Case Study, Chapter 45, Digestive and Gastrointestinal Treatment Modalities
1. Molly Baker, a patient 35 years of age weighs 72 kg. She was admitted to the burn unit for full-thickness or third-degree burns over 36% of her body surface according to the use of the rule of nines. She has a paralytic ileus and has high residuals with enteral feeding using the nasojejunal tube. The physician ordered a lower rate for the enteral feeding and ordered total parenteral nutrition (TPN) via a subclavian triple lumen catheter to provide the patient's nutritional needs. When a patient has burns over a large portion of the body, the patient is in a hypermetabolic state and usually requires 35 to 40 kcal/kg/day and needs 25% of the calories each day in high biologic value proteins. (Learning Objective 5)
a. What nursing measures should the nurse implement to prevent potential complications related to the patient's enteral feeding?
b. What nursing measures should the nurse implement to prevent potential complications related to the administration of TPN?
2. The nurse working in a rehabilitation facility receives a patient from the acute care hospital for management after a severe closed-head injury. The patient is in a semiconscious state, and has impaired swallowing. The admission orders call for insertion of a nasogastric (NG) tube for feedings and medication administration. (Learning Objectives 2 and 3)
a. What is the correct method for measuring the length of an NG tube for correct placement in the stomach?
b. You note that the student caring for Mr. Fields is verifying tube placement by listening when a bolus of air is injected into the NG tube via a syringe. How should you intervene? What other methods can the student use to verify tube placement? What is the rationale?
c. What is the correct procedure for administering medications via an NG tube that has a continuous feeding infusing?
d. The patient develops diarrhea the second day at the rehabilitation facility. The nurse assesses for which electrolyte abnormalities? What actions can the nurse implement to decrease the diarrhea?