The process by which nutrient molecules pass through the wall of the digestive system into the blood.

Anorexia lack of appetite - BMI of less than 18.5

Anorexia Nervosa an eating disorder in which a normal-weight person diets and becomes significantly underweight, yet, still feeling fat, continues to starve

Anthropometric relating to measurement of the physical characteristics of the body, such as height and weight-- take weight before breakfast.

Aspiration Breathing fluid, food, vomitus, or an object into the lungs

Basal Metabolism body processes involving involuntary activities only, such as breathing, heartbeat, and chemical reactions of the body at rest

Body Mass Index (BMI) a ratio that allows you to assess your body size in relation to your height and weight

Bulimia eating disorder characterized by excessive eating followed by purging often occurs with anorexia nervosa

Calorie unit of heat defined as the quantity of heat required to raise the temperature of 1 gram of water by 1 degree centigrade at atmospheric pressure only carbs,protein,and fat provide energy--- Vitamins and minerals needed for the metabolism of energy , do not provide calories.

Carbohydrate any organic compound that is made of carbon, hydrogen, and oxygen and that provides nutrients to the cells of living things

Cholesterol a steroid that forms an essential component of animal cell membranes and acts as a precursor molecule for the synthesis of other biologically important steroids, such as hormones.

Clear Liquid Diet a diet that consists of foods that are liquid at room temperature and leave little residue in the intestine. Ex: Water, Sprite, Ginger Ale, all beverages without any residue, broth, Jello

Digestion The process by which the digestive system breaks food down into nutrients that are transported to the cells

Dysphagia inability to swallow or difficulty swallowing

Enteral Nutrition alternate form of feeding that involves passing a tube into the gastrointestinal tract to allow instillation of the appropriate formula

Full Liquid Diet diet that contains milk, plain frozen desserts, pasteurized eggs, cereal gruels, and milk and egg substitutes in addition to clear liquids; contains liquids that can be poured at room temperature

Gastrostomy surgical creation of an opening into the stomach for the purpose of administering foods and fluids(Long term feeding)

Ketosis presence of an abnormal amount of ketone bodies in the blood and urine indicating an abnormal utilization of carbohydrates as seen in uncontrolled diabetes

and starvation is frequently associated with acidosis

Lipid organic compounds made mostly of carbon and hydrogen with a small amount of oxygen; examples are fats, oils, waxes, and steroids; are insoluble in water and used by cells for energy storage, insulation, and protective coatings, such as in membranes

Minerals inorganic crystalline substances found naturally in the earth,found in all body fluids and tissues in the form of salt Nacl, or combined with organic compounds iron in hemogoblin-- some minerals provide structure in the body some regulate body processes.

Nasogastric (NG) Tube flexible catheter is inserted into nose and down esophagus to stomach; may be for feeding or to suction out stomach fluids (usually short term less than 4 weeks)-- risk for aspiration nasal injury or Gerd or unable to have head elevated are not candidates for NG tube..

Nasointestinal (NI) Tube tube inserted through the nose and into the upper portion of the small intestine (usually short term less than 4 weeks)

NPO nothing by mouth

Nutrient Substances needed for cells to function and be repaired, for energy, and for growth. Main nutrients: protein, carbohydrates, lipids (fats), vitamins and minerals

Nutrition the study of nutrients and how they are used by the body, as well as the impact of human behavior and environment on the process of nourishment it involves physiology,psychology,and socioeconomic s.

