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Questions and Answers
What is a key requirement for a patient to qualify for enteral nutrition?
What is a key requirement for a patient to qualify for enteral nutrition?
Bolus feeds should be given in volumes less than 200 mL to avoid poor tolerance.
Bolus feeds should be given in volumes less than 200 mL to avoid poor tolerance.
True
What should be done if a patient experiences persistent diarrhea during enteral feeding?
What should be done if a patient experiences persistent diarrhea during enteral feeding?
Evaluate for C. Diff and notify healthcare provider.
The tube should be flushed with _____ mL of regular warm water every 4 hours.
The tube should be flushed with _____ mL of regular warm water every 4 hours.
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Match the complications with their corresponding management strategies:
Match the complications with their corresponding management strategies:
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Which of the following actions can help prevent aspiration pneumonia during enteral feeding?
Which of the following actions can help prevent aspiration pneumonia during enteral feeding?
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It is acceptable to microwave enteral feeding formulas to warm them before administration.
It is acceptable to microwave enteral feeding formulas to warm them before administration.
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What is the maximum number of calories allowed per day for TPN administration?
What is the maximum number of calories allowed per day for TPN administration?
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TPN should be stopped abruptly to prevent hypoglycemia.
TPN should be stopped abruptly to prevent hypoglycemia.
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What two medications can be added to TPN?
What two medications can be added to TPN?
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TPN should be administered at __________ temperature.
TPN should be administered at __________ temperature.
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Match the complications with their associated symptoms:
Match the complications with their associated symptoms:
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Which of the following should be monitored every 4-6 hours during TPN?
Which of the following should be monitored every 4-6 hours during TPN?
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Changing the TPN bag should be done every 48 hours.
Changing the TPN bag should be done every 48 hours.
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What is the most important prevention measure for Hepatitis A?
What is the most important prevention measure for Hepatitis A?
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Hepatitis C has an available vaccine.
Hepatitis C has an available vaccine.
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What action should be taken if air embolism is suspected during TPN?
What action should be taken if air embolism is suspected during TPN?
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It is essential to keep __________ 10% at the bedside to prevent hypoglycemia during TPN.
It is essential to keep __________ 10% at the bedside to prevent hypoglycemia during TPN.
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List one common symptom of cirrhosis.
List one common symptom of cirrhosis.
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Hepatitis B is transmitted through ______.
Hepatitis B is transmitted through ______.
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Match the type of hepatitis to its route of transmission:
Match the type of hepatitis to its route of transmission:
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Which complication is associated with liver biopsy?
Which complication is associated with liver biopsy?
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Portal hypertension can lead to the rupture of varices.
Portal hypertension can lead to the rupture of varices.
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What dietary change is advised for patients with acute hepatitis?
What dietary change is advised for patients with acute hepatitis?
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Patients with cirrhosis may experience ______ due to ammonia buildup.
Patients with cirrhosis may experience ______ due to ammonia buildup.
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Which of the following is NOT a symptom of hepatitis?
Which of the following is NOT a symptom of hepatitis?
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What is a hallmark symptom of pancreatitis?
What is a hallmark symptom of pancreatitis?
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Cullen's sign is characterized by periumbilical bruising.
Cullen's sign is characterized by periumbilical bruising.
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What medication is commonly used to manage pain in acute pancreatitis?
What medication is commonly used to manage pain in acute pancreatitis?
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The decrease in calcium levels in pancreatitis can result in __________ and __________ signs.
The decrease in calcium levels in pancreatitis can result in __________ and __________ signs.
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Match the following lab findings with their corresponding implications in pancreatitis:
Match the following lab findings with their corresponding implications in pancreatitis:
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What is the primary medication used to lower blood pressure in patients with variceal rupture prevention?
What is the primary medication used to lower blood pressure in patients with variceal rupture prevention?
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Alcohol consumption is recommended for patients at risk of variceal rupture.
Alcohol consumption is recommended for patients at risk of variceal rupture.
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What is a hallmark sign of hepatic encephalopathy?
What is a hallmark sign of hepatic encephalopathy?
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Patients with ascites should reduce their dietary intake of __________.
Patients with ascites should reduce their dietary intake of __________.
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Match the following medications with their purpose:
Match the following medications with their purpose:
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Which of the following is NOT a symptom of ascites?
Which of the following is NOT a symptom of ascites?
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Hypokalemia can occur as a side effect of lactulose treatment.
