VOPP Enteral Feeding _ TPN 2014-1

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Enteral Feeding & TPN:

Recorded April 2014 Enteral Feeding & TPN

Enteral Feeding:

Enteral Feeding

What is it?:

What is it? Enteral nutrition is a liquid containing carbohydrates, protein, vitamins and minerals similar to products such as Ensure There are generic types that the physician or dietician can choose from to meet the needs of the patient Enteral nutrition comes in 240ml cans up to bags or bottles of 2L.

REASONS FOR ENTERAL FEEDING:

REASONS FOR ENTERAL FEEDING 4 Difficulty swallowing Facial trauma Unconscious Boost calories But gut is still working

Feeding Tubes and Routes of Access:

Feeding Tubes and Routes of Access 5

TYPE of PLACEMENT BASED ON:

TYPE of PLACEMENT BASED ON 6 Determining Factors Client’s condition Length of use Cost Convenience Skill of care giver

ADMINISTRATION:

ADMINISTRATION 7 Formula based on patient’s needs Continuous Initiation – start slow, monitor for tolerance Semi-fowler’s to high fowler’s at all times HOB >=30-45 degrees Intermittent/Bolus Semi-fowler’s to high fowler’s during the infusion More natural feeding

ASSESSMENT AND CARE OF PATIENT:

ASSESSMENT AND CARE OF PATIENT 8 Residuals Nausea Bowel tones & s/s of a functioning gut Intake and Output Dehydration Fingerstick blood glucose HOB at least 30 degrees Changing bag/tubing Monitoring response to changes in feeding rate Frequent mouth care

POTENTIAL COMPLICATIONS:

POTENTIAL COMPLICATIONS 9 Aspiration frequent coughing; increased resp rate, secretions, and irritability; increase WBC, wet voice, crackles in lungs sounds Nausea Tube clogged Diarrhea Hyperglycemia; hypoglycemia Dehydration – needs H20 bolus if not on IV fluids

Total Parenteral Nutrition:

Total Parenteral Nutrition

What is it?:

What is it? Solution to meet the nutritional needs of the patient Individualized per patient Infuses via central line Prepared in pharmacy Large bags – 2 to 3 liters Highly concentrated solution Isotonic or Hypertonic glucose (D5W to D25W) Crystalline amino acids Lipids Electrolytes, vitamins, trace elements Insulin as ordered TPN Lipids

Administration:

Administration Initiate slowly so body adjusts Continuous versus Cyclic Lipids TPN requires a filter, Lipids use no filter Why? Patient cannot receive adequate nutrition from the GI tract Obstructions, abdominal surgery, severe crohn's disease, illeus , severe acute pancreatitis, GI fistulas, critically ill clients

Total Parenteral Nutrition:

Total Parenteral Nutrition TPN is refrigerated until used Check the bag against physician orders Requires two person check Compare name on bag to patient ID Change both bag and tubing every 24 hours Don’t give IV meds, piggybacks, or IV solutions in TPN line Dedicated lumen Use a filter on TPN but not on Lipids

TPN Line set up:

TPN Line set up

Nursing Responsibilities:

Nursing Responsibilities Check for allergies Preparing TPN to hang Assessment Finger-stick blood glucose monitoring Q4-6 hours Metabolic panel monitoring for electrolyte levels Complications I&O, daily weight, VS, temp Encouraging frequent mouth care Patient Teaching

Complications:

Complications Fluid Overload Hyper/hypoglycemia Electrolyte imbalance Liver or gallbladder dysfunction / fatty liver Allergic reaction Infection of central line Refeeding syndrome Psychological

The End:

The End Please be sure to check out the other items in the module and complete the quiz for the module Check the course schedule for the Q&A session covering this module

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