Question

Mrs. Reese is a 36-year-old woman who was diagnosed with Crohn’s disease 2 years ago. She was recently admitted to the hospital with an exacerbation of her Crohn’s disease. She was severely malnourished and was found to have complete bowel obstruction with multiple adhesions. She is 5’ 4” tall and weighs 108 pounds, with a usual weight of 122 lbs. She is scheduled for surgery, and undergoes a small bowel resection to remove the diseased bowel and create a temporary ileostomy. Following surgery, she has a central line catheter placed and is started on total parenteral nutrition with intralipids.

1. Calculate this patient’s percent of weight loss (show your work).
2. Why was this patient started on total parenteral nutrition (TPN) rather than enteral feedings or peripheral parenteral nutrition (PPN)?
3. What are some of the complications that occur with intravenous catheters?
4. How can the nurse reduce these complications?
5. Why is it important for the nurses to start the parenteral feedings slowly and monitor electrolyte levels?

Answer 1

A total parentral nutrition was used to stabilize the patient.it is calculated to meet the patients energy needs .for patients who undergo ileopstomy nutritional management is essential to prevent complications assosiated with high output stoma.After small bowel resection when the remnant bowel is less than 200 cm long,and concludes with an ostomy,the incidance of high output stoma is high.

Complications of intravenous catheters include infiltration ,heamatoma,air embolism,phelebitis.

Always practice aseptic technique,Clean the key parts before administrion of any medicines.hand wahing must be practised.Decontaminate hands always.Double checking is needed.

Parentral nutition should start slowly so that the body has time to adapt to both glucose and the hyperosmolality of the solution,and also to prevent elcetrolye imbalance.