d. Observe for nausea and vomiting due to suture line edema, food intake (too much, too fast).
4. Goal: prevent complications.
a. Check dressing q4h for bleeding.
b. Vitamin B,2 and iron replacement as indicated to avoid pernicious anemia and iron deficiency anemia.
c. Avoid dumping syndrome.
♦ D. Evaluation/outcome criteria:
1. Hemorrhage, dumping syndrome avoided.
2. Healing begins.
3. Adjust lifestyle to prevent recurrence/marginal ulcer.
XI. Dumping syndrome: hypoglycemic-type episode; occurs postoperativly after gastric resection (may also occur after vagotomy, antrectomy, or gastroenterostomy), when food and fluids that are more hyperosmolar than the jejunal secretions pass quickly into jejunum, producing fluid shifts from bloodstream to jejunum. This is a mild problem for about 20% of patients and will disappear in a few months to a year. Symptoms cause serious problem for about 7% of patients. This discomfort may occur during a meal or up to 30 min after the meal and last from 20-60 min. The reaction is greatest after the ingestion of sugar.
♦ A. Assessment:
1. Subjective data:
a. Feeling of fullness, weakness, faintness.
b. Palpitations.
c. Nausea.
d. Discomfort during or after eating.
2. Objective data:
a. Diaphoresis.
b. Diarrhea.
c. Fainting.
d. Symptoms of hypoglycemia.
♦ B. Analysis/nursing diagnosis:
1. Altered nutrition, more than body requirements, related to body’s inability to properly digest high-carbohydrate, high-sodium foods.
2. Diarrhea related to food passing into jejunum too quickly.
3. Risk for injury related to hypoglycemia.
4. Knowledge deficit related to dietary restrictions.
♦ C. Nursing care plan/implementation:
1. Goal: health teaching.
Include:
(1) Increased fat, protein to delay emptying.
(2) Rest after meals.
(3) Small, frequent meals.
(4) Fluids between meals.
Wftb. Avoid:
(1) Foods high in salt, carbohydrate.
(2) Large meals.
(3) Stress at mealtime.
(4) Fluids at mealtime.
♦ D. Evaluation/outcome criteria:
1. No complications.
2. Patient heals.
3. No further ulcers.
4. Incorporates health teaching into lifestyle and prevents syndrome.
XII. Total parenteral nutrition: provide nutrition through a central venous line to patients who are in a catabolic state; are malnourished and cannot tolerate food by mouth; are in negative nitrogen balance; or have conditions that interfere with protein ingestion, digestion, and absorption, e.g., Crohn’s disease, major burns, and side effects of radiation therapy of abdomen.
A. Types of solutions:
1. Hydrolyzed proteins (Hyprotein, Amigen).
2. Synthetic amino acids (Freamine).
3. Usual components:
a. 3-8% amino acid.
b. 10-25% glucose, c. Multivitamins, d. Electrolytes.
e. Fats (lipid or fat emulsions). Lipid emulsions are contraindicated if patient has allergy to eggs.
4. Supplements that can be added: a. Fructose.
b. Alcohol.
c. Minerals: iron, copper, calcium.
d. Trace elements: iodine, zinc, magnesium, e. Vitamins: A, B, C.
f. Androgen hormone therapy.
g. Insulin.
h. Heparin.
B. Administration:
1. Dosage varies with clinical condition; 1 L q5-8h; rate of flow must be constant.
2. Solution prepared under laminar flow hood (usually in pharmacy); solution must be refrigerated; when refrigerated, expires in 24 hr; once removed from refrigerator, expires in 12 hr.
3. Incompatible with many antibiotics; check with pharmacy.
4. Route: catheter inserted in a large vein (e.g., subclavian) by physician; placement confirmed by x-ray before beginning infusion (Figure 7—9).
5. Side effects:
a. Hyperosmolar coma.
b. Hyperglycemia >130 mg/dL.
c. Septicemia.
d. Thrombosis/sclerosis of vein.
e. Air embolus.
f. Pneumothorax.
6. Prolonged use: >10 days, fat needed; intralipids piggybacked close to insertion site;