for IV therapy. • State laws vary about your role and that of LPNs/LVNs in IV therapy. Copyright © 2017, Elsevier, Inc. All rights reserved. 17

IV Therapy (Cont. ) • Peripheral and central venous sites are used. • Peripheral

IV Therapy (Cont. ) • Peripheral and central venous sites are used. • Peripheral IV sites are away from the center of the body. • Central IV sites are close to the heart. • The subclavian vein and the internal jugular vein are central venous sites. • The cephalic and basilic veins in the arm also are used. Catheters inserted into these sites are called peripherally inserted central catheters (PICCs). • Central venous sites are used: • For parenteral nutrition • To give large amounts of fluid • For long-term IV therapy • To give drugs that irritate peripheral veins Copyright © 2017, Elsevier, Inc. All rights reserved. 18

IV Therapy (Cont. ) • Basic equipment used in IV therapy • The solution

IV Therapy (Cont. ) • Basic equipment used in IV therapy • The solution container is a plastic bag. • It is called the IV bag. • A catheter or needle is inserted into a vein. • The IV tube or infusion tubing connects the IV bag to the catheter or needle. Fluid drips from the bag into the drip chamber. The clamp is used to regulate the flow rate. • The IV bag hangs from an IV pole (IV standard) or ceiling hook. Copyright © 2017, Elsevier, Inc. All rights reserved. 19

IV Therapy (Cont. ) • Flow rate • The doctor orders the amount of:

IV Therapy (Cont. ) • Flow rate • The doctor orders the amount of: • Fluid to give (infuse) • Time to give it in • The RN figures the flow rate. • The flow rate is the number of drops per minute (gtt/min) or milliliters per hour (m. L/hr). • The RN sets the clamp for the flow rate, or an electronic pump may be used to control the flow rate. • An alarm sounds if something is wrong. • Tell the nurse at once if you hear an alarm. Copyright © 2017, Elsevier, Inc. All rights reserved. 20

IV Therapy (Cont. ) • Never change the position of the clamp or adjust

IV Therapy (Cont. ) • Never change the position of the clamp or adjust any controls on IV pumps. • You can check the flow rate if a pump is not used. • Count number of drops in 1 minute. • Tell the RN at once if: • No fluid is dripping. • The rate is too fast. • The rate is too slow. • The time tape shows how much fluid to give over a period of time. • Tell the RN at once if too much or too little fluid was given. Copyright © 2017, Elsevier, Inc. All rights reserved. 21

Your state and agency may allow you to: IV Therapy (Cont. ) • Change

Your state and agency may allow you to: IV Therapy (Cont. ) • Change dressings at peripheral IV sites. • Discontinue a peripheral IV. You are never responsible for: • Starting or maintaining IV therapy • Regulating the flow rate • Changing IV bags • Giving blood or IV drugs Copyright © 2017, Elsevier, Inc. All rights reserved. 22