Pharm Chapter 14: Nutritional Support

Key Term: Jejunostomy tube

A GI route used for enteral tube feedings

Key Term: Gastrostomy tube

A GI tube used for enteral tube feedings

Key Term: Intermittent infusion

Considered an inexpensive method for administering enteral nutrition

Key Term: Hyperalimentation (HA)

A form of malnutrition in which the intake of nutrients is oversupplied

Key Term: Valsalva maneuver

A method to prevent air embolism during dressing and tubing changes in which patients are asked to turn their head in the opposite direction of the insertion site, take a deep breath, hold it, and bear down

Key Term: Percutaneous endoscopic gastrostomy (PEG) tube

A tube placed surgically, endoscopically, or radiologically for the purpose of delivering nutrition; requires an intact GI system

Key Term: Cyclic method

A type of continuous feeding infused over 8-16 hours daily (day or night)

Key Term: Parenteral nutrition (PN)

Administration of nutrients by a route other than the GI tract; also called TPN

Key Term: Enteral nutrition (EN)

Delivery of nutrition or fluid via a tube into the GI tract, which requires a functional, accessible GI tract

Key Term: Intermittent enteral feedings

Feedings administered every 3-6 hours over 30-60 min by gravity drip or infusion pump

Key Term: Continuous feedings

Feedings prescribed for the critically ill and for those who receive feedings into the small intestine

Key Term: Nasoduodenal/Nasojejunal

GI routes used for enteral tube feedings

Key Term: Nutritional support

Includes oral feedings, EN, and PN. Provides nutrients to patients who are critically ill.

Key Term: Gastrointestinal tubes

Small in diameter, made of urethan or silicone, and are flexible and long. They are radiopaque, which makes their position easy to identify by X-ray

Key Term: Total parenteral nutrition (TPN)

The administration of nutrients by a route other than the GI tract; also called parenteral nutrition

Key Term: Bolus

The first method used to deliver enteral feedings, by which 250-400 mL of solution is rapidly administered through a syringe into the tube 4-6 times a day

Key Term: Jejunostomy routes

Tube passed through stoma directly into jejunum.

The nurse is caring for a patient receiving total parenteral nutrition (TPN). Which interventions will the nurse include in the patient's plan of care? a. Monitor blood glucose levels b. Protect the solution from exposure to light at all times c. Monitor the patient for changes in temp d. Accelerate the rate of infusion to keep the infusion on time as needed e. Monitor intake and output f. Keep TPN solution that is not in use at room temp

a, c, e *Patients receiving TPN are at risk for hyperglycemia; glucose should be monitored. The nurse should monitor for temperature changes, as fever could indicate infection. Intake and output should be monitored, as the patient could experience a fluid volume deficit or excess. The rate of the infusion should not be accelerated, as this may lead to complications in the patient's condition. The pharmacy will determine if the solution requires protection from light; most nutritional solutions do not require such precautions. TPN preparations should be refrigerated and administered within 24 h.

The patient receiving enteral feedings has poor skin turgor, and urinary output is 40 mL/h. What is the nurse's first intervention? a. Assess fluid intake b. Call the provider c. Assess BP d. Monitor hemoglobin and hematocrit

a. Assess fluid intake *Dehydration can occur if the patient does not receive a sufficient amount of fluid with or between feedings.

The nurse is reviewing the care plan with a patient using enteral nutrition. Which interventions by the nurse are appropriate for this strategy? (Select all) a. Check the continuous route for gastric residual every 2-4 hours b. Raise the HOB to 30-45 degree angle before administering EN c. Change the feeding bag every 3 days d. Report diminished or absent bowel sounds to provider e. Explain that any diarrhea the patient experiences is related to the nutrition

a. Check the continuous route for gastric residual every 2-4 hours b. Raise the HOB to 30-45 degree angle before administering EN d. Report diminished or absent bowel sounds to provider

The health care provider has indicated that the patient requires an elemental commercial enteral feeding preparation. The nurse anticipates that the provider will order which preparation? a. Criticare HN b. Ultracal c. Osmolite d. Resource

a. Criticare HN *Criticare HN is classified as an elemental commercial enteral feeding preparation. Ultracal, Osmolite, and Resource are polymeric preparations.