Obesity weighing twenty percent or more above desirable weight for height; in an adult, obesity is defined as a body mass index of 30 or more extremely obese BMI of 40 or more

Parenteral Nutrition A mode of feeding that does not use the GI tract, instead providing nutrition by intravenous delivery of nutrient solutions

Percutaneous Endoscopic Gastrostomy Tube (PEG)

surgically or laparoscopically placed gastrostomy tube, inserted into stomach for feeding. ( long term feeding)

Peripheral Parenteral Nutrition (PPN)

( IV) prescribed for patients who require nutrient supplementation through a peripheral vein because they have an inadequate intake of oral feedings

Protein macromolecule that contains carbon, hydrogen, oxygen, and nitrogen; needed by the body for growth and repair and to make up enzymes

Recommended Dietary Allowance (RDA)

the average daily nutrient intake level that meets the nutrient requirements of 97% to 98% of healthy individuals in a particular life stage and gender group

Residual feeding remaining in the stomach when tube feeding,- check for residual before each feeding or every 4 to 6 hours during continuous feeding - High gastric residual volumes 200 to 250 ml or greater look for high risk for aspiration and pneumonia. -- some times withhold feeding if residual is greater then 200 ml .. Flush tube with water after checking gastric residual.

Macrominerals Ca, Cl, Mg, P, K, Na, S needed in body at greater than 100mg/day

microminerals needed in smaller amounts. Fe, Co, Cu, Mn, I, Se, Cr, Mb,Flless than 100mg/day

Gastric gavage feeding through a tube in the stomach., instillation of liquid nutritional supplement into the stomach, feeding

jejunostomy tube hollow tube inserted into the jejunum through the abdominal wall for administration of liquefied foods for patients who have a high risk of aspiration (long term feeding)

Hemoglobin Normal 12-18 g/dl under 12 = anemia

Hematocrit normal ranges- FEMALES: 36 - 48; -MALES: 42 - 54; Is 3 x hemoglobin; -DECREASED: anemia; -INCREASED: dehydration

serum albumin normal= 3.5 - 5.5 g/dL; -DECREASED: malnutrition (prolonged protein depletion), malabsorption, a simple protein in the blood that acts as a carrier molecule. and commonly used to assess for malnutrition. but they have long 1/2 lives and do not always represent current nutritional status

prealbumin Prealbumin 15-25mg/dl: Nitrogen Balance: used as an index of protein nutritional status. Nitrogen is released with the catabolism of amino acids and is excreted in urine as urea.Nitrogen balance therefor indicates whether the person is anabolic (positive nitrogen balance) or catabolic (negative nitrogen balance)., Shorter half life than albumin; Marker for protein deficiency; Perform frequently to see if nutritional intervention is effective

transferrin (normal = 240-480 mg/dL) decreased → anemia, protein deficiency, ----- iron-binding protein that carries iron in plasma

Blood urea nitrogen Test that determines the amount of urea nitrogen, a waste product of protein metabolism, present in a blood sample normal 17-18 mg/dl - increased = starvation, dehydration Decrease = malnutrition , over hydration

Creatinine waste product of muscle metabolism; nitrogenous waste excreted in urine normal 0.4- 1.5 mg/dl - increase = dehydration decrease = reduction in total muscle mass, severe malnutrition.

Low profile gastrostomy device for patients that are active yet require long term continuous or intermittent feeding - children you can conceal with clothing, can be immersed in water has a cap.

Parenteral Nutrition IV feedings. The administration of nutritional support via the intravenous route. Can be administered centrally (TPN) or peripherally through (PPN),

TPN total parenteral nutrition: Intravenous TPN solutions typically contain sugar (dextrose), protiens (amino acids), electrolytes (sodium, potassium, chloride), and vitamins -- hypertonic nutrient solution more concentrated then PPN solution.

