Nursing Process - Pharmacology

Assessment

  • Assess the tape around the nasogastric tube
  • Assess sign and symptoms of intolerance to feedings
  • Intake and output
  • Bowel sounds
  • Baseline laboratory values

Nursing Diagnoses

  • Risk for fluid volume deficit
  • Risk for diarrhea related to tube feedings
  • Potential for loss of skin integrity related to diarrhea
  • Risk for aspiration

Planning

  • Patient will receive adequate nutritional support
  • Side effects will be managed
  • No skin breakdown will occur
  • Patient will not aspirate

Interventions

  • Check tube placement
  • Check for gastric residual before intermittent or bolus feedings
  • Check continues feedings for residual every 2 to 4 hours
  • Feeding should be at room temperature
  • Flush feeding tube based on method of delivery
  • Monitor side effects such as diarrhea
  • Dilute drug solutions appropriately
  • Monitor vital signs
  • Monitor hydration
  • Weigh patient daily
  • Change feeding bag daily

Education

  • Patient should report diarrhea, sore throat, and abdominal cramping Evaluation
  • Patient will not lose weight
  • Patient will not have skin break down
  • Patient will not experience diarrhea, abdominal cramping or distention
  • Patient will remain in a positive nitrogen balance
  • Patient will not become dehydrated

PARENTERAL NUTRITION

Parenteral nutrition support is used for patients who have severe burns, disorders of the GI tract, acquired immunodeficiency syndrome (AIDS), or a debilitating disease such as metastatic cancer.

These patients receive an infusion of a solution that contains hyperosmolar glucose, amino acids, vitamins, electrolytes, minerals, and trace elements. In addition, the patient might be given fat emulsion supplemental therapy to increase the number of calories and to receive fat-soluble vitamins. The infusion is given through a central venous line such as the subclavian or internal jugular vein to prevent irritation to the peripheral veins.

The nurse must monitor the patient for signs of complications as a result of inserting the catheter and the infusion of the feeding.

Catheter insertion can cause

  • Pneumothorax.
  • Hemothorax.
  • Hydrothorax.

Parental nutrition infusion can cause:

  • Air embolism.
  • Infection.
  • Hyperglycemia.
  • Hypoglycemia.
  • Fluid overload.

It is important that strict asepsis (gloves and masks) be used when changing the IV tubing and the dressing at the infusion site because parenteral nutrition solutions are an excellent medium for yeast and bacteria to grow. The pharmacy uses a laminar airflow hood when preparing parenteral nutritional solutions to reduce this risk.

Monitor the patient carefully for hyperglycemia when you initiate parenteral nutrition support because the pancreas needs time to adjust to the hypertonic dextrose solution, which is high in glucose. Sometimes hyperglycemia is temporary and dissipates once the pancreas makes the necessary adjustments.

However, hyperglycemia might persist if the infusion rate is too fast. To prevent this from occurring, begin with 1 liter of solution for the first 24 hours. Increase this by 500 to 1000 mL each day until you reach a daily volume of 2500 mL to 3000 mL.

Change the solution and tubing every 24 hours. Change the dressing every 48 to 72 hours or according to the agency policy.

Caution: Don’t suddenly interrupt parenteral nutrition support because the patient can experience hypoglycemia. Discontinue gradually by decreasing the infusion rate. However, hypoglycemia may occur in spite these precautions.


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Pharmacology Topics