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

Chapter 25Chapter 25

Nutritional Support Nutritional Support and IV Therapyand IV Therapy

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Doctor’s OrderDoctor’s Order

The doctor may order nutritional support or The doctor may order nutritional support or IV therapy to meet food and fluid needs for IV therapy to meet food and fluid needs for persons who:persons who: Cannot eat or drink because of illness, surgery, Cannot eat or drink because of illness, surgery,

or injuryor injury Have problems eating or refuse to eat or drinkHave problems eating or refuse to eat or drink Cannot eat enough to meet their nutritional Cannot eat enough to meet their nutritional

needsneeds

Slide 2Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Enteral NutritionEnteral Nutrition

Enteral nutrition is giving nutrients into the Enteral nutrition is giving nutrients into the gastro-intestinal (GI) tract through a feeding gastro-intestinal (GI) tract through a feeding tube.tube. Gavage is the process of giving a tube feeding.Gavage is the process of giving a tube feeding. Tube feedings replace or supplement normal Tube feedings replace or supplement normal

nutrition.nutrition.


Common feeding tubesCommon feeding tubes Naso-gastric (NG) tube—Feeding tube is inserted through Naso-gastric (NG) tube—Feeding tube is inserted through

the nose into the stomach.the nose into the stomach. Naso-enteral tube—Feeding tube is inserted through the Naso-enteral tube—Feeding tube is inserted through the

nose into the small bowel.nose into the small bowel. Gastrostomy tube (stomach tube)—Doctor surgically Gastrostomy tube (stomach tube)—Doctor surgically

creates an opening in the stomach and a tube is inserted.creates an opening in the stomach and a tube is inserted. Jejunostomy tube—Feeding tube is inserted into a Jejunostomy tube—Feeding tube is inserted into a

surgically created opening in the jejunum of the small surgically created opening in the jejunum of the small intestine.intestine.

Percutaneous endoscopic gastrostomy (PEG) tube—Percutaneous endoscopic gastrostomy (PEG) tube—Doctor inserts the feeding tube with an endoscope.Doctor inserts the feeding tube with an endoscope.


Enteral Nutrition (cont’d)Enteral Nutrition (cont’d)

FormulasFormulas The doctor orders the type of formula, the The doctor orders the type of formula, the

amount to give, and when to give tube feedings.amount to give, and when to give tube feedings. Formula is given at room temperature.Formula is given at room temperature.

Feeding timesFeeding times Scheduled feedings (intermittent feedings) are Scheduled feedings (intermittent feedings) are

given at certain times.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.Continuous feedings are given over 24 hours.• A feeding pump is used.A feeding pump is used.



Report the following observations at once:Report the following observations at once: NauseaNausea Discomfort during the feedingDiscomfort during the feeding VomitingVomiting Distended (enlarged and swollen) abdomenDistended (enlarged and swollen) abdomen CoughingCoughing Complaints of indigestion or heartburnComplaints of indigestion or heartburn Redness, swelling, drainage, odor, or pain at the ostomy Redness, swelling, drainage, odor, or pain at the ostomy

sitesite FeverFever Signs and symptoms of respiratory distressSigns and symptoms of respiratory distress Increased pulse rateIncreased pulse rate Complaints of flatulence Complaints of flatulence DiarrheaDiarrhea



Aspiration is a major risk from tube feedings.Aspiration is a major risk from tube feedings. Aspiration can occur:Aspiration can occur:

• During insertionDuring insertion

• From tube movement out of placeFrom tube movement out of place

• From regurgitationFrom regurgitation

To help prevent regurgitation and aspiration:To help prevent regurgitation and aspiration:• Position the person in Fowler’s or semi-Fowler’s Position the person in Fowler’s or semi-Fowler’s

position before the feeding.position before the feeding. Follow the care plan and the nurse’s directions.Follow the care plan and the nurse’s directions.

• Maintain Fowler’s or semi-Fowler’s position after the Maintain Fowler’s or semi-Fowler’s position after the feeding.feeding. Follow the care plan and the nurse’s directions.Follow the care plan and the nurse’s directions.

• Avoid the left side-lying position.Avoid the left side-lying position.



Persons with feeding tubes usually are not Persons with feeding tubes usually are not allowed to eat or drink.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: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 ulcersCause pressure ulcers

Assisting the nurse with tube feedingsAssisting the nurse with tube feedings In some states and agencies, nursing assistants give tube In some states and agencies, nursing assistants give tube

feedings and remove NG tubes.feedings and remove NG tubes. You are never responsible for inserting feeding tubes or You are never responsible for inserting feeding tubes or

checking their placement.checking their placement.



Comfort Measures

Common comfort measures every 2 hours while the person is awake include oral hygiene, lubricant for the lips, and mouth rinses.

Measures for nose irritation include cleaning the nose and nostrils every 4 to 8 hours, and securing the tube to the nose and to the person’s garment at the shoulder area to prevent pulling or dangling.