PPN Peripheral Parenteral Nutrition is a less concentrated solution sometimes prescribed for pt.'s who have a malfunctioning GI tract and need short term nutrition lasting <2 weeks. (Peripheral veins can't tolerate highly concentrated solutions).

prealbumin vs serum albumin Albumin is a protein, actually one of the plentiful proteins in the blood (over half the amount of all serum proteins). It is made in the liver and its value describes the protein status of both the internal organs and the blood. This substance is responsible for maintaining the normal colloidal osmotic pressure that helps fluids flow along vascular the spaces only. Thus, a decrease in such will lead to the escape of these fluids to the tissue spaces and manifests as edema. Albumin has a long half-life, about 20 days and a huge serum pool. Because of its half-life, this makes albumin a late index of malnutrition. When albumin levels have gone down below normal, these imply that a significant quantity of the serum pool was gone.

prealbumin, although it is another protein indicator, it is different from albumin because it has a shorter half-life. This makes it a more sensitive protein indicator at 2 days half-life. It is also synthesized in the liver with the main tasks of protein transport and protein binding. In the more technical sense, prealbumin is named transthyretin because prealbumin has a misleading connotation that makes it a precursor to albumin, which is definitely not the case. Lastly, it has a lesser serum pool compared to albumin.

1. Albumin has a longer half-life than prealbumin.

2. Albumin has a greater serum pool than prealbumin.

3. Prealbumin is a better (more reliable) and faster indicator for assessing one's nutritional level.

4. Albumin gives a longer term picture of the patient's nutrition stat while prealbumin reflects changes in the protein levels for shorter timeframes.

Read more: Difference Between Albumin and Prealbumin | Difference Between | Albumin vs Prealbumin http://www.differencebetween.net/object/comparisons-of-food-items/difference-between-albumin-and-prealbumin/#ixzz1pmxiJCop

Six categories of nutrients 1. Carbohydrates2. Proteins 3. Lipids (fats)4. Vitamins 5. Minerals6. Water1 thru 3 provide energy.

A nurse is caring for a Patient who is a vegan at the health care facility. Which of the following must be included in the client's diet?

calcium, riboflavin, vitamins B12 and D, and iron

you insert an I.V. catheter into the skin at what angle ?

at a 30-degree angle and then as the skin is pierced, you decreases the angle to 15 degrees.

patient who has been experiencing prolonged wound healing from a surgical procedure. A deficiency in which of the following nutrients would be associated with this condition?

Vitamin C and zinc

use of total parenteral nutrition (TPN). action should you implement in the care of this patient?

TPN must always be administered with a pump.Medications may only be added by pharmacy prior to administration of the solution. TPN bags are changed a minimum of every 24 hours

You are preparing to insert a 1. Place patient in high Fowler's position 90 degrees.

nasogastric tube first one ever (NGT) into an adult patient you should

2.Measure intended length to insert the NGT from tip of nose around ear to xiphoid process 3.Lubricate the tube tip with water-soluble lubricant.4.Direct the tube upward and backward along the floor of the nose.5.Instruct the patient to place chin onto the chest.6.Advance the tube while the patient swallows offer a cup of water with straw.

complete proteins include meats, fish, poultry, milk, cheese, and eggs Soybean is only plant A complete protein contains an adequate amount of all of the essential amino acids that should be incorporated into a diet. Some protein contains all the amino acids needed to build new proteins, which generally come from animal and fish products. A complete protein must not lack even one essential amino acid in order to be considered complete.

incomplete proteins include. An incomplete protein is any protein that lacks one or more essential amino acids in correct proportions. These can also be referred to as partial proteins. Even if the protein contains all the essential amino acids, they must be in equal proportions in order to be considered complete. If not, the protein is considered incomplete .Peanut butter and rice GrainsNutsBeansSeedsPeasCorn

What vitamin is synthesized with an adequate supply of carbohydrates

vitamin K and vitamin B12.

What foods is considered a complex carbohydrate?

Bread, cereal, potatoes, rice, pasta, crackers, flour products, and legumes contain complex carbohydrates.

While on a phosphorus-restricted diet you should not eat

Milk and milk products, soft drinks, and processed foods are rich in phosphorus

adult female who has a folic acid defiency increased risk for

Folic acid deficiency in pregnant women can lead to neural tube deficits like spina bifida in the fetus

a vegan A vegan diet should be skillfully planned to provide complete protein, calcium, riboflavin, vitamins B12 and D, and iron.

