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What's parental nutrition and enteral nutrition?
Parental-thru tubes in to the vein, does not go thru the GI tract
- Enteral-goes thru GI tract via:
- NG Tube
- G Tube
- PO
- Rectal
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How does TPN get in to the vein?
PICC or central line
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What's hyperalimentation and result of it...
over admin of TPN
there is a lot of sugar in TPN, it will sit in the bowels and comprimise the cells, so now bacteria will be able to enter the blood stream
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Intralipids
IV fat emulssion that provides extra calories and fatty acids
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What's in TPN?
It is individually made for each pt based on morning labs. Provides amino acids, vitamins and minerals. All that they are missing or need
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What's Peripheral TPN mixed with? Central?
- Peripheral-10% Dextrose
- Central- 50% Dextrose
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Nursing care for a pt. on TPN
- Daily weight and I &O
- Assess for exudate (pus)
- Monitor temp q4
- WBC
- Change tubing every day!!! and....
- ***DRESSING CHANGES NEED TO BE STERILE
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How do I monitor a pt on TPN for hyperglycemia?
Do blood glucose test q6h. May require insulin
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What happens if TPN stops abruptly
Hypoglycemia....cuz pancreas is eating up all of the sugar, so even if it stops it is still eating it all up. Need to taper it back.
Hang D10% till a new bag of TPN is ready.
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What's PPN
- it is partial nutrition by parental and the other parent by enteral.
- Peripheral up to 10%
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Peripheral line
In the arms or legs, or external jugular for hand. It is used if you are needing an IV for less than 5 days.
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What kind of line is used for IV's lasting longer than a week?
Midline Catheter
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What do you flush lines with?
Central and peripheral
Heparin is central and saline lock is peripheral
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Central line or a PIC line
long catheter that's inserted and threaded up in to the SVC. Certified nurse can do it, but placement needs to be verified with an x-ray prior fluid insertion.
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If you are flushing a PICC line....how much do you use? and why?
only a 10ml syringe cuz it's a small line and 10ml creates less pressure
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Central Line
Inserted by Dr. in to subclavicular or intrajugular ven. Needs an x ray to look at placement
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Hickman
- Larger lumen
- tunneled under the skin
- insertion site is always away from the infection site
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Broviac
smaller lumen (kids), tunnelled under the skin
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Port a Cath
is under the skin for direct puncture and is kept in for years....chemo patients use this
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Quinton
Non tunneled catheter used for dialysis. Goes directly in to the vena cava. Last resort for admin of meds. Temporary
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What do I assess on pt getting TPN
- Daily weight
- I & O
- Pus (exudate)
- Temp q4
- WBC
- Blood Sugar q6
- Make sure dressing is changed by STERILE TECHNIQUE
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How does hyperglycemia happen to pt on TPN?
Lots of sugars in the solution, pancreas doesnt release enough insulin. May have to give insulin injection.
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How does infection occur from TPN?
Bacteria likes sugar, bowel is filled with bacteria. When the sugar isnt rid of by insulin it breaks down the intestines and bacteria gets in to the blood stream....sepsis
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