Complex Concepts II Module 3 Exam Blueprint.
Complex Concepts II Module 3 Exam Blueprint
Acute Nutritional Support
(1-2) Enteral (mod obj. 3A – 1,2,3,4) Nursing assessment, complications, interventions: (p.297 ATI):
Nursing Assessment:
• Enteral feedings are instituted when a client is unable take adequate nutrition orally.
• INDICATIONS
o POTENTIAL DIAGNOSES
▪ Inability to eat due to a medical condition (comatose, Intubated)
▪ Pathologies that cause difficulty swallowing or increase risk of aspiration (stroke,
advanced Parkinson’s disease, multiple sclerosis)
▪ Inability to maintain adequate oral nutritional intake and need for supplementation due to
increased metabolic demands (cancer therapy, burns, sepsis)
• CLIENT PRESENTATION
o Malnutrition (decreased prealbumin, decreased transferrin or total iron-binding capacity)
o Aspiration pneumonia
Complications/ Interventions:
• Overfeeding
o Overfeeding results from infusion of a greater quantity of feeding than can be readily digested,
resulting in abdominal distention, nausea, and vomiting.
o NURSING ACTIONS
▪ Check residual every 4 to 6 hr.
▪ Follow protocol for slowing or withholding feedings for excess residual volumes. Many facilities
hold for residual volumes of 100 to 200 mL and then restart at a lower rate after a period of
rest.
▪ Check pump for proper operation and ensure feeding infused at correct rate.
• Diarrhea
o Diarrhea occurs secondary to concentration of feeding or its constituents.
o NURSING ACTIONS
▪ Slow the rate of feeding and notify the provider.
▪ Confer with a dietitian.
▪ Provide skin care and protection.
▪ Evaluate for Clostridium difficile if diarrhea continues, especially if it has a very foul odor.
• Aspiration pneumonia
o Pneumonia can occur secondary to aspiration of feeding, and can be a life-threatening
complication. Tube displacement is the primary cause of aspiration of feeding.
o NURSING ACTIONS
▪ Stop the feeding.
▪ Turn the client to his side and suction the airway. Administer oxygen if indicated.
▪ Monitor vital signs for an elevated temperature.
▪ Auscultate breath sounds for increased congestion and diminishing breath sounds.
▪ Notify the provider and obtain a chest x-ray if prescribed.
• Refeeding syndrome
o Refeeding syndrome is a potentially life-threatening condition that occurs when enteral feeding is
started in a client who is in a starvation state and whose body has begun to catabolize protein and fat
,Complex Concepts II Module 3 Exam Blueprint.
for energy.
o NURSING ACTIONS
▪ Monitor for new onset of confusion or seizures.
▪ Assess for shallow respirations.
,Complex Concepts II Module 3 Exam Blueprint.
▪ Monitor for increased muscular weakness.
▪ Notify the provider and obtain serum electrolytes if needed
(2-3) Parenteral (mod obj. 3A – 1,2,3,4) Composition, prioritization, nursing interventions/ complications: (p.298 ATI):
Composition:
• TPN contains complete nutrition, including calories in a high concentration (10% to 50%) of dextrose,
lipids/essential fatty acids, protein, electrolytes, vitamins, and trace elements. Standard IV bolus therapy
is typically no more than 700 calories/day.
• Partial parenteral nutrition or peripheral parenteral nutrition (PPN) is less hypertonic, intended for short-term
use, and administered in a large peripheral vein. Usual dextrose concentration is 10% or less. Risks include
phlebitis.
Prioritization:
• Preparation of the Client:
o Determine the client’s readiness for TPN.
o Obtain daily laboratory values, including electrolytes. Solutions are customized for each client
according to daily laboratory results.
• ONGOING CARE
o The flow rate is gradually increased and gradually decreased to allow body adjustment (usually no
more than a 10% hourly increase in rate).
▪ Never abruptly stop TPN. Speeding up/slowing down the rate is contraindicated. An abrupt rate
change can alter blood glucose levels significantly.
o Assess vital signs every 4 to 8 hr.
o Follow sterile procedures to minimize the risk of sepsis.
▪ TPN solution is prepared by the pharmacy using aseptic technique with a laminar flow hood.
▪ Change tubing and solution bag (even if not empty) every 24 hr.
▪ A filter is added to the tubing to collect particles from the solution.
▪ Do not use the line for other IV bolus solutions (prevents contamination and interruption of
the flowrate).
▪ Do not add anything to the solution due to risks of contamination and incompatibility.
▪ Use sterile procedures, including a mask, when changing the central line dressing (per
facility procedure).
• Check capillary glucose every 4 to 6 hr for at least the first 24 hr.
• Clients receiving TPN frequently need supplemental regular insulin until the pancreas can increase
its endogenous production of insulin.
• Keep dextrose 10% in water at the bedside in case the solution is unexpectedly ruined or the next bag is not
available. This will minimize the risk of hypoglycemia with abrupt changes in dextrose concentrations.
• If a bag is unavailable and administered late, do not attempt to catch up by increasing the infusion
rate because the client can develop hyperglycemia.
• OLDER ADULT CLIENTS have an increased incidence of glucose intolerance
Nursing Interventions/ Complications:
• Metabolic complications
o Metabolic complications include hyperglycemia, hypoglycemia, and vitamin deficiencies
o NURSING ACTIONS
▪ Daily laboratory tests are prescribed and results obtained before a new solution is prepared.
▪ Fluid needs are typically replaced with a separate IV bolus to prevent fluid volume excess.
, Complex Concepts II Module 3 Exam Blueprint.
▪ Monitor for hyperglycemia.
