1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 23 Nutritional Support and IV Therapy

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Enteral nutrition is giving nutrients into the gastrointestinal tract through a feeding tube.  Nasogastric (NG) tube  Nasointestinal tube Nasoduodenal tube Nasoduodenal tube Nasojejunal tube Nasojejunal tube  Gastrostomy tube (stomach tube)  Jejunostomy tube  Percutaneous endoscopic gastrostomy (PEG) tube

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The doctor orders: The type of formula The type of formula The amount to give The amount to give When to give tube feedings When to give tube feedings  A nurse gives formula through the feeding tube.  Formula is given at room temperature.  Tube feedings are given: At certain times (scheduled feedings) At certain times (scheduled feedings) Over a 24-hour period (continuous feedings) Over a 24-hour period (continuous feedings)  A feeding pump is used.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Aspiration is a major risk from tube feedings. It can cause pneumonia and death. It can cause pneumonia and death.  Aspiration can occur: During insertion During insertion If the tube moves out of place If the tube moves out of place From regurgitation From regurgitation  To assist the nurse in preventing 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.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Persons with feeding tubes usually are NPO. 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  The following measures are common: Clean the nose and nostrils every 4 to 8 hours. Clean the nose and nostrils every 4 to 8 hours. Secure the tube to the nose. Secure the tube to the nose. Secure the tube to the person’s garment at the shoulder area. Secure the tube to the person’s garment at the shoulder area.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  You assist the nurse with tube feedings. In some states and centers, nursing assistants give tube feedings and remove NG tubes. In some states and centers, nursing assistants give tube feedings and remove NG tubes.  You are never responsible for inserting feeding tubes or checking their placement.

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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.

21. Slide 21 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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

22. Slide 22 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. 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

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Assisting with TPN The nurse is responsible for all aspects of TPN. The nurse is responsible for all aspects of TPN. You assist the nurse by carefully observing the person. You assist the nurse by carefully observing the person. You assist the nurse with the person’s basic needs and activities of daily living. You assist the nurse with the person’s basic needs and activities of daily living.

24. Slide 24 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  IV THERAPY (INTRAVENOUS THERAPY, IV INFUSION)  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  RNs are responsible for IV therapy.  Peripheral and central venous sites are used. Peripheral sites are away from the center of the Peripheral sites are away from the center of thebody. Central sites are close to the heart. Central sites are close to the heart.

25. Slide 25 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  IV equipment The solution container is a plastic bag. The solution container is a plastic 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.

29. Slide 29 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. Or an electronic pump is used to control the flow rate. Or an electronic pump is used to control the flow rate.  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. 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. 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

32. Slide 32 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Assisting with IV therapy Your state and center may allow you to: Your state and center 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

33. Slide 33 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Persons needing nutritional support or IV therapy are often very ill.  At all times, you must give quality care and protect the person’s rights.  Sometimes decisions are made to stop nutritional support or IV therapy. Talk to the nurse if you have problems with the decision. Talk to the nurse if you have problems with the decision.