Deficiency in vitamin D intake inadequate absorption of calcium and phosphorus and a deficiency of mineralization in bones and teeth

vitamin E deficiency Increased hemolysis of red blood cells, poor reflexes, impaired neuromuscular functioning, and anemias

Vitamin C - oranges broccoli green pepper

needed for wound healing , zinc wound healing

vitamin B complex Needed for cellular respiration—NAD+ and FAD; keeps nerves in healthy condition; important for energy metabolism. Ex. Pork, liver, fresh veggies, whole grains, legumes.

Vitamin A (retinol,retinal,) -liver, carrots, egg yolk, fortified milk

necessary for vision and helps prevent night blindness skin and mucous membrane ,immune function.

Vitamin D -Sunlight, fortified milk fish liver oils.

calcium and phosphorus metabolism, calcium absorption.

Vitamin E - Veg oil, wheat germ, whole grain products

Antioxidant protects vitamin A ,hem synthesis

Vitamin K synthesized in intestine from gut bacteria

coagulant that alters clotting times : dark green leafy veggies, liver, tomatoes

Calcium ( RDA) 1,000 mg (Macromineral) -milk, broccoli,canned fish with bones, greens

most abundant, 99% bones and teeth, 1% in body fluids- role in nerve transmission, muscle contracting, blood clotting along with vitamin D for bones. Defic = tetany,osteoporosis Excess = Renal Calculi

Phosphorus(RDA) 700mg (Macromineral) Milk milk products, soft drinks, processed foods/

second most abundant,bone tooth formation, acid base balance energy metabolism . Defic = anorexia,muscle weakness,Hypophoshatemia -- Excess hypocalcemic tetany

Magnesium (RDA) 310-420mg green leafy (Macromineral)vegetables,nuts,bean grains

bones and tooth formation, protein synthesis, carbo-hydrate metabolism, Defic Hypomagnesemia: weakness,muscle pain heart function Excess hypermagnesemia : cns depression coma,hypotension

Sulfur from protein (Macromineral)- meat,eggs,milk dried peas and beans , nuts

enzyme reactions and detoxification reaction

Potassium (RDA) 4,700 mg(Macromineral) whole grain fruits leafy vegetables

major ion of intracellular fluid,(Na, K+ pump) fluid balance acid base balance Defic = Hypokalemia : muscle cramps and weakness, irregular heartbeat Excess = Hyperkalemia irritability, anxiety cardiac, arrhythmia heart block

Sodium (RDA) 1,500mg(Macromineral) Salt, processed foods

major ion of extracellular fluid,fluid balance , acid balance Defic= hypoatremia : muscle cramps, cold and clammy skinExcess Edema weight gain, high blood pressure

Chloride (RDA) 2,300 mg(Macromineral) Salt

Component of HCL in stomach, fluid balance acid base balance Defic = hypochloremia : muscle spasm, alkalosis, depressed respiration Excess =

hyperchloremia acidosis

Iron (RDA) Micromineral 8-18 mg - liver lean meats enriched and whole grain

iron (as part of the protein hemoglobin) carries oxygen from our lungs throughout our bodies. Having too little hemoglobin is called anemia. Iron also helps our muscles store and use oxygen. iron, you can also eat foods that help your body absorb iron better. For example, you can eat a fruit or vegetable that is a good source of vitamin C (see table on Dietary Sources of vitamin C) with a food or meal that contains non-heme iron (see table below for Dietary Sources of Iron). Vitamin C helps your body absorb the non-heme iron foods you eat, especially when the food containing non-heme iron and the vitamin-C rich food are eaten at the same meal.

