1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 24 Nutritional Support and IV Therapy

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  The doctor may order nutritional support or IV therapy to meet food and fluid needs for: Persons who cannot eat or drink because of illness, surgery, or injury Persons who cannot eat or drink because of illness, surgery, or injury Persons who have problems eating or refuse to eat or drink Persons who have problems eating or refuse to eat or drink Persons who cannot eat enough to meet their nutritional needs Persons who cannot eat enough to meet their nutritional needs

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  ENTERAL NUTRITION  Enteral nutrition is giving nutrients into the gastrointestinal tract through a feeding tube.  Nasogastric (NG) tube A feeding tube is inserted through the nose into the stomach. A feeding tube is inserted through the nose into the stomach.  Nasointestinal tube A nasoduodenal tube is inserted into the duodenum. A nasoduodenal tube is inserted into the duodenum. A nasojejunal tube is inserted into the jejunum. A nasojejunal tube is inserted into the jejunum.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  Gastrostomy tube (stomach tube) A doctor surgically creates an opening in the stomach. A doctor surgically creates an opening in the stomach.  Jejunostomy tube A feeding tube is inserted into a surgically created opening in the jejunum of the small intestine. A feeding tube is inserted into a surgically created opening in the jejunum of the small intestine.  Percutaneous endoscopic gastrostomy (PEG) tube The doctor inserts the feeding tube with an endoscope. The doctor inserts the feeding tube with an endoscope.

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  Formulas The doctor orders the type of formula, the amount to give, and when to give tube feedings. The doctor orders the type of formula, the amount to give, and when to give tube feedings. A nurse gives formula through the feeding tube. A nurse gives formula through the feeding tube. Formula is given at room temperature. Formula is given at room temperature. Sometimes formula is kept cold with ice chips around the container. Sometimes formula is kept cold with ice chips around the container.  Scheduled feedings (intermittent feedings) are given at certain times.  Continuous feedings are given over a 24-hour period. A feeding pump is used. A feeding pump is used.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  Report the following observations at once: Nausea Nausea Discomfort during the feeding Discomfort during the feeding Vomiting Vomiting Distended abdomen Distended abdomen Coughing Coughing Complaints of indigestion or heartburn Complaints of indigestion or heartburn Redness, swelling, drainage, odor, or pain at the ostomy site Redness, swelling, drainage, odor, or pain at the ostomy site Fever Fever Signs and symptoms of respiratory distress Signs and symptoms of respiratory distress Increased pulse rate Increased pulse rate Complaints of flatulence Complaints of flatulence Diarrhea Diarrhea

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  Aspiration is a major risk from tube feedings. Aspiration can occur: Aspiration can occur:  During insertion  From tube movement out of place  From regurgitation To assist the nurse in preventing regurgitation and aspiration: To assist the nurse in preventing regurgitation and aspiration:  Position the person in Fowler’s or semi-Fowler’s position before the feeding. –Follow the care plan and the nurse’s directions.  Maintain Fowler’s or semi-Fowler’s position after the feeding. –Follow the care plan and the nurse’s directions.  Avoid the left side-lying position.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  Persons with feeding tubes usually are not allowed to eat or drink. Dry mouth, dry lips, and sore throat can cause discomfort. Dry mouth, dry lips, and sore throat can cause discomfort.  Feeding tubes can: Irritate and cause pressure on the nose Irritate and cause pressure on the nose Change the shape of the nostrils Change the shape of the nostrils Cause pressure ulcers Cause pressure ulcers  In some states and agencies, nursing assistants: Give tube feedings Give tube feedings Remove NG tubes Remove NG tubes  You are never responsible for inserting feeding tubes or checking their placement.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  PARENTERAL NUTRITION (Total Parenteral Nutrition, TPN, Hyperalimentation)  Parenteral nutrition is giving nutrients through a catheter inserted into a vein.  This method is used when: The person cannot receive oral feedings or enteral feedings The person cannot receive oral feedings or enteral feedings Oral or enteral feedings are not enough to meet the person’s needs Oral or enteral feedings are not enough to meet the person’s needs  TPN risks include infection, fluid imbalances, and blood sugar imbalances.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  Report the following signs and symptoms to the nurse at once: Fever, chills, and other signs and symptoms of infection Fever, chills, and other signs and symptoms of infection Signs and symptoms of sugar imbalances Signs and symptoms of sugar imbalances Chest pain Chest pain Difficulty breathing or shortness of breath Difficulty breathing or shortness of breath Cough Cough Nausea and vomiting Nausea and vomiting Diarrhea Diarrhea

