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Terms in this set (99)

- total parenteral nutrition (IV feeding) via PICC or central line
- Has 20% glucose —> accuchecks q4hr AND risk of infection: stop infusion, culture drainage, clean catheter, pull line out. Peripheral < 20%, central 20-50% dextrose
- If bag is empty and the next bag isn't ready, give D10 or D20 to prevent hypoglycemia

PERIPHERAL
- requires peripheral IV access
- May no meet all nutrition support
- Still a hyperosmolar solution; is only recommended for a few days; still tough on veins
- Contains: sterile water added for the correct 24-hour volume, amino acid for protein (no more than 5% of the total concentration), dextrose for carbs (no more than 10% final concentration due to peripheral access), electrolytes based off daily morning labs, vitamins (make bag yellow), trace elements, insulin (added as needed to control glucose), lipids as fat (mixed with infusion or administered separately, comes in 10 or 20%, increases calories without increasing osmolality, no bacteria static properties so need to use strict sterile technique, tubing is only good for lipid infusion, need to know the triglyceride levels).

CENTRAL
- requires large, high-flow vessel access such as SVC: central line in neck, chest, port, or PICC
- Central line care: dressing change every 7 days, if dressing is lifting on edges then it is no longer intact and must be changed via strict sterile technique via specialized team. Line caps are pressurized to keep line from clotting and the cap needs to be changed every 72-96 hours. Flush central lines using push pause method with 10 mL or sterile saline.
- PICC lines have an increased risk for DVTS: MONITOR FOR THIS
- can be used for months
- contents: same as peripheral EXCEPT dextrose is greater than 10-70%, no amino acid differences
- volume: volume of air going into lungs; about 500 mL to start

-Pressure: amt of pressure going in on inspiration

-AC: assist control: pt breaths added to vent breathsvolume measurement that can either totally breathe for patient or let patient breathe spontaneously. Depends on sedation of pt. Pt full tidal volume gets added to machine breaths —> concern is hyperventilation. Either decrease RR on machine or sedate pt to decrease their own RR

-CV: controlled ventilation breathes for patient

-SIMV: Machine has mandatory breath number. When pt takes spontaneous breaths it will be at their own tidal volume which likely is not adequate gas exchange. This concern is hypoventilation.

-Pressure support ventilation (PSV): adding additional pressure to overcome narrow ET tube. We have PIP so breath will be stopped if pressure gets too high. Decreases pt WOB.

-CPAP: continuous pressure increases WOB since patient has to expire against pressure from machine. Pt MUST have spontaneous respiration's. Always assess whether or not pt is actually breathing on their own. What's their RR? If they become Apnic, take off CPAP. Contraindications: vomiting, unable to handle secretions, unable to release mask — concern is aspiration. An increase in intrathoracic pressure can decrease CO. Acute decompensated HF may struggle with CPAP since they already have decreased CO.

-BiPAP: inspiration pressure and lower expiration pressure; two different settings.

-APRV: CPAP with short expiration. 1:1 —> 2:1 —> 3:1 —> 4:1. Tough on pt bc its opposite way to breathe.

CPAP, BiPAP, APRV: pt must have spontaneous respirations