Combining Incomplete Proteins to Create Complete Proteins

By combining foods from two or more incomplete proteins, a complete protein can be created. The amino acids that may be missing from one type of food can be compensated by adding a protein that contains that missing amino acid. When eaten in combination at the same meal, you are providing your body with all the essential amino acids it requires. These are considered complementary proteins when they are combined to compensate for each other's lack of amino acids.Examples of combined complementary proteins to create a complete protein in one meal include:

Grains with Legumes - sample meal: lentils and rice with yellow peppers.Nuts with Legumes - sample meal: black bean and peanut salad.Grains with Dairy - sample meal: white cheddar and whole wheat pasta.Dairy with Seeds - sample meal: yogurt mixed with sesame and flax seeds.Legumes with Seeds - sample meal: spinach salad with sesame seed and almond salad dressing.

Recommended Daily Intake by Food Pyramid GroupBased on a 2,000-calorie diet

Group Daily Amount # of Servings Serving Size Calories Per ServingGrains 6 oz. 6 1 oz. 80-100Veggies 2-1/2 cups 5 1/2 cup 25-40Fruits 2 cups 2 1 cup 60-80Fats 6 tbsp. 6 1 teaspoon 40Milk 3 cups 3 1 cup 90-120Protein 5-1/2 oz. 2 3 oz. 165-225

old pyramid vs new pyramid Groups Old Pyramid New PyramidGrains 6-11 Servings 6 ouncesVegetables 3-5 Servings 2.5 cupsFruits 2-4 Servings 2 cupsMeat and Beans 2-3 Servings 5.5 ouncesMilk 2-3 Servings 3 cupsOils use sparingly 6 teaspoons

Weight gain/loss considered significant if it falls into these guidelines:

• 1% to 2% in 1 week• 5% in 1 month• 7.5% in 3 months• 10% in 6 months

Measure waist circumference around umbilicus level for indicator of abdominal fat

• Abdominal fat important and reliable indicator of risk for disease like type 2 diabetes, dyslipidemia, hypertension, cardiovascular disease• Measurement over 40" in men and 35" in women increases risks

To measure basal metabolic rate (calories needed at rest)

multiply weight by 11 for men and 10 for women. (e.g. 130 lb (male) x 11cal/lb = 1430 cal/day)

Carbohydrates: • Simple - monosaccharide and disaccharide• Complex - polysaccharide• More easily and quickly digested than protein and fat• All carbohydrates are converted into glucose for energy• Glucose in burned efficiently and completely and

does not leave a toxic product for kidneys to excrete• All calories (except fiber) provide 4 calories per gram, regardless of source• At least 50-100 grams are needed daily to prevent ketosis • Recommended that carbs provide 45% to 65% of total calories, mostly in form of complex carbs

Protein: • Vital component of every living cell• In human body more than 1000 different proteins are made using our 22 amino acids• 9 amino acids are classified as essential because they cannot be synthesized in the body; they must be obtained from the diet• Other 13 amino acids just as important, but can be made by body as long as nitrogen is available• Protein required for formation of all body structures, including genes, enzymes, muscle, bone matrix, and blood• Complete protein (high quality) and incomplete protein (low quality) based on amino acid composition• Complete contain sufficient amount/proportions of all the essential amino acids to support growth; incomplete are deficient in one or more essential amino acids• Generally animal proteins are complete and plant proteins are incomplete• Nitrogen balance is a comparison between catabolism and anabolism and can be measured by comparing nitrogen intake (protein intake) and nitrogen excretion (nitrogen lose in urine, urea, feces, hair, nails, and skin)o Neutral nitrogen balance - catabolism and anabolism are occurring at the same rateo Positive nitrogen balance - nitrogen intake is greater than excretion (periods of growth, pregnancy, lactation, recovery from illness)o Negative nitrogen balance - more nitrogen excreted than ingested (starvation and catabolism that occurs

in situations that immediately follows surgery, illness, trauma, and stress)

• Major function of protein is to maintain body tissues that break down from normal wear and tear and to support the growth of new tissue• Provides 4 calories/ gram• Recommended daily intake for adults is 0.8g/kg of desirable body weight