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11 Thirst Thirst Rapid heart rate or an irregular heartbeat Rapid heart rate or an irregular heartbeat Weakness or fatigue Weakness or fatigue Sweating Sweating Pallor Pallor Trembling Trembling Confusion or changes in behavior Confusion or changes in behavior

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  The nurse is responsible for all aspects of TPN. You assist the nurse: You assist the nurse:  By carefully observing the person  With the person’s basic needs and activities of daily living  By following the person’s care plan Many aspects of IV therapy apply to TPN. Many aspects of IV therapy apply to TPN.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  IV THERAPY  Intravenous (IV) therapy (IV infusion) is giving fluids through a needle or catheter inserted into a vein.  Doctors order IV therapy to: Provide fluids when they cannot be taken by mouth Provide fluids when they cannot be taken by mouth Replace minerals and vitamins lost because of illness or injury Replace minerals and vitamins lost because of illness or injury Provide sugar for energy Provide sugar for energy Give drugs and blood Give drugs and blood

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  RNs are responsible for IV therapy.  State laws vary regarding the role of LPNs/LVNs and nursing assistants in IV therapy.

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  Peripheral and central venous sites are used. Peripheral IV sites are away from the center of the body. Peripheral IV sites are away from the center of the body. Central IV sites are close to the heart. Central IV sites are close to the heart.  The subclavian vein and the internal jugular vein are central venous sites.  The cephalic and basilic veins in the arm also are used. Catheters inserted into these sites are called peripherally inserted central catheters (PICCs). Central venous sites are used: Central venous sites are used:  For parenteral nutrition  To give large amounts of fluid  For long-term IV therapy  To give drugs that irritate peripheral veins

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  The basic equipment used in IV therapy The solution container is a plastic bag. The solution container is a plastic bag.  It is called the IV bag. A catheter or needle is inserted into a vein. A catheter or needle is inserted into a vein. The IV tube or infusion tubing connects the IV bag to the catheter or needle. The IV tube or infusion tubing connects the IV bag to the catheter or needle. Fluid drips from the bag into the drip chamber. Fluid drips from the bag into the drip chamber. The clamp is used to regulate the flow rate. The clamp is used to regulate the flow rate. The IV bag hangs from an IV pole (IV standard) or ceiling hook. The IV bag hangs from an IV pole (IV standard) or ceiling hook.

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  Flow rate The doctor orders: The doctor orders:  The amount of fluid to give (infuse)  The amount of time to give it in The RN figures the flow rate. The RN figures the flow rate.  The flow rate is the number of drops per minute (gtt/min). The RN sets the clamp for the flow rate. The RN sets the clamp for the flow rate. An electronic pump may be used to control the flow rate. An electronic pump may be used to control the flow rate.  An alarm sounds if something is wrong.  Tell the nurse at once if you hear an alarm.

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18 Never change the position of the clamp or adjust any controls on IV pumps. Never change the position of the clamp or adjust any controls on IV pumps. You can check the flow rate. You can check the flow rate.  To check the flow rate, count the number of drops in 1 minute. Tell the RN at once if: Tell the RN at once if:  No fluid is dripping  The rate is too fast  The rate is too slow The time tape shows how much fluid to give over a period of time. The time tape shows how much fluid to give over a period of time.  Tell the RN at once if too much or too little fluid was given.

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19 Your state and agency may allow you to: Your state and agency may allow you to:  Change dressings at peripheral IV sites  Discontinue a peripheral IV You are never responsible for: You are never responsible for:  Starting or maintaining IV therapy  Regulating the flow rate  Changing IV bags  Giving blood or IV drugs