Enteral Nutrition and TPN Management

Nutrient delivery through a tube, catheter, or stoma to the GI tract.

Monitoring for effectiveness, including weight gain and rising albumin levels, to indicate proper protein status.

Aseptic technique, tracing lines, HOB elevated (30 degrees), checking placement before feeding, and appropriate feeding rate.

Feeding method where a large volume of enteral feed is given all at once.

Associated with rapid feeding or large bolus feeds; characterized by abdominal discomfort and rapid blood sugar changes.

Elevate head of bed (HOB) at least 30 degrees during and after feedings to reduce risk of aspiration.

Discard feeding bags and tubing every 24 hours to prevent infection.

Inflammation of the pancreas caused by activated pancreatic enzymes digesting the pancreas itself. Characterized by sudden, severe pain, often radiating to the back.

Bruising on the flanks (sides of the abdomen) indicating retroperitoneal bleeding, a sign of severe pancreatitis.

Bluish-grey discoloration around the belly button (umbilicus) caused by bleeding in the abdominal cavity, a sign of acute pancreatitis.

TPN aims for weight gain of 1 kg/day, improved albumin and pre-albumin levels.

Treatment focuses on relieving pain, preventing complications, and supporting the pancreas to heal. This includes pain medications, fluid management, and dietary restrictions.

TPN is administered through central or PICC lines and is a high-calorie nutrition supplement.

A long-term condition involving progressive destruction of the pancreas due to inflammation and fibrosis. It often leads to digestive problems and may require long-term enzyme supplementation.

TPN contains 70% glucose.

Only insulin and heparin are added to TPN.

Regular monitoring of vital signs, blood sugar levels, and daily weights are essential for TPN.

Abrupt TPN discontinuation can lead to hypoglycemia. Gradual tapering is crucial.

Maintaining strict aseptic technique during TPN administration is vital to prevent infection.

An air embolus is a serious complication of TPN. Recognize symptoms and act quickly.

A pharmacist prepares the TPN solution, and the TPN bag should be checked for improper preparation such as oil or cracking.

Symptoms include RUQ discomfort, nausea/vomiting, anorexia, weight loss, fever, chills, jaundice, dark urine, pale feces, and flu-like symptoms.

Hepatitis A is transmitted through the fecal-oral route.

Hepatitis B is transmitted through body fluids, semen, blood, and from mother to baby

Hepatitis C is transmitted primarily through blood and semen and has a long, asymptomatic incubation period

Hepatitis D only occurs with Hepatitis B infection.

Scarring of the liver that results in a loss of liver function

Increased pressure in the portal vein, leading to swollen veins (varices).

Symptoms include low blood pressure, increased heart rate, bruising, rigid abdomen, and abdominal distention.

Rest, activity as tolerated, proper nutrition and hydration, increased protein, calories, and vitamins.

Complications include fatigue, ascites, beefy red tongue, weight loss/abdominal pain/distention, pruritus, confusion (ammonia buildup), jaundice, spider angiomas, palmar erythema, anemia, thrombocytopenia, petechiae, and gastroesophageal bleeds.

A collection of swollen veins (varices) in the body, which may rupture and cause airway issues.

Managing fluid buildup in the abdomen (ascites) by monitoring weight, abdominal girth, adjusting diet (low sodium, high potassium), and using diuretics as needed.

Procedure to drain excess fluid from the abdomen (ascites).

A brain disorder caused by ammonia buildup due to the liver's inability to process it correctly.

Flapping tremor of the hands, a hallmark sign of hepatic encephalopathy.

A medication that reduces ammonia levels in the blood, helping manage hepatic encephalopathy.

Pancreatitis can be caused by alcohol abuse or gallstones.

Possible complications include a rupture leading to peritonitis and hypovolemic shock.

Avoid straining, coughing, alcohol, and NSAIDs to prevent variceal rupture. Use Colace for constipation and consider beta-blockers like propranolol to lower blood pressure.

Balloon tamponade (Sengstaken-Blakemore tube) to stop bleeding, followed by ligation or sclerotherapy.