Question

Mrs. Reese is a 36-year-old woman who was diagnosed with Crohn’s disease two 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 nutritionwith intralipids.

1. Calculate this patient’s percent of weight loss.

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

To calculate the weight

Current weight:108lbs

Usual weight:122lbs

Lost weight:14lbs

Weight loss(%)=lost weight÷Actual or usual weight×100

=14÷122×10

=11.4 or 11%

=The percentage of weight loss is 11%

As the patient is severely malnourished a complete nutrition has to be given as a whole which is possible with a TPN.Here a parental nutrition can only act as a supplement and not to recover quickly from malnourishment. Enternal feeding is not possible because of bowel obstruction.

The complications of IV are

• Infiltration
• Pain
• Hematoma
• Phlebitis
• Thrombosis
• Infection

The nurse cam reduce these complications by

• Following aseptic techniques while cannulation
• Disinfection or hand hygiene
• Remove line if not necessary
• Change IV every 72 hours
• Assess for redness,pain,swelling
• Secure it from being dislodging

The parental feeding has to be started slowly because of the calorie requirement post surgery and there are chances of electrolyte imbalance post surgery so it has to be monitored to prevent any micronutrient deficiencies.