Kwashiorkor

Advance protein and caloric deficit – increase protein

- Hepatomegaly
requirement
- Prone to infection
- Discoloration – melanin and keratin
 Dextrose for CHO
Trace Elements
Vitamins
Fats/Lipids may be added /separate emulsion to treat or
give some fatty acids

TNA – total nutrient add mixture (3in1) part of TPN

Clients: Cancers of throat, facial surgery,

unconscious/unresponsive, severe anorexia, serious
illness,

Subclavian vein – catheter triple lumen (common) / pick

lines

Can you do piggyback medications – blood etc. with TPN

– to prevent incompatibilities , use strict aseptic
technique

Nursing Management in TPN :

A procedure in which a flexible feeding tube is placed
through the abdominal wall and into the stomach
Same preparation when we do NGT feeding
1. Make sure that it is placed correctly – might
xray, check site, patency , S/S infection
2. When u change TPN bag/tubing – 24hrs /
institution policy
3. TPN is usually used with an electronic infusion
devices
4. Start 1mL/min  titrate upward as ordered
when the pt can tolerate
5. Monitor V/S / 10 min for 1st hrs – for drug
interactions
6. Monitor q hr for the 1st 4 hrs
7. Do not attempt to catch up  inform your
doctor
8. Monitor weight daily especially at 6 am
a. Report if 3lbs/wk gain = possible fluid
retention/overload

Prevent catabolism of protein and muscle stores

Conposition : amino acids
Environmental influences: sedentary lifestyle, fast food
chains, television watching

Psychologic factors: Stress eating

Impaired circulatory function –

Regular meals w/ small servings : Pinggang pinoy

DISTURBANCES OF DIGESTION  TIPS
 Ballon tamponade – insertion of tube

 Propanolol (Inderal) – beta blocker – blocks

receptors in heart  REDUCES PORTAL PRESSURE
by reducing/minimizing blood flow in the
gastroesophageal veins

 Hypoglycemia???
 Vasopressin (Petrisin?) – constricting your afferent
arterioles , temporary lowering portal pressure
o S/E: pallor , abdominal cramping

 Injection Sclero – stop bleeding

 Portacaval shunt surgery – directly inferior vena
cava by passing the liver
ROLLING HIATAL HERNIA
GASTRITIS

Stress induced gastritis – gastric mucosa would be

ischemic