Chapter 25 Nutritional Support and IV Therapy Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Doctor’s Order  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  Have problems eating or refuse to eat or drink  Cannot eat enough to meet their nutritional needs Slide 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Enteral Nutrition  Enteral nutrition is giving nutrients into the gastro-intestinal (GI) tract through a feeding tube.  Gavage is the process of giving a tube feeding.  Tube feedings replace or supplement normal nutrition. Slide 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Common feeding tubes  Naso-gastric (NG) tube—Feeding tube is inserted through the nose into the stomach.  Naso-enteral tube—Feeding tube is inserted through the nose into the small bowel.  Gastrostomy tube (stomach tube)—Doctor surgically creates an opening in the stomach and a tube is inserted.  Jejunostomy tube—Feeding tube is inserted into a surgically created opening in the jejunum of the small intestine.  Percutaneous endoscopic gastrostomy (PEG) tube— Doctor inserts the feeding tube with an endoscope. Slide 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Enteral Nutrition (cont’d)

 Formulas  The doctor orders the type of formula, the amount to give, and when to give tube feedings.  Formula is given at room temperature.  Feeding times  Scheduled feedings (intermittent feedings) are given at certain times. At least 4 feedings are given each day. At least 4 feedings are given each day. The nurse uses a syringe or a feeding bag. The nurse uses a syringe or a feeding bag.  Continuous feedings are given over 24 hours. A feeding pump is used. A feeding pump is used. Slide 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Enteral Nutrition (cont’d)

 Report the following observations at once:  Nausea  Discomfort during the feeding  Vomiting  Distended (enlarged and swollen) abdomen  Coughing  Complaints of indigestion or heartburn  Redness, swelling, drainage, odor, or pain at the ostomy site  Fever  Signs and symptoms of respiratory distress  Increased pulse rate  Complaints of flatulence  Diarrhea Slide 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Enteral Nutrition (cont’d)

 Aspiration is a major risk from tube feedings.  Aspiration can occur: During insertion During insertion From tube movement out of place From tube movement out of place From regurgitation From regurgitation  To help prevent regurgitation and aspiration: Position the person in Fowler’s or semi-Fowler’s position before the feeding. 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. 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. Avoid the left side-lying position. Slide 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Enteral Nutrition (cont’d)

 Persons with feeding tubes usually are not allowed to eat or drink.  Dry mouth, dry lips, and sore throat can cause discomfort.  Feeding tubes can:  Irritate and cause pressure on the nose  Change the shape of the nostrils  Cause pressure ulcers  Assisting the nurse with tube feedings  In some states and agencies, nursing assistants give tube feedings and remove NG tubes.  You are never responsible for inserting feeding tubes or checking their placement. Slide 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Enteral Nutrition (cont’d)

 Parenteral nutrition is giving nutrients through a catheter inserted into a vein.  Often called total parenteral nutrition (TPN) or hyperalimentation  Nutrient solution is given directly into the bloodstream; nutrients do not enter the GI tract.  This method is used when:  The person cannot receive oral or enteral feedings.  Oral or enteral feedings are not enough to meet the person’s needs. Slide 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Parenteral Nutrition

 Report the following to the nurse at once:  Fever, chills, and other signs and symptoms of infection  Signs and symptoms of sugar imbalances  Chest pain  Difficulty breathing or shortness of breath  Cough  Nausea and vomiting  Diarrhea  Thirst  Rapid heart rate or an irregular heartbeat  Weakness or fatigue  Sweating  Pallor (pale skin)  Trembling  Confusion or behavior changes Slide 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Parenteral Nutrition (cont’d)

 Assisting with TPN  The nurse is responsible for all aspects of TPN.  You assist the nurse by carefully observing the person.  You assist with the person’s basic needs and activities of daily living. Slide 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Parenteral Nutrition (cont’d)

 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.  Replace minerals and vitamins lost because of illness or injury.  Provide sugar for energy.  Give drugs and blood.  RNs are responsible for IV therapy.  State laws vary about your role and that of LPNs/LVNs in IV therapy. Slide 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. IV Therapy

 Peripheral and central venous sites are used.  Peripheral IV sites are away from the center of the body.  Central IV sites are close to the heart. The subclavian vein and the internal jugular vein are central venous sites. 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). 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: For parenteral nutrition For parenteral nutrition To give large amounts of fluid To give large amounts of fluid For long-term IV therapy For long-term IV therapy To give drugs that irritate peripheral veins To give drugs that irritate peripheral veins Slide 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. IV Therapy (cont’d)

 Basic equipment used in IV therapy  The solution container is a plastic bag. It is called the IV bag. It is called the IV bag.  A catheter or needle is inserted into a vein.  The IV tube or infusion tubing connects the IV bag to the catheter or needle. Fluid drips from the bag into the drip chamber. The clamp is used to regulate the flow rate.  The IV bag hangs from an IV pole (IV standard) or ceiling hook. Slide 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. IV Therapy (cont’d)

 Flow rate  The doctor orders the amount of: Fluid to give (infuse) Fluid to give (infuse) Time to give it in Time to give it in  The RN figures the flow rate. The flow rate is the number of drops per minute (gtt/min) or milliliters per hour (mL/hr). The flow rate is the number of drops per minute (gtt/min) or milliliters per hour (mL/hr).  The RN sets the clamp for the flow rate or an electronic pump may be used to control the flow rate. An alarm sounds if something is wrong. An alarm sounds if something is wrong. Tell the nurse at once if you hear an alarm. Tell the nurse at once if you hear an alarm. Slide 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. IV Therapy (cont’d)

 Never change the position of the clamp or adjust any controls on IV pumps.  You can check the flow rate if a pump is not used. Count number of drops in 1 minute. Count number of drops in 1 minute.  Tell the RN at once if: No fluid is dripping. No fluid is dripping. The rate is too fast. The rate is too fast. The rate is too slow. The rate is too slow.  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. Tell the RN at once if too much or too little fluid was given. Slide 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. IV Therapy (cont’d)

 Your state and agency may allow you to: Change dressings at peripheral IV sites. Change dressings at peripheral IV sites. Discontinue a peripheral IV. Discontinue a peripheral IV.  You are never responsible for: Starting or maintaining IV therapy Starting or maintaining IV therapy Regulating the flow rate Regulating the flow rate Changing IV bags Changing IV bags Giving blood or IV drugs Giving blood or IV drugs Slide 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. IV Therapy (cont’d)