A patient is receiving TPN at home. The visiting nurse assists the family with the care plan, which includes changing the TPN solution and tubing. What is the recommended initial frequency for changing the tubing? a. Every 24 hours b. Every 36 hours c. Every 48 hours d. Every 72 hours

a. Every 24 hours

Which is appropriate nursing care for a patient receiving total parenteral nutrition (TPN) in an acute care setting? (Select all) a. Monitor blood glucose levels b. Measure I&O each shift c. Administer blood products through TPN line d. Monitor the TPN insertion site for erythema, leaking, or edema e. Monitor the patient's weight monthly for significant changes

a. Monitor blood glucose levels b. Measure I&O each shift d. Monitor the TPN insertion site for erythema, leaking, or edema

The patient is receiving a bolus feeding through a gastrostomy tube and develops diarrhea. What is a priority nursing intervention? a. Slow the bolus feedings b. Finish the bolus and continue to monitor the patient c. Stop the feeding and administer an antispasmodic d. Call the provider

a. Slow the bolus feedings *Diarrhea can be caused by rapid administration of feeding, high caloric solutions, malnutrition, gastrointestinal bacteria, and drugs. Diarrhea can usually be managed or corrected by decreasing the feeding flow rate, and as diarrhea lessens, the feeding flow rate can be gradually increased.

The patient undergoing catheter placement for total parenteral nutrition experiences coughing, shortness of breath, chest pain, and cyanosis. Which complication does the nurse suspect the patient is experiencing? a. Aspiration pneumonia b. Air embolism c. Infection d. Pneumothorax

b. Air embolism *Coughing, shortness of breath, chest pain, cyanosis, hypotension, apprehension are symptoms of air embolism.

The health care provider has written an order for the patient to receive a milk-based commercial enteral feeding preparation. The nurse anticipates that the provider will order which preparation? a. Criticare HN b. Boost c. Microlipid d. Vivonex

b. Boost *Boost is a milk-based preparation. Criticare HN and Vivonex are elemental preparations; Microlipid is a modular preparation.

The nurse is to administer enteral meds to a patient who cannot swallow and is receiving continuous enteral feedings. Which is correct concerning administration of the enteral meds? a. Order meds are added to the enteral feeding solution b. Liquid meds are diluted, given as a bolus, and followed with water c. Extra amounts of water are used to dissolve timed-release meds d. Undiluted hyperosmolar meds may be given to a patient on fluid restriction

b. Liquid meds are diluted, given as a bolus, and followed with water

The nurse identifies that the patient has been ordered Ultracal. The nurse recognizes that Ultracal is an example of which type of commercial enteral feeding preparation? a. Monomeric b. Polymeric c. Lactose-free d. Elemental

b. Polymeric

The nurse is determining a patient's gastric residual before administering an enteral feeding; the last feeding was 240 mL. The patient will be discharged on enteral feedings. It is important to include in the teaching plan that a residual of more than which amount would indicate delayed gastric emptying (based on last feeding)? a. 60mL b. 125 mL c. 150 mL d. 175 mL

c. 150 mL

The nurse would be correct in identifying which outcome as the most serious complication of tube feedings? a. Constipation b. Dehydration c. Aspiration pneumonia d. Bowel perforation

c. Aspiration pneumonia *Aspiration pneumonitis is one of the most serious and potentially life-threatening complications of tube feedings. Bowel perforation is a complication of placement, not feeding. Dehydration and diarrhea are expected side effects.

The nurse is reviewing the plan of care for a patient receiving enteral therapy. What is the most common complication of enteral therapy? a. Aspiration b. Constipation c. Diarrhea d. Muscle weakness

c. Diarrhea

The nurse finds that the patient's enteral feeding is infusing at 150 mL/h instead of the ordered rate of 50 mL/h. What is the nurse's highest priority initial action? a. Notify the provider of the error b. Complete an incident report c. Stop the infusion and check the patient d. Call the pharmacy to stop the next bag

c. Stop the infusion and check the patient *Although all of the actions should be completed at some point, the highest priority is the patient's safety. Thus, the infusion should be stopped, the patient's condition assessed, and the rate then clarified.

The nurse identifies that the patient has been ordered Peptamen Liquid. The nurse recognizes that Peptamen Liquid is an example of which type of commercial enteral feeding preparation? a. Blenderized b. Polymeric c. Lactose-free d. Elemental

d. Elemental

A patient has been on TPN for 1 month, and there is an order to discontinue TPN tomorrow. The nurse contacts the provider because sudden interruption of TPN therapy may cause which condition? a. Dehydration b. Tremors c. Urinary retention d. Hypoglycemia

d. Hypoglycemia

The nurse is assisting a patient with self-administration of an enteral feeding. It is important to include in the teaching plan that the feeding should be administered at which temp? a. Slightly warmed b. Chilled c. Ice cold d. Room temp

d. Room temp

The patient is receiving enteral feedings through a gastrostomy tube at a rate of 100 mL/h. The nurse assesses residual volume as 80 mL. What is the nurse's primary intervention? a. Discard the residual volume and continue to monitor the feeding. b. Decrease the feeding to 80 mL/h for the next hour. c. Assess the patient's bowel sounds. d. Stop the feeding for 1 h and reassess.

d. Stop the feeding for 1 h and reassess. *The residual volume should not be greater than 50% of the hourly rate. This indicates that the feeding is not absorbing. The feeding should be stopped for an hour, and then the residual volume should be reassessed.