肠内营养英文课件.ppt

* 肠胃病新见 * * * * * * flushing fix skin care Change tube every 6-8weeks according to material of different tubes oral care Monitoring nutritional status nutritional status Height and Weight Gastrointestinal function Intake and output Skinfold thickness Lab test Feeding tube function Assessment of Nutritional Status 1 2 Nursing Care of Client with Total Parenteral Nutrition 3 Content Nursing Care of Client with Tube Feeding (Enteral Nutrition) 1986年2月，上海周绮思女士因患急性肠扭转切除全部小肠，华瑞决定长期无偿向提供生存所需的全套全静脉营养产品 1992年4月8日，历史将记住这一天。蔡惟成为世界上完全依靠人工全静脉营养孕育的第一人。周绮思母女的事例也因此被载入吉尼斯世界纪录 Definition Parenteral Nutrition(PN) indicates nutrition is provided intravenously Patients who cannot eat Patients who will not eat Patients who should not eat Patients who cannot eat enough Patients with complex metabolic problems Basic Indications Burns Severe diarrhea and vomiting. Complicated trauma or surgery Pancreatitis Gastrointestinal obstruction Gastrointestinal tract anomalies and fistula Inflammatory bowel disease Short bowel syndrome Severe anorexia nervosa Parenteral nutrition solution CVC PICC PVC Types of catheter for TPN PVC Tips: Large peripheral vein Time 2 weeks The risk of a central catheter is too great Short catheter: 48-72 hr 穿刺处 形成结节 用留置针输注脂液 用钢针输注脂液继发溃疡 cvc PICC 锁骨下静脉、颈内静脉、股静脉 输注高浓度和大剂量液体 减少反复静脉穿刺的痛苦 需要熟练的置管技术，无菌条件 气胸、导管败血症等并发症 Retention time of Intravenous access 留置针 小于等于48-72小时 短期CVC 1星期 - 4星期 PICCs（第一代） 三-六个月左右 静脉输液港 6星期 - ++++ 2星期 - ++++ 植入式化疗泵 PICCs（第二、三代） 5月 - 1年 PICC 外周穿刺 穿刺危险小 穿刺成功率高 外周留置 感染率低 (2%) 留置时间长 (数月至壹年) 长期静脉输液 CVC 颈内、锁骨下穿刺 盲穿 穿刺并发症危险 躯干部位留置 感染率高 (26%) 短期留置 急重症、大手术，短期留置 Nursing diagnosis and collaborative problem Risk for infection Impaired physical mobility Potential complication: hyperglycemia, hypoglycemia, electrolyte imbalance related to administration of TPN Potential complication: air embolus related to incorrect position of TPN catheter Nursing diagnosis Administratio