Chapter 20 Nutritional Support and IV Therapy All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

Chapter 20

Nutritional Support and IV Therapy

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Nutritional Support and IV Therapy

Reasons for nutritional support Many persons cannot eat or drink because of

illness, surgery, or injury. Chewing or swallowing problems Refusal to eat or drink Inability to eat enough to meet nutritional needs Food cannot pass from the mouth into the

stomach or small intestines. Nutritional support or intravenous (IV) therapy

Ordered by the doctor to meet food and fluid needs

2All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Enteral Nutrition

Enteral nutrition is giving nutrients into the gastro-intestinal tract through a feeding tube. Naso-gastric (NG) tube Naso-enteral tube

• Nasoduodenal tube

• Nasojejunal tube

Gastrostomy tube (stomach tube) Jejunostomy tube Percutaneous endoscopic gastrostomy (PEG)

tube


Formulas

The doctor orders: The type of formula The amount to give 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, intermittent feedings) Over a 24-hour period (continuous feedings)

• A feeding pump is used.


Report Immediately

Report the following observations at once: Nausea Discomfort during the feeding Vomiting Distended 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


Preventing Aspiration

Aspiration is a major risk from tube feedings. It can cause pneumonia and death.

Aspiration can occur: During insertion If the tube moves out of place 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.

• 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.


Comfort Measures

Persons with feeding tubes usually are NPO (nothing by

mouth). 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

The following measures are common: Clean the nose and nostrils every 4 to 8 hours.

Secure the tube to the nose.

Secure the tube to the person’s garment at the shoulder area.


Tube Feedings

You assist the nurse with tube feedings. 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.


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. Oral or enteral feedings are not enough to meet

the person’s needs.

TPN risks include infection, fluid imbalances, and blood sugar imbalances.


Observations to Report

Report the following signs and symptoms to the nurse at once: Fever, chills, and other signs and symptoms of infection

Signs and symptoms of sugar imbalances

Chest pain

Difficulty breathing, shortness of breath, or cough

Nausea, vomiting, or diarrhea

Thirst

Rapid heart rate or an irregular heartbeat

Weakness or fatigue

Sweating

Pallor or trembling

Confusion or changes in behavior


Caring for the Person with TPN

Assisting with TPN The nurse is responsible for all aspects of TPN. You assist the nurse by carefully observing the

person. You assist the nurse with the person’s basic needs

and activities of daily living.


Intravenous Therapy(IV Therapy, IV Infusion)

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. Peripheral and central venous sites are used.

Peripheral sites are away from the center of the body. Central sites are close to the heart.


Equipment

IV equipment The solution container is a plastic 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.


Flow Rate

Flow rate is number of drops per minute The RN sets the clamp for 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. Never change the position of the clamp or adjust any

controls on IV pumps. You can check the flow rate by counting drops in 1 minute or

comparing the fluid line with the time line on the time tape. Tell the RN at once if:

• No fluid is dripping.• The rate is too fast.• The rate is too slow.


Assisting with IV Therapy

Assisting with IV therapy Your state and center may allow you to:

• Change dressings at peripheral IV sites

• Discontinue a peripheral IV

You are never responsible for:• Starting or maintaining IV therapy

• Regulating the flow rate

• Changing IV bags

• Giving blood or IV drugs


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.


Documents

Chapter 20 Nutritional Support and IV Therapy All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved