**Complex Concepts I Exam 3: Nutrition

The nurse is preparing to instill medication into a client's nasogastric tube. Which actions should the nurse take before instilling the medications? Select all that apply 1. Check the residual volume 2. Aspirate the stomach contents 3. Turn off the suction to the nasogastric tube 4. Remove the tube and place it in the other nostril 5. Test the stomach contents for a pH of less than 3.5

1,2,3,5

To determine the length for inserting a nasogastric sump tube, the nurse is most correct in placing the distal tip of the tube at the client's nose and measuring the distance from there to the 1.Jaw and then midway to the sternum 2.Mouth and then between the nipples 3.Midsternum and then to the umbilicus 4.Ear and then to the xiphoid process

4

Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting an NG tube for liquid enteral feedings? A. Aspirate for gastric secretions with a syringe. B. Begin feeding slowly to prevent cramping. C. Get an X-ray of the tip of the tube within 24 hours. D. Clamp off the tube until the feedings begin.

A

The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is: A. Verify correct placement of the tube B. Check that the feeding solution matches the dietary order C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach D. Ensure that feeding solution is at room temperature

A

While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client's family how to deal with it at home, what should the nurse do? A. Irrigate the tube with warm water. B. Advance the tube into the intestine. C. Apply intermittent suction to the tube. D. Withdraw the obstruction with a 30-ml syringe.

A

A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs? A. Initiate continuous enteral feedings. B. Encourage a high protein, high-calorie diet. C. Implement total parenteral nutrition. D. Provide six small meals a day.

C

Caring for a client receiving TPN and is NPO.When reviewing the chart, the nurse notes the following prescription: capillary blood glucose AC and HS. Which action should the nurse take? A. Check the client's blood glucose according to facility mealtimes. B. Contact the provider to clarify the prescription. C. Request for meals to be provided for the client. D. Hold the prescription until the client is no longer NPO.

B

Stephanie, a 28 y.o. accident victim, requires TPN. The rationale for TPN is to provide: A. Necessary fluids and electrolytes to the body. B. Complete nutrition by the I.V. route. C. Tube feedings for nutritional supplementation. D. Dietary supplementation with liquid protein given between meals.

B

The patient is on TPN and is lethargic. He has been complaining of thirst and headache and has had increased urination. Which of the following problems would cause these symptoms? a. Electrolyte imbalance b. Hypoglycemia c. Hyperglycemia d. Hypercapnia

C

Match the items together Bacterial contamination Crushed medication Lack of free water Displaced feeding tube Rapid increase in volume of formula administered Fluid & electrolyte shifts Constipation Diarrhea Refeeding syndrome Aspiration pneumonia Nausea/Vomiting Tube occlusion

Bacterial contamination- Diarrhea Lack of free water- Constipation Crushed medication- Tube occlusion Displaced feeding tube- Aspiration pneumonia Rapid increase in volume of formula administered- Nausea/Vomiting Fluid & electrolyte shifts- Refeeding syndrome

Your patient has a GI tract that is functioning but has the inability to swallow foods. Which is the preferred method of feeding for your patient? A. TPN B. PPN C. NG feeding D. Oral liquid supplements

C

The nurse supervises care of a client who is receiving enteral feeding via a nasogastric tube. The nurse determines that care is appropriate if which of the following is observed? SELECT ALL THAT APPLY: A. The nursing assistant uses a stethoscope to listen for bowel sounds. B. The nursing assistant listens for a "puff" of air in the patient's stomach to check tube placement. C. The nursing assistant checks the residual and records it before returning it to the patient. D. The nursing assistant elevates the head of the bed to semi-Fowler's position during the tube feeding and for thirty minutes after the tube feeding. E. The nursing assistant elevates the head of the bed approximately 15 degrees during the tube feeding.

C, D

Nsg Interventions for TPN

Check capillary glucose every 4-6 hours for at least the first 24 hours. Regular insulin may be needed until pancreas increases insulin production. Keep D10% in water at the bedside in case solution is ruined or next bag not available. If bag is unavailable & administered late, do not attempt to catch up by increasing the infusion rate. Older adult clients- increased incidence of glucose intolerance 2 nurse check prior to admin

Caring for a dehydrated client receiving continuous tube feedings thru a pump at 75ml/hr. When the nurse assesses the client at 0800, which of the following findings requires intervention? A. A full pitcher of water is sitting on the client's bedside table within the client's reach. B. The disposable feeding bag is from the previous day at 1000 and contains 200 mL of feeding. C. The client is lying on the right side with a visible dependent loop in the feeding tube. D. The head of the bed is elevated 20°.