• Air embolism
Complex Concepts II Module 3 Exam Blueprint
Acute Nutritional Support
(1-2) Enteral (mod obj. 3A – 1,2,3,4) Nursing assessment, complications, interventions: (p.297 ATI):
Nursing Assessment:
• Enteral feedings are instituted when a client is unable take adequate nutrition orally.
• INDICATIONS
o POTENTIAL DIAGNOSES
▪ Inability to eat due to a medical condition (comatose, Intubated)
▪ Pathologies that cause difficulty swallowing or increase risk of aspiration (stroke,
advanced Parkinson’s disease, multiple sclerosis)
▪ Inability to maintain adequate oral nutritional intake and need for supplementation due to
increased metabolic demands (cancer therapy, burns, sepsis)
• CLIENT PRESENTATION
o Malnutrition (decreased prealbumin, decreased transferrin or total iron-binding capacity)
o Aspiration pneumonia
Complications/ Interventions:
• Overfeeding
o Overfeeding results from infusion of a greater quantity of feeding than can be readily digested,
resulting in abdominal distention, nausea, and vomiting.
o NURSING ACTIONS
▪ Check residual every 4 to 6 hr.
▪ Follow protocol for slowing or withholding feedings for excess residual volumes. Many facilities
hold for residual volumes of 100 to 200 mL and then restart at a lower rate after a period of
rest.
▪ Check pump for proper operation and ensure feeding infused at correct rate.
• Diarrhea
o Diarrhea occurs secondary to concentration of feeding or its constituents.
o NURSING ACTIONS
▪ Slow the rate of feeding and notify the provider.
▪ Confer with a dietitian.
▪ Provide skin care and protection.
▪ Evaluate for Clostridium difficile if diarrhea continues, especially if it has a very foul odor.
• Aspiration pneumonia
o Pneumonia can occur secondary to aspiration of feeding, and can be a life-threatening
complication. Tube displacement is the primary cause of aspiration of feeding.
o NURSING ACTIONS
▪ Stop the feeding.
▪ Turn the client to his side and suction the airway. Administer oxygen if indicated.
▪ Monitor vital signs for an elevated temperature.
▪ Auscultate breath sounds for increased congestion and diminishing breath sounds.
▪ Notify the provider and obtain a chest x-ray if prescribed.
• Refeeding syndrome
o Refeeding syndrome is a potentially life-threatening condition that occurs when enteral feeding is
started in a client who is in a starvation state and whose body has begun to catabolize protein and fat
,Complex Concepts II Module 3 Exam Blueprint.
for energy.
o NURSING ACTIONS
▪ Monitor for new onset of confusion or seizures.
▪ Assess for shallow respirations.
,Complex Concepts II Module 3 Exam Blueprint.
▪ Monitor for increased muscular weakness.
▪ Notify the provider and obtain serum electrolytes if needed
(2-3) Parenteral (mod obj. 3A – 1,2,3,4) Composition, prioritization, nursing interventions/ complications: (p.298 ATI):
Composition:
• TPN contains complete nutrition, including calories in a high concentration (10% to 50%) of dextrose,
lipids/essential fatty acids, protein, electrolytes, vitamins, and trace elements. Standard IV bolus therapy
is typically no more than 700 calories/day.
• Partial parenteral nutrition or peripheral parenteral nutrition (PPN) is less hypertonic, intended for short-term
use, and administered in a large peripheral vein. Usual dextrose concentration is 10% or less. Risks include
phlebitis.
Prioritization:
• Preparation of the Client:
o Determine the client’s readiness for TPN.
o Obtain daily laboratory values, including electrolytes. Solutions are customized for each client
according to daily laboratory results.
• ONGOING CARE
o The flow rate is gradually increased and gradually decreased to allow body adjustment (usually no
more than a 10% hourly increase in rate).
▪ Never abruptly stop TPN. Speeding up/slowing down the rate is contraindicated. An abrupt rate
change can alter blood glucose levels significantly.
o Assess vital signs every 4 to 8 hr.
o Follow sterile procedures to minimize the risk of sepsis.
▪ TPN solution is prepared by the pharmacy using aseptic technique with a laminar flow hood.
▪ Change tubing and solution bag (even if not empty) every 24 hr.
▪ A filter is added to the tubing to collect particles from the solution.
▪ Do not use the line for other IV bolus solutions (prevents contamination and interruption of
the flowrate).
▪ Do not add anything to the solution due to risks of contamination and incompatibility.
▪ Use sterile procedures, including a mask, when changing the central line dressing (per
facility procedure).
• Check capillary glucose every 4 to 6 hr for at least the first 24 hr.
• Clients receiving TPN frequently need supplemental regular insulin until the pancreas can increase
its endogenous production of insulin.
• Keep dextrose 10% in water at the bedside in case the solution is unexpectedly ruined or the next bag is not
available. This will minimize the risk of hypoglycemia with abrupt changes in dextrose concentrations.
• If a bag is unavailable and administered late, do not attempt to catch up by increasing the infusion
rate because the client can develop hyperglycemia.
• OLDER ADULT CLIENTS have an increased incidence of glucose intolerance
Nursing Interventions/ Complications:
• Metabolic complications
o Metabolic complications include hyperglycemia, hypoglycemia, and vitamin deficiencies
o NURSING ACTIONS
▪ Daily laboratory tests are prescribed and results obtained before a new solution is prepared.
▪ Fluid needs are typically replaced with a separate IV bolus to prevent fluid volume excess.
, Complex Concepts II Module 3 Exam Blueprint.
▪ Monitor for hyperglycemia.
• Air embolism
