Podcast
Questions and Answers
What is the primary requirement for a patient to receive enteral nutrition?
What is the primary requirement for a patient to receive enteral nutrition?
Which of the following is the best practice for checking tube placement before enteral feeding?
Which of the following is the best practice for checking tube placement before enteral feeding?
What is the most appropriate way to address issues of tube patency during enteral feeding?
What is the most appropriate way to address issues of tube patency during enteral feeding?
In the case of feeding intolerance, what should be the immediate response?
In the case of feeding intolerance, what should be the immediate response?
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What is a potential complication of administering bolus feeds too quickly?
What is a potential complication of administering bolus feeds too quickly?
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What should be avoided to prevent aspiration pneumonia during enteral feeding?
What should be avoided to prevent aspiration pneumonia during enteral feeding?
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Which practice is recommended to manage diarrhea during enteral feeding?
Which practice is recommended to manage diarrhea during enteral feeding?
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For preventing infection in enteral feeding, what is the recommended practice regarding feeding equipment?
For preventing infection in enteral feeding, what is the recommended practice regarding feeding equipment?
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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?
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When introducing enteral calories, what is the advisable approach?
When introducing enteral calories, what is the advisable approach?
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What is the primary reason for administering TPN through central or PICC lines?
What is the primary reason for administering TPN through central or PICC lines?
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Which of the following symptoms should be monitored in patients receiving TPN?
Which of the following symptoms should be monitored in patients receiving TPN?
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What is the preferred method for administering insulin when a patient is on TPN?
What is the preferred method for administering insulin when a patient is on TPN?
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What outcome indicates successful TPN therapy?
What outcome indicates successful TPN therapy?
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What complication is associated with sudden chest pain and dyspnea in TPN patients?
What complication is associated with sudden chest pain and dyspnea in TPN patients?
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To prevent hypoglycemia when TPN is unavailable, what should be kept at the bedside?
To prevent hypoglycemia when TPN is unavailable, what should be kept at the bedside?
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What is a crucial care management step when managing a TPN patient?
What is a crucial care management step when managing a TPN patient?
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What technique should be used to minimize the risk of infection in a patient receiving TPN?
What technique should be used to minimize the risk of infection in a patient receiving TPN?
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Which of the following actions should NOT be taken with TPN administration?
Which of the following actions should NOT be taken with TPN administration?
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What should be done if TPN shows signs of cracking?
What should be done if TPN shows signs of cracking?
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Which of the following symptoms is least likely to be associated with any type of hepatitis?
Which of the following symptoms is least likely to be associated with any type of hepatitis?
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What is the primary route of transmission for Hepatitis A?
What is the primary route of transmission for Hepatitis A?
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In the case of Hepatitis C, which group is most at risk for developing serious complications?
In the case of Hepatitis C, which group is most at risk for developing serious complications?
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Which of the following statements about hepatitis prevention is correct?
Which of the following statements about hepatitis prevention is correct?
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What symptom is specifically indicative of cirrhosis in hepatitis patients?
What symptom is specifically indicative of cirrhosis in hepatitis patients?
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Which hepatitis virus is known for having no vaccine available for prevention?
Which hepatitis virus is known for having no vaccine available for prevention?
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Considering the management of hepatitis, which of the following nutritional strategies is recommended?
Considering the management of hepatitis, which of the following nutritional strategies is recommended?
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Which laboratory finding is most likely elevated in a patient with hepatitis?
Which laboratory finding is most likely elevated in a patient with hepatitis?
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Which risk factor is most associated with Hepatitis B transmission?
Which risk factor is most associated with Hepatitis B transmission?
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Which of the following is NOT a sign of hepatitis?
Which of the following is NOT a sign of hepatitis?
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Which hepatitis type is transmitted primarily through contaminated blood and requires co-infection with Hepatitis B for infection?
Which hepatitis type is transmitted primarily through contaminated blood and requires co-infection with Hepatitis B for infection?
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Which symptom is commonly associated with hepatic cirrhosis but not specifically indicative of hepatitis itself?
Which symptom is commonly associated with hepatic cirrhosis but not specifically indicative of hepatitis itself?
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What is the primary nutritional recommendation for a patient with acute hepatitis?
What is the primary nutritional recommendation for a patient with acute hepatitis?
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What is the key method for preventing the transmission of Hepatitis A?
What is the key method for preventing the transmission of Hepatitis A?
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Which laboratory finding is typically expected to be elevated in patients with liver dysfunction due to hepatitis?
Which laboratory finding is typically expected to be elevated in patients with liver dysfunction due to hepatitis?
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Which of the following groups is considered most at risk for Hepatitis C infection?
Which of the following groups is considered most at risk for Hepatitis C infection?
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Which of the following is NOT a standard symptom exhibited during the acute phase of hepatitis infection?