D

Client receiving TPN and returns from Physical therapy. Nurse notices IV pump for the TPN is turned off. After restarting the pump, the nurse should monitor the client for which finding? A. Hypertension B. Excessive thirst C. Fever D. Diaphoresis Due to hypoglycemia

D. Diaphoresis Due to hypoglycemia

Management of Care for TPN

Flow rate is gradually increased and gradually decreased to allow body adjustment- no more than 10% hourly increase in rate. Never abruptly stop TPN; abrupt rate change can alter blood glucose levels! V/S every 4-8 hours & daily weights Follow sterile procedures to minimize risk of sepsis. TPN prepared by pharmacy using aseptic technique with a laminar flow hood. Change tubing & solution bag every 24 hours. Ensure tubing has a filter to collect particles from solution Don't use line for other IV bolus solutions to prevent contamination and interruption of flow rate. Don't add anything to solution due to contamination risk & incompatibility. Use sterile technique, including mask, when changing central line dressing per facility procedure.

TOTAL PARENTERAL NUTRITION

Hypertonic IV bolus solution; given to prevent or correct nutritional deficiencies & minimize adverse effects of malnourishment. Given thru a central line Contains complete nutrition- calories in high concentration of dextrose(10-50%), lipids/fatty acids, protein, electrolytes, vitamins & trace elements.

Clinical Manifestations requiring Enteral Feeds:

Malnutrition Aspiration of pneumonia Inability to eat due to medical condition- coma, intubated Inability to maintain adequate oral nutritional intake & need for supplementation due to increased metabolic demands- cancer, burns, sepsis. Difficulty swallowing or increase risk of aspiration- stroke, multiple sclerosis, Parkinson's disease

Pt with PEG tube and getting intermittent feedings. Prior to administering the feeding, which action should the RN take first? Flush the tube with water. Place the client in semi-Fowler's position. Cleanse the skin around the tube site. Aspirate the tube for residual contents.

Semi- Fowler's position

Enteral Feeds- Management of Care:

To prevent overfeeding- greater quantities than can be readily digested. Check residuals per facility policy- usually every 4-6 hrs. Follow protocol for slowing or withholding feedings for excess residual volume. Check pump for proper operation & ensure feeding infusion at correct rate. For diarrhea- due to concentration of feeding or constituents Slow rate of feeding & notify provider Confer with dietitian Provide skin care & protection Evaluate for C. diff if diarrhea continues and if very foul odor is present. Aspiration pneumonia- tube displacement primary cause for aspiration of feeding To prevent, Confirm tube placement before feedings & elevate HOB at least 30 degrees during feeds and for 1 hour after. If suspected stop feeding, turn the patient to one side and suction the airway. Administer O2 if indicated. Monitor V/S for elevated temp. Auscultate breath sounds for increased congestion & diminished breath sounds. Notify the provider and obtain chest Xray if ordered. Refeeding Syndrome- occurs when feeding started in a starvation state & body catabolizes protein & fat for energy. Life threatening Monitor for new onset of confusion or seizures. Assess for shallow respirations Monitor for increased muscular weakness. Notify provider & obtain blood electrolytes if needed.

Client Presentation for TPN :

Weight loss greater than 10% of body weight and NPO or unable to eat/drink for more than 5 days. Muscle wasting, poor tissue healing, burns, bowel disease disorders, acute kidney failure. Any condition that: Affects ability to absorb nutrition Prolonged recovery time Creates hypermetabolic state Creates chronic malnutrition Chronic pancreatitis Diffuse peritonitis Short bowel syndrome Gastric paresis from DM Severe burns

A nurse prepares a feeding for a client with a nasogastric (NG) tube and discovers it is clogged. Which action does the nurse perform? Gently move the tube in and out. Aspirate from the tube with a syringe. Use cranberry juice to dissolve the clog. Flush the tube with water.

flush

Enteral feedings

used for clients who are unable to swallow or take in calories and protein orally. It can be in addition to an oral diet or the only source of nutrition.