Inner-most endoth layer, responsible for GI secretions and sensitivity to chemicals and mechanical stimuli. Different areas have columnar epith cells. These cells, along with mucous, make mucosa impermeable to HCl
Mucosal lining b/down leads to translocation of B into bloodstream and the beginning of overwhelming infxn - immune response - organ failure - death from sepsis. Normally E. Coli. Needs to protect GI lining
Outcome of Gut Translocation
Bowel is resevoir of B, normal flora. If enter portal of systemic circulation, initiate sepsis or perpetuate on-going process
EBP w/ gut translocation
Early and continued enteral feeding promotes mucosal integrity, minimizing gut breakdown. Limit IV feeding! Switch to enteral or normal food ASAP.
Nurse's role with nutrition
Positive comments about trays, intake flow sheets, consult RD for diet instructions, poor appetite, suspected malnutrition, alternate nutritional support
Factors for diet selection
Diagnosis, age, diet order, albumin levels, pressure ulcers, food/drug interactions, length of stay. High risk - consult RD.
nothing by mouth, nothing pre-op
anorexia in in-patients
ill pts often have poor appetite. ketosis (linked to starvation) suppresses appetite, diagnostic tests and NPO can disrupt meal times. Watch that folks don't miss meals
Tube - gut functioning but can't eat. ST: NG, ND. LT: gastrostomy or jejunostomy tube. IV - gut not functioning. TPN/hyperalimentation
For longer-term feeding. Weight at end drops through stomach to duodenum. Stays for months. Inserted by nurse. 2 tubes. Top - sucks out juices to prevent vomiting. Bottom - allows to feed past motility problems. Push to stomach, then peristalsis pulls further. Can't use until xray confirms.
percutaneous endoscopic gastroscopy
Advantages of enteral nutrition
Physiologic and easier, preserves immune fxn, preserves gut barrier fxn, cheaper than TPN, fewer complications
gastric-residual volume. how much fluid we put in and how well body is tolerating it. estimates for liquid amts aren't EB. should be <200 but be really concerned if >400
Preventing infxn with enteral feeding
Clean top of formula can with alcohol wipe before opening, switch bedside container every 24 hrs, replace formula every 4 hrs
Milky. Provide supplemental kilocalories and prevent essential fatty acid deficiencies. Normally separate bc don't mix well. Select line based on tonicity -- higher tonicity reqs central line.
Central vs peripheral veins for TPN
<10% dextrose - peripheral in combo with AAs and lipids. >10% central vein
Start slow and incr if they tolerate. 40-60 mL/hr. Too quick - osmotic diuresis/dehydration
TPN and causes of death
Gall stones bc too much pdxn of bile in relation to diet. Or, immune cells in liver become too fatty and don't work.
Chroris. Ulcerative colitis. Gut stops working. Parts are removed.
Complications of TPN (1-4)
Things that we can control: 1) Pneumothorax, 2) Air embolism; 3) Catheter occlusion; 4) Catheter sepsis
Complications of TPN (5-10)
Metabolic things that can happen that we can anticipate - check lab values every few hours. 5) thrombosis of central vein; 6) hyperglycemic hyperosmolar nonketotic dehydration/coma; 7) electrolyte imbalance; 8) hypercapnia; 9) hypoglycemia; 10) fatty liver