Fats: • Insoluble in water, therefore insoluble in blood• Composed of carbon, hydrogen, and oxygen• 95% of lipids in diet are in form of triglycerides - compound lipids (phospholipids) and derived lipids (cholesterol) make up remaining 5%• Degree of saturation depends on amount of hydrogen in fat molecules - saturated = more hydrogen; unsaturated = less hydrogen• Most animal fats considered saturated and have solid consistency at room temp• Most vegetable fats considered unsaturated and are liquid at room temp (oils)• Sat. fat raise serum cholesterol levels; unsat. Fat reduces serum cholesterol levels • Trans fat raises serum cholesterol levels • Fat digestion mostly occurs in small intestine; bile from gallbladder emulsifies fat to increase surface area so pancreatic lipase can break it down more effectively• Most fats absorbed into lymphatic circulation with help of protein carrier and transported to liver• Fats provide 9 cal/gram - RDA no more than 20%-35% of total caloric intake -- less than 10% fat calories from saturated fats - less than 300 mg/day of cholesterol• Fat aids in absorption of fat soluble vitamins and provides insulation, structure, and temp control

Regulatory Nutrients: : Vitamins, minerals, and water are needed by the

body for the metabolism of energy nutrients

Vitamins: • Most vitamins active in form of coenzymes, which together with enzymes facilitate thousands of chemical reactions in body ex. ATP,NADH, • Needed for metabolism of carbohydrates, protein, and fat• Water soluble vitamins: C, B-complex: ascorbic acid, thiamin, riboflavin, niacin, pyridoxine, biotin pantothenic acid, folate, cobalamin)o Absorbed through the intestinal wall directly into bloodstreamo Not stored in body• Fat soluble vitamins: A,D,E,Ko Absorbed with fat into lymphatic circulationo Must be attached to a protein for transport through blood streamo Body stores excess fat soluble vitamins in liver and adipose tissue

Minerals: • Inorganic elements found in all body fluids and tissues in form of salts or combined with organic compounds• Some provide structure within the body; others help regulate body processes• Not broken down or rearranged in body• Macrominerals are needed by body in amounts greater than 100 mg/day: calcium, phosphorus, sulfur, sodium, chloride, potassium, and magnesium• Micromolecules (trace elements) are needed by body in amounts less than 100 mg/day: iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, iodine, arsenic, boron, nickel, silicon, cobalt, and vanadium• Ultratrace elements are consumed in microgram quantities every day: aluminum, lithium, nickel, silicon, tin, and vanadi

Water: • Accounts for 50% to 60% of adult's total weight

• 2/3 of body's water is contained within cell (intracellular fluid [ICF]); the remainder is extracellular fluid (ECF) which includes all other fluid, like plasma and interstitial fluid• Total body water and ECF decrease with age; ICF increases with increase in body mass • More vital for life than food; provides fluid medium necessary for all chemical reactions • Acts as solvent that dissolves many solutes - aids in digestion, absorption, circulation, and excretion• Helps regulate body temp via evaporation from skin• Acts as lubricant - needed for mucous secretions and for movement between joints

• Water produced through the metabolism of carbs, protein, and fat• Water intake should equal water output

Anthropometric measurements are used to determine body dimensions - in adults they give indirect measurements of body protein and fat stores

• BMI - height and weight• Triceps skin fold - measures subcutaneous fat stores• Midarm circumfrerence - measures skeletal muscle mass and fat stores

Nasogastric tube: • Measure tube from tip of nose to tip of earlobe and then down to tip of xiphoid process• When tube reaches pharynx have pt touch chin to chest, have pt sip on water through straw or swallow• Also can be used to decompress or drain the stomach of fluid, unwanted stomach contents (like poison or medication and air, allowing it to rest, before/after surgery, to promote healing)• Can be used to monitor GI bleeding and prevent intestinal obstruction

