Study Notes 10/13/2008

Transcription

1 Chapter 28 Nutritional Support and IV Therapy Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. The doctor may order nutritional support or IV therapy to meet food and fluid needs for: Clients who cannot eat or drink because of illness, surgery, or injury Clients who have problems eating or refuse to eat or drink Clients who cannot eat enough to meet their nutritional needs Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 2 Enteral Nutrition Enteral nutrition is giving nutrients into the gastrointestinal tract through a feeding tube. Nasogastric (NG) tube A feeding tube is inserted through the nose into the stomach. Nasointestinal tube A nasoduodenal tube is inserted into the duodenum. A nasojejunal tube is inserted into the jejunum. Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 3 1

2 Enteral Nutrition (Cont d) Gastrostomy tube (stomach tube) A doctor surgically creates an opening in the stomach. Jejunostomy tube A feeding tube is inserted into a surgically created opening in the jejunum of the small intestine. Percutaneous endoscopic gastrostomy (PEG) tube The doctor inserts the feeding tube with an endoscope. Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 4 Enteral Nutrition (Cont d) Formulas The doctor orders the type of formula, the amount to give, and when to give tube feeding. A nurse gives formula through the feeding tube. Formula is given at room temperature. Sometimes formula is kept cold with ice chips around the container. Scheduled feedings (intermittent feedings) are given at certain times. Continuous feedings are given over a 24-hour period. A feeding pump is used. Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 5 Preventing Aspiration Aspiration is a major risk from tube feedings. Aspiration can occur: During insertion From tube movement out of place From regurgitation 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. 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 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 6 2

3 Other risks of tube feeding Report the following observations at once: Nausea Discomfort during the feeding Vomiting Distended abdomen Coughing Complaints of indigestion or heartburn Redness, swelling, drainage, odour, or pain at the ostomy site Fever Signs and symptoms of respiratory distress Increased pulse rate Complaints of flatulence Diarrhea Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 7 Comfort Measures for Tube Feeding Clients 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 You are never responsible for inserting feeding tubes or checking their placement. Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 8 IV Therapy 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. Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 9 3

4 RNs are responsible for IV therapy. Laws and institutional guidelines vary regarding the role of others in IV therapy. Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 10 Peripheral and central venous sites are used. Peripheral IV sites are away from the centre 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: To give large amounts of fluid For long-term IV therapy To give drugs that irritate peripheral veins Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 11 The 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 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 12 4

5 Flow rate The doctor orders: The amount of fluid to give (infuse) The amount of time to give it in The RN figures the flow rate. The flow rate is the number of drops per minute (gtt/min). The RN sets the clamp for the flow rate. 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 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 13 Never change the position of the clamp or adjust any controls on IV pumps. You can check the flow rate. To check the flow rate, count the 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 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 14 Your employer may allow you to: 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 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 15 5