Which of the following is NOT a standard symptom exhibited during the acute phase of hepatitis infection?
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What is the most significant risk factor for acquiring Hepatitis B?
What is the most significant risk factor for acquiring Hepatitis B?
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Which vitamin deficiency is often associated with liver diseases, particularly cirrhosis?
Which vitamin deficiency is often associated with liver diseases, particularly cirrhosis?
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Which of the following practices is least effective in preventing transmission of viral hepatitis?
Which of the following practices is least effective in preventing transmission of viral hepatitis?
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Study Notes
Enteral Nutrition
- Delivery Method: Nutrients delivered via tube, catheter, or stoma.
- Pre-Requisite: Patient must have a functional gastrointestinal (GI) tract (present bowel sounds).
- Assessment of Effectiveness: Monitor weight gain and albumin levels to assess protein status. Improved parameters indicate effective nutrition.
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Care Management:
- Use aseptic technique during all procedures.
- Verify all lines/tubes are correctly connected to patient to prevent accidental misconnections.
- Elevate head of bed (HOB) to >30 degrees during and for 30-60 minutes after feeding to prevent aspiration/reflux.
- Confirm tube placement before each feeding (X-ray or pH testing). Use caution – bolus or intermittent feeds of >200 mL can cause tolerance issues.
- Administer feedings at room temperature; warm or cold can cause diarrhea and abdominal discomfort.
- Do not microwave formula.
- Flush feeding tube with 15-30 mL of warm water every 4 hours to maintain tube patency and hydration. Crushing medications for oral administration should be done 1 medication at a time and flushed with warm water between medications.
- Introduce calories gradually.
- Discard feeding bag and tubing daily
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Complications:
- GI discomfort/diarrhea: Start infusion slowly and increase rate based on tolerance. Ensure feedings are at room temperature. Slow down rate. Notify healthcare provider. If diarrhea persists, evaluate for C. Diff.
- Dumping syndrome: Symptoms include rapid weight gain postprandial. Bolus or intermittent feeding can contribute to dumping syndrome; administer small, frequent, protein-rich meals. Avoid concentrated sugars and lactose. Avoid fluids for 1 hour before and after meals (do not take fluids with meals) and lie down for 20-30 minutes after meals.
- Infection: Discard supplies daily - strict hygiene
- Aspiration Pneumonia: Confirm placement, elevate HOB, stop feeding, turn patient, suction airway, administer oxygen, monitor vitals and lung sounds, notify HCP, get X-ray.
Total Parenteral Nutrition (TPN)
- Use: For patients with a nonfunctional GI tract or severe illness.
- Delivery Method: Delivered through central or PICC lines.
- Calorie Limit: Max 700 calories/day.
- Formula Composition: TPN is 70% glucose solution.
- Medication Administration: Only insulin and heparin are allowed to be added, per pharmacy protocols, to the TPN bag, to control blood glucose and clotting, respectively.
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Potential Complications:
- Metabolic Imbalances: Glucose imbalances, hypokalemia, hypophosphatemia, hypocalcemia are possible.
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Care Management:
- Assess for allergies (soybeans, safflower, eggs).
- Monitor blood glucose levels (BSL) frequently (every 4-6 hours).
- Monitor for hyperglycemia/hypoglycemia.
- NEVER stop TPN abruptly, this can cause severe hypoglycemia. Adjust rate gradually. Do not attempt “catch up” feeding increases to previous deficit.
- Monitor vital signs (VS) frequently (every 4-8 hours).
- Daily weight monitoring.
- Change TPN bag daily.
- TPN administration requires its own line and pump - no medications should be added to it via “piggybacking”.
- Monitor intake and output (I&O) to prevent dehydration/hypovolemia.
- Keep a backup dextrose solution (10%) on hand to treat hypoglycemia.
- Check TPN bag for abnormal signs [e.g., oil layer] and do not use if present. Contact pharmacy immediately.
- Gradually discontinue TPN to avoid rebound hypoglycemia.
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Desired Outcomes: Weight gain of 1 kg daily and increased albumin/pre-albumin levels.
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Complications:
- Infection: Strict aseptic technique is critical. Monitor for redness, tenderness, or drainage at the IV site. Change dressings and tubing per appropriate intervals.
- Air Embolus: Symptoms: SOB, chest pain, anxiety, hypoxia, increased heart rate. Immediate actions: clamp the catheter, place the patient on the left side in Trendelenburg position, administer oxygen, and notify the healthcare provider.
- Perforation: Symptoms: bleeding, decreased blood pressure, increased heart rate. Immediately notify the healthcare provider.
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Complications:
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Description
This quiz covers the essentials of enteral nutrition, including delivery methods, patient assessment, and care management practices. Key topics include ensuring a functional gastrointestinal tract and the importance of monitoring for effective nutrition. Test your knowledge on tube feeding protocols and safety measures.
