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Total Parenteral Nutrition Peritoneal Dialysis PD Central Venous Pressure CVP
Total Parenteral Nutrition Peritoneal Dialysis PD Central Venous Pressure CVP
Total Parenteral Nutrition Peritoneal Dialysis PD Central Venous Pressure CVP
iti # $TPN% - Hyperglycemia o %hirst: nausea: headache: *ea;ness - Other name: Hyperalimentation HA - Re!ound Hypoglycemia - Primary method of providing a complete o 7o not eat late at night nutrients o "f there is a!rupt hypoglycaemia: - Refers to the provision of all required nutrients - E clusively !y the "# route $%OP of %P, and infuse "$O%O,"& - $upplements ordinary or tu!e feeding sol8n - %hrough o <luid overload o Peripheral line o &entral line Note: When there is TPN, do not draw blood. &onnected to 'ugular( $u!clavian vein 'ugular is used to enter the P"!it #"al Dialysis $PD% circulatory - =sing peripheral cavity to *ithdra* !lood "ndications: through diffusion or osmosis 0ess ha>ardous than hemodialysis $hort term use - Often the treatment of choice of older adults o )o*el in+ury( surgery o )o*el disease "ndications: o $evere malnutrition Poor cardiac function o ,utritional prep- Prior to surgery Peripheral #ascular disease o .ala!sorption / !o*el cancer <ree lifestyle 0ong term use 0ong distance to hemodialysis o )o*el resection o Prolonged intestinal failure &ontraindications: Hernia ,utritional requirement: $ignificant loin pain Amino acids &olostomy 1lucose O!esity 0ipids )lindness .inerals Psychosis #itamins 7ecrease in 0ung function H23 4 electrolytes %race Elements ,ursing .anagement - )aseline measurements 5#s for sepsis6 - Accurate daily monitoring - &linical O!servation - 7aily *eight - Patient8s $trength - Anthropometric .easurements - Prevention of infection - )asic ,ursing care - &are of equipment 5last priority6 &omplications of %P, - $epsis o 9atch for fever: s*eating: chills: inflammation - Pneumothora - Air em!olism o Perform valsalva maneuver o .anifestations: &yanotic: $O): chest pain: cough - &lotted catheter line - &atheter displacement Equipment - comforta!le chair - *ater sin; - *eighing scale - drip stand - hoo;s - dialysate ? Phases( Procedures @- <ill( "nflo* @-20 of dialysate infused !y graving <"00 into the peritoneal space 5@3-23min6 2- 7*ell <luid d*ells in the cavity for a specified time ?- 7rain( Outflo* <luid then flo*s out of the !ody 7RA",$ !y gravity into a drainage !ag )ag must !e lo*er APeritoneal / may cavities / diffusion 7ialysate additives Heparin o Prevent clotting of catheter tu!ing
Skills: TPN/ PD/ CVP by EGBautista, USI-BSN/ Aug08 Potassium - <inal e changes of the night is left to d*ell o Prevent hypo;alemia through the day 4 drained the ne t evening as the process is repeated Anti!iotic o 1iven *hen peritonitis is present *Potassium & Antibiotic should not be given sabay. %ypes: @2?B&ontinuous Am!ulatory P7 Automated P7 "ntermittent P7 continuous cycle P7 &omplications: @- Peritonitis 2- Pain ?- E it site 4 %unnel infection B- Poor 7ialysate Outflo* H- 7ialysate lea;age Peritonitis - ma+or complication of P7 - causes: connecting site contaminated - .anifestations: o &loudy dialysate outflo* o <ever o A!dominal tenderness o A!dominal pain o 1eneral malaise o ,ausea 4 vomiting Pain - common during inflo* E it site 4 tunnel infection - Predisposing factor o 7ialysate lea;age o Pulling( t*isting of the catheter - .anifestations: o Redness o %enderness o Pain Poor 7ialysate Outflo* - .ain cause: o &onstipation - Other causes: o Jin;ed( clamped connection tu!ing o &lient8s position 5supine: lo*: fo*lers6 o <i!rin clot formation o P7 catheter displacement 7ialysate 0ea;age - occur more often in o!ese( dia!etic clients: older adults on long term steroid therapy
