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Question Answer
What things can a nurse do to decrease or eliminate diarrhea caused by enteral feedings?
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Canned formula at room temperature, follow strict sanitation principles, increase rate slowly, if hypertonic: give initial feeding 1/2 strength and work up from there.
____ is the use of specific nutritional therapies to treat illness, injury or medical condition.
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Medical Nutrition Therapy (MNT)
When ____ % of a client's needs are being met by reliable dietary intake, PN is usually discontinued.
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A malnourished client's receiving TPN. She begins experiencing cardiac dysrhythmias, CHF, respiratory distress, convulsions, and coma. This is?
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Refeeding Syndrome
Clients on TPN need exogenous vitamin ____.
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How is (TPN) catheter sepsis prevented?
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Change TPN tubing every 24 hours, don't hang lipids over 12 hours, use sterile masks and gloves during changes, clean injection port each time it is used, and use an in-line 0.22?m filter
A client on TPN has chills, fever, and glucose tolerance. You suspect they have?
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catheter sepsis
How can an air embolus be prevented during insertion of a TPN catheter?
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Have them lay on left lateral decubitus position and perform Valsalva maneuver
A client on PN has diaphoresis, shakiness, confusion, and decreased LOC. They most likely have?
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Hypoglycemia. Taper TPN to 10% of infusion rate 1-2 hours before stopping, administer 50% dextrose or glucagon
What are possible complications of PN therapy?
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Metabolic alterations, pneumothorax (right after placement), air embolus from insertion or changing tubing, catheter sepsis
Continuous tube feedings are began at the prescribed rate. It is increased every ____ hours, usually by ____ mLs
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8-12 hours by 30-60 mL
Intermittent feedings should begin with ____ mL at a time. It should be increased in ____ mL increments over 4-6 feedings.
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150-250 mL; increased 50 mL
Bolus tube feedings should be infused over ____ minutes.
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Isometric tube feedings whether intermittent or continuous should be started at ____.
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Full strength (300-400 mOsm)
PICCs are started in a vein of the ____ and threaded into the ____.
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Forearm; subclavian or superior vena cava
Parenteral nutrition with greater than 10% dextrose requires ____ placed in an area like the superior vena cava.
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Central venous catheter (CVC)
Clients with short-term nutritional needs often receive IV solutions of ____ via a peripheral vein.
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less than 10% dextrose
You observe oil droplets and/or a creamy layer in a 3 in 1 admixture. You know this means?
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The emulsion has turned into large droplets that can result in fat emboli if administered.
What is a 3 in 1 admixture?
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PN solution with lipid emulsion infused over 24 hours
What is the difference between EN and PN therapy?
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EN= GI works and via tube; PN= GI doesn't work or client is in poop physiological state, IV feeding.
Who should receive parenteral nutrition (PN)?
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People unable to digest or absorb enteral nutrition, sepsis, head injury, burns
Severely malnourished clients are at risk for ____ from enteral or parenteral nutrition.
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Refeeding Syndrome. Cations Potassium, Magnesium, and Phosphate more intracellularly
What should be reported after and enteral feeding?
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Amount and type of feeding, response of tube feeding/tolerance, patency of tube, condition of skin if tubes placed in abdominal wall, side effects
What should you do if a client vomits and aspirates formula?
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Position client in side lying position, suction airway, notify health care provider, and obtain a chest x-ray
What should be done if a patient develops nausea and vomiting while receiving enteral feedings?
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Notify HCP, check tube patency, and aspirate for residual
What should be done for a patient on enteral feedings that develops diarrhea three times in 24 hours?
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Notify HCP, confer with dietician, institute skin care measures, change in antibiotics if patient is on them
Finger-stick glucose should be done every ____ hours until max enteral feeding administration rate is reached and maintained for 24 hours.
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8 hours
A client receiving enteral feedings should have a new bag and administration set every ____.
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24 hours
What should you do if the gastric residual is greater than 200 mL?
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hold feeding, notify HCP, maintain patient in elevated bed at least 30?, check residual in one hour
What is the daily free water requirement?
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