• Tube feeding can only hang for 8 hours

Parenteral nutrition is giving nutrients through Parenteral nutrition is giving nutrients through a catheter inserted into a vein.a catheter inserted into a vein. Often called Often called total parenteral nutritiontotal parenteral nutrition (TPN) or (TPN) or

hyperalimentationhyperalimentation Nutrient solution is given directly into the Nutrient solution is given directly into the

bloodstream; nutrients do not enter the GI tract.bloodstream; nutrients do not enter the GI tract. This method is used when:This method is used when:

The person cannot receive oral or enteral The person cannot receive oral or enteral feedings. ie gastric paresisfeedings. ie gastric paresis

Oral or enteral feedings are not enough to meet Oral or enteral feedings are not enough to meet the person’s needs.the person’s needs.


Parenteral NutritionParenteral Nutrition

Total Parenteral NutritionTotal Parenteral Nutrition

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 18

Report the following to the nurse at once:Report the following to the nurse at once: Fever, chills, and other signs and symptoms of infectionFever, chills, and other signs and symptoms of infection Signs and symptoms of sugar imbalancesSigns and symptoms of sugar imbalances Chest painChest pain Difficulty breathing or shortness of breathDifficulty breathing or shortness of breath CoughCough Nausea and vomitingNausea and vomiting DiarrheaDiarrhea ThirstThirst Rapid heart rate or an irregular heartbeatRapid heart rate or an irregular heartbeat Weakness or fatigueWeakness or fatigue SweatingSweating Pallor (pale skin)Pallor (pale skin) TremblingTrembling Confusion or behavior changesConfusion or behavior changes


Parenteral Nutrition (cont’d)Parenteral Nutrition (cont’d)

Assisting with TPNAssisting 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 You assist the nurse by carefully observing the

person:person: Protecting the IV when ambulating, following Bloodborne Protecting the IV when ambulating, following Bloodborne

Pathogen Standard and reporting any site issues to the nurse. Pathogen Standard and reporting any site issues to the nurse.

You assist with the person’s basic needs and You assist with the person’s basic needs and activities of daily living.activities of daily living.


Parenteral Nutrition (cont’d)Parenteral Nutrition (cont’d)

Intravenous (IV) therapy (IV infusion) is giving fluids Intravenous (IV) therapy (IV infusion) is giving fluids through a needle or catheter inserted into a vein.through a needle or catheter inserted into a vein.

Doctors order IV therapy to: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 Replace minerals and vitamins lost because of illness

or injury.or injury. Provide sugar for energy.Provide sugar for energy. Give drugs and blood.Give drugs and blood.

RNs are responsible for IV therapy.RNs are responsible for IV therapy. State laws vary about your role and that of State laws vary about your role and that of

LPNs/LVNs in IV therapy.LPNs/LVNs in IV therapy.


IV TherapyIV Therapy

Peripheral and central venous sites are used.Peripheral and central venous sites are used. Peripheral IV sites are away from the center of the Peripheral IV sites are away from the center of the

body.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 The subclavian vein and the internal jugular vein are central venous sites.central venous sites.

• The cephalic and basilic veins in the arm also are used. The cephalic and basilic veins in the arm also are used. Catheters inserted into these sites are called Catheters inserted into these sites are called peripherally peripherally inserted central catheters inserted central catheters (PICCs).(PICCs).

Central venous sites are used:Central venous sites are used:• For parenteral nutritionFor parenteral nutrition• To give large amounts of fluid To give large amounts of fluid • For long-term IV therapyFor long-term IV therapy• To give drugs that irritate peripheral veinsTo give drugs that irritate peripheral veins


IV Therapy (cont’d)IV Therapy (cont’d)

Basic equipment used in IV therapyBasic equipment used in IV therapy The solution container is a plastic bag.The solution container is a plastic bag.

• It is called the It is called the IV bagIV 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 The IV tube or infusion tubing connects the IV

bag to the catheter or needle. Fluid drips from the bag to the catheter or needle. Fluid drips from the bag into the drip chamber. The clamp is used to bag into the drip chamber. The clamp is used to regulate the flow rate.regulate the flow rate.

The IV bag hangs from an IV pole (IV standard) The IV bag hangs from an IV pole (IV standard) or ceiling hook.or ceiling hook.



Flow rateFlow rate The doctor orders the amount of:The doctor orders the amount of:

• Fluid to give (infuse)Fluid to give (infuse)

• Time to give it inTime 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 flow rate is the number of drops per minute (gtt/min)

or milliliters per hour (mL/hr).or milliliters per hour (mL/hr).

The RN sets the clamp for the flow rate or an The RN sets the clamp for the flow rate or an electronic pump may be used to control the flow electronic pump may be used to control the flow rate.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.



Never change the position of the clamp or adjust Never change the position of the clamp or adjust any controls on IV pumps.any controls on IV pumps.

You can check the flow rate if a pump is not used.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: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 MD orders specify how much fluid to give over The MD orders specify how much fluid to give over a certain time perioda certain time period



Your state and agency may allow you to: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:You are never responsible for:• Starting or maintaining IV therapyStarting or maintaining IV therapy

• Regulating the flow rateRegulating the flow rate

• Changing IV bagsChanging IV bags

• Giving blood or IV drugsGiving blood or IV drugs



Documents

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