Hypokalemia can occur as a side effect of lactulose treatment.
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What is the primary method for draining fluid in patients with severe ascites?
What is the primary method for draining fluid in patients with severe ascites?
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In managing hepatic encephalopathy, a low ___________ diet is recommended.
In managing hepatic encephalopathy, a low ___________ diet is recommended.
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What is one complication associated with pancreatitis?
What is one complication associated with pancreatitis?
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Study Notes
Enteral and TPN Assessment and Care Management
- Enteral Nutrition: Nutrient delivery via tube, catheter, or stoma. Assesses effectiveness by monitoring weight gain and albumin levels. A good protein status is indicated by rising weight and albumin levels.
- Assessment: Ensure functional gastrointestinal tract (bowel sounds).
- Interventions: Aseptic technique is crucial. Trace lines/tubes back to the patient to prevent misconnections. Elevate the head of the bed (HOB) to > 30 degrees to prevent aspiration/reflux for 30-60 minutes post-feeding. Check tube placement before each feeding using X-rays or pH strips (gastric content <4pH). Stop feedings if adjustments need to be made to the patient's position, which may require lowering the HOB.
- Feeding Management: Check residuals every 4-6 hours, return residuals to the patient. Continue feeds with volumes greater than 500 mL can cause poor tolerance. Reduce the volume of bolus/intermittent feeds to less than 200 mL if tolerance is poor. Holds and reassesses in 1 hour. Slow the rate if needed.
- Administration: Administer at room temperature (avoid diarrhea/discomfort). Do not microwave. Flush the tube with 15-30 mL of warm water, not saline, every 4 hours to maintain patency and hydration. Administer medications by crushing 1 pill at a time and flushing with each medicine to ensure correct dosage. Gradually introduce calories for better tolerance. Discard bag and tubing every 24 hours.
Complications
- Gastrointestinal (GI) discomfort/diarrhea: Start infusions slowly, and increase rate as tolerated. Maintain room temperature formula. Slow infusion rate and notify healthcare provider (HCP) if diarrhea persists.
- Dumping syndrome: Small, frequent meals with protein are recommended. Avoid concentrated sugars and lactose. No fluids 1 hour pre- and post-meals.
- Infection: Strict aseptic technique is required. Monitor for erythema, tenderness, or exudates at the insertion site. Change the dressing every 48-72 hrs and IV tubing daily.
Aspiration Pneumonia
- Confirm tube placement
- Elevate HOB at least 30 degrees during feeds and 1 hour post feeding.
- Turn the patient and suction the airway.
- Administer oxygen as needed.
- Monitor vitals and auscultate lungs.
- Notify HCP to get X-rays.
Total Parenteral Nutrition (TPN)
- Intended for patients with non-functional gastrointestinal tracts.
- Administered through central or PICC lines.
- Limit daily calories to 700 calories per day.
- TPN is composed of 70% glucose.
- Insulin and heparin are the only two injectable meds added to TPN.
- Insulin regulates blood sugar, heparin prevents blood clots.
- Monitor for glucose imbalances, hypokalemia, hypophosphatemia, and hypocalcemia.
- Never abruptly stop TPN, as this can cause hyper or hypoglycemia.
- Assess VS every 4-8 hours, and blood sugar (BSL) every 4-6 hours.
- Assess and monitor daily weight.
- Change bag every 24 hours.
- No other medications should be added to the TPN bag.
Hepatitis (ABCDE) Prevention
- Alcohol use and acetaminophen overdoses can cause hepatitis; avoid.
- Monitor for right upper quadrant (RUQ) discomfort, nausea/vomiting (N/V), anorexia, weight loss, fever, chills, jaundice, dark urine, and pale feces.
- Rest, activity as tolerated; provide nutrition/hydration focusing on calories, proteins, and vitamins; avoid alcohol.
Cirrhosis
- Characterized by liver scarring – irreversible. Scratches liver function.
- Preventive measures include avoiding infections from viral hepatitis.
- Prevent excessive alcohol consumption.
- Daily vitamin supplementation.
- Fatigue, ascites, beefy red tongue, and weight loss, abdominal pain, and abdominal distention are common symptoms.
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Description
This quiz focuses on the principles of enteral nutrition and total parenteral nutrition (TPN) assessment and care management. It covers key components such as nutrient delivery methods, assessment techniques, and best practices for feeding management. Test your knowledge on ensuring safe and effective nutrition care.