&ontinuous Am!ulatory P7 - client performs self-dialysis !y infusing B 20 e changes of dialysate into the peritoneal cavity - dialysate remains B-C hoursD E days a *ee; - 7*ell Period: o &ontinuous connect system 5straight transfer set6 o 7isconnect system 5F transfer set6 Prone for infection - 7ialysate must !e *arm Automated P7 - used in acute care setting output dialysis center - =ses automated cycling machine - Advantages: o Permits in-house dialysis *hile the client sleeps o incidence of peritonitis is reduced o used to administer large volume of dialysis solution "ntermittent P7 - com!ines osmotic pressure gradients *ith true dialysis - requires e change of 20: o ?3-G3 minutes interval time o @H-23 minutes of drain time - Requires 23-B3 e changes of 20 o ? times a *ee; - &an !e automated or manual - PO%E,%"A0 A7#A,%A1E$ o Progressive removal of H2O 4 ,a o Relatively lo* ris; of inducing hypotension o &orrection of co-e istent hyponatremia !y sieving of ,a into the ultrafiltrate &ontinuous I cycle P7 - uses an automated cycling machine - e changes occur at night *hile the client sleeps
E<<0=E,% &O0OR$: )loody or !lood-tinged o @-2 *ee;s / normal &lear 4 light yello* o 9ell esta!lished P,
Skills: TPN/ PD/ CVP by EGBautista, USI-BSN/ Aug08 )ro*n-colored effluent &omplications: o %here is !o*el pro!lem disorder - carotid artery puncture o )o*er imperforation - Pneumothora $ame color as urine 4 has same glucose - air em!olism concentration - arrhythmia o "mperforated !ladder - perforation of $#&( R-atrium( R-ventricle Opaque( cloudy - infection o pineapple +uice - Pleural effusion o "nfection occur - E travasion of infusate ,ursing care: - Allergic reaction to catheter material K)efore treatment - evaluate !aseline #$ Equipment: - *eigh client - sterile !ag of fluid *ith attached fluid - !aseline la! tests administration set K7uring P7 - "# set solution @- ta;e 4 record #$ q @H-?3 minutes - .anometer 2- assess for signs 4 respiratory distress - $topcoc; ?- chec; dressing around the catheter e it site q ?3 for *etness Position of the Patient: $=P",E B- monitor the prescri!ed d*ell time 4 initiate A "n line *ith the heart outflo* H- monitor !lood glucose levels "nterpretation G- o!serve outflo* pattern - L of a!ove normal E- accurately record the total amount of outflo* o 9ea;ening( failure of the Right side of after each e change the heart or e cessive intravascular C- *eigh volume - Pressure M Hcm H2O P7 can correctK o "ntravascular volume deficit( drug Hyper;alemia induced e cessive vasodialation Hypo &#P measurements must !e interpreted on Hypernatremia their o*n: !ut vie*ed along side the patients8s Hypo full clinical picture .eta!olic acidosis - $everal measurements are required to identify Hypercalcemia a trend Hyperuricemia 7eterminants: - cardiac competence o M ventricular function raises &#P - )lood volume o L venous return raises &#P - "ntra Aortic 4 "ntra Peritoneal Pressure o L &#P - $ystemic vascular resistance o L &#P
C"#t!al V"# us P!"ssu!" $CVP% - !lood from the systemic veins flo*s into the right atrium - pressure in the right atrium is the &#P - A catheter is passed viaD o $u!clavian vein or +ugular vein ",%O I o $uperior vena cavaD - to determine the venous return in the intravascular volume of the right atrium - ,ormal value: o H-@3 cm H2o Purpose: - to serve as a guide of fluid !alance in critically ill patients - to estimate the circulating !lood volume - to determine the function of the right side of the heart - to assist in monitoring circulatory failure - none of these varia!les are measured directlyD they must !e interpreted