Nasointestinal tube: • Measure for NG tube and then add 8" to 10" for intestinal placement• Place patient on right side• Usually placed in the stomach and allowed to

advance through peristalsis through pyloric sphincter (may take up to 24h)• May cause a type of dumping syndrome because the pyloric valve in the stomach which is normally slows transit of food is bypassed

Removal of NG tube: 1. Discontinue suction and separate tube from suction2. Flush with 10 mL of water of saline OR clear with 30 - 50 mL of air3. Clamp tube with fingers by doubling tube on itself4. Have pt take deep breath and hold it. Quickly and carefully remove tube while patient holds breath

Checking pH level of aspirated contents:

• Stomach: pH less than 5.5; grassy green, tan, off-white, bloody, or brown• Intestines: pH 7.0 or higher; medium to deep golden-yellow (may be greenish-brown if stained with bile)• Respiratory tract: pH 6.0 or higher; off-white and tinged with mucus

Percutaneous Endoscopic Gastrostomy (PEG) tube: (jejunostomy tube is alternative)

• For long term feeding• Placed in stomach by surgeon or gastroenterologist• Gastric feedings are usually intermittent; intestinal feedings are always continuous to avoid triggering dumping syndrome

Safety with tube feedings: • Check tube placement before administering any fluids, medications, or feeding using multiple techniques: x-ray, pH testing, aspirate characteristics, external length marking, and CO2 monitoring• Check residual before each feeding or every 4-6 hours during continuous feeding. • High gastric residual (200-250 mL or greater) can be associated with high risk for aspiration and aspiration-related pneumonia• A residual of more than 10% - 20% above the hourly rate for feeding may indicate that the feeding should

be interrupted or delayed• Assess the abdomen for abnormalities. Assess for bowel sounds at least once per shift to check for presence of peristalsis and a functional intestinal tract - also Gastric distention, nausea, vomiting, bloating, or pain may be good indicator of how well pt is tolerating a tube feeding• Make sure patient is as upright as possible during feeding. HOB to at least 30° and remain elevated for at least 1 hour after feeding• Never give meds while a feeding is being infused; never add meds directly to feeding formula• Flush tube with water before, during, and after administering meds

Comfort Measures for NG tubes: • Frequent oral hygiene (q2-4h) to prevent drying of tissues and to relieve thirst. • Keep nares clean, especially around tube• Help control local irritation from the tube in the throat; analgesic throat lozenges or anesthetic sprays • Encourage pt, if they're able to, to verbalize concerns about the tube feeding and presence of tube• Ensure tube is secured to pt's nose and gown to prevent tension and tugging on the tube, causing trauma to nares & tube displacement

Parenteral Nutrition • IV therapy for pt's who can't meet nutritional needs due to non-functional GI tracts, comatose, have high caloric/nutritional needs due to illness or injury, undergoing aggressive cancer therapy, and those recovering from burs, surgery, sepsis, or multiple fractures• Administered centrally via central venous access devise (TPN) • Administered peripherally via short-term IV access in peripheral veino Difference btwn central and peripheral is concentration of solutiono TPN is highly concentrated, hypertonic nutrient

solution - provides calories, restores nitrogen balance, replaces essential fluids, vitamins, electrolytes, minerals, and trace elements - also promote tissue and wound healing and normal metabolic function - provides bowel a chance to heal and reduces activity in the gallbladder, pancreas, and small intestineo Criteria for TPN: inability to absorb nutrients from GI tract for more than 10 days; presence of a debilitating illness lasting more than 2 weeks; serum albumin level less than 3.5 g/dL; excessive nitrogen loss from wound infection, fistula, or abscess; renal or hepatic failure; and non-function of GI tract for 5-7 dayso PPN is less concentrated for pt's who have malfunctioning GI tract and need short-term nutrition lasting less than 2 weeks -- administered through peripheral vein• TPN solutions are hypertonic & contain 3 primary components necessary to maintain nutrition: proteins, carbs, and fats. • PPN solutions are isotonic and contain components similar to TPN but in lesser concentrations and amounts

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