Chief Complaint CC/History of Present Illness:
Mrs. Morris is a 66-year-old woman who has been complaining of nausea, vomiting, weakness, abdominal pain and abdominal fullness for the past 3 days. She has had a fever for the last 24 hours and reports that her mid-abdominal pain is colicky and “crampy”. She states her “Crohn’s” has been acting up for the past 4 weeks with diarrhea, anorexia, extreme fatigue and weight loss. She is 65 inches tall and weighs 65 kg with a usual weight of 75 kg. Mrs. Morris was admitted to the Med/Surg unit with a complete small bowel obstruction, multiple adhesions, and exacerbation of Crohn’s disease. She is NPO and an exploratory lap is scheduled with lysis of adhesions and small bowel resection to remove diseased bowel. Mrs. Morris will be NPO postoperatively and it is expected that her GI tract will not be accessible for at least 10-14 days.
Social and Past Medical History:
Mrs. Morris currently lives alone in a senior living apartment. Her husband died of pancreatic cancer 2 months ago and they had no children. She has had Crohn’s disease since she was 37 years old and was diagnosed with diabetes type 2, five years ago.
Your Initial Nursing Assessment:
GENERAL APPEARANCE: anxious, appears weak and pale
SKIN/INTEG: skin dry, tenting noted, eyes sunken
RESP: breath sounds clear with equal aeration bilaterally, non-labored
CARDIAC: skin pale, warm & dry, S1S2, no edema, pulses 2+ in all extremities
NEURO: alert & oriented x4,
GI/GU: abdomen firm and distended. Absent bowel sounds, has not voided yet
MISC: complains of crampy, colicky abdominal pain in RLQ, 8/10, nausea and vomiting
Initial Vital Signs:
T: 100.8 F
P: 110
R: 22
BP: 100/60
O2 sats: 98%
Lab/diagnostic Results:
CBC Current High/Low/WNL?
WBC 15000
HGB 9 g/dL
Basic Metabolic panel Current High/Low/ WNL?
Sodium 146
Potassium 3.3
Glucose 165
Albumin 2.9 g/dL
Prealbumin 5 mg
Transferrin 104 mg/dL
BUN 7
Creatinine 1.2
1. What data is RELEVANT and must be recognized by the nurse as clinically significant to the need for nutritional support in Mrs. Morris?
2. Describe the difference between Peripheral Parenteral Nutrition and Total Parenteral Nutrition.
3. Describe the types of parenteral nutrition solutions.
4. Describe the purpose of the components of Parenteral Nutrition.
5. Calculate the total 24 hour caloric content of the Dextrose, Amino Acids and IVFE (Lipids) for Mrs. Morris.
6. Define central venous catheter therapy
7. Is a PICC line a central venous catheter? And if so, why?
8. List the 5 key components of the Institute for Healthcare Improvement (IHI) central line bundle that must be implemented regarding the central venous catheter (CVC).
9. Related to Mrs. Morris’s TPN and CVC therapy, what nursing priority (s) will guide your plan of care? (these nursing priorities may or may not be written as NANDA diagnostic statements)
10. What interventions will you initiate based on the nursing priority (s) identified in # 9?
11. What body systems will you focus on based on Mrs. Morris’s TPN therapy and your nursing priority (s)?12. Mrs. Morris is at risk for complications due to the administration of TPN.
a. What are the worst possible complications to anticipate with TPN administration and CVC management?
b. What signs/symptoms should the nurse anticipate to identify the development of this complication? What relevant nursing action will need to be implemented for this complication?
13. What is Mrs. Morris likely experiencing or feeling right now in her situation?
14. What can you do to engage yourself with Mrs. Morris’s experience and show her that she matters to you as a person?
Peripheral Parenteral Nutrition refers to providing enteral nutrition via a peripheral site such as a hand or arm vein rather than through central venous access directly into the bloodstream. It involves not only providing nutrients but also electrolytes, vitamins and fat emulsions. This form of nutrition is typically used when there are short-term nutritional needs or if access difficulties exist with central catheters (Hemmeter & Rayner, 2015).
Total Parenteral Nutrition on the other hand involves administering all necessary calories via direct access into the bloodstream through either a central line placed in either an internal jugular or subclavian vein (Tompkins & Cox Lee, 2016). The advantage of this method compared to Peripheral PN is that it allows more precise control over individual components while avoiding liver processing thus increasing nutrient uptake efficiency. Furthermore, medications can also be administered simultaneously without affecting absorption rates: however close monitoring needed ensure these elements remain balanced order achieve desired outcomes! In conclusion both types parenteral nutrition have their own pros cons depending situation presented patient important consider these manual deciding route best suited individual’s needs moving forward ultimately ensuring sufficient levels reached maintain health quality life time allowing them return full strength soon possible.
Transient memory is the memory for a boost that goes on for a brief time (Carlson, 2001). In reasonable terms visual transient memory is frequently utilized for a relative reason when one can’t thoroughly search in two spots immediately however wish to look at least two prospects. Tuholski and partners allude to momentary memory similar to the attendant handling and stockpiling of data (Tuholski, Engle, and Baylis, 2001). They additionally feature the way that mental capacity can frequently be antagonistically impacted by working memory limit. It means quite a bit to be sure about the typical limit of momentary memory as, without a legitimate comprehension of the flawless cerebrum’s working it is challenging to evaluate whether an individual has a shortage in capacity (Parkin, 1996).
This survey frames George Miller’s verifiable perspective on transient memory limit and how it tends to be impacted, prior to bringing the examination state-of-the-art and outlining a determination of approaches to estimating momentary memory limit. The verifiable perspective on momentary memory limit
Length of outright judgment
The range of outright judgment is characterized as the breaking point to the precision with which one can distinguish the greatness of a unidimensional boost variable (Miller, 1956), with this cutoff or length generally being around 7 + 2. Mill operator refers to Hayes memory length try as proof for his restricting range. In this members needed to review data read resoundingly to them and results obviously showed that there was a typical maximum restriction of 9 when double things were utilized. This was regardless of the consistent data speculation, which has proposed that the range ought to be long if each introduced thing contained little data (Miller, 1956). The end from Hayes and Pollack’s tests (see figure 1) was that how much data sent expansions in a straight design alongside how much data per unit input (Miller, 1956). Figure 1. Estimations of memory for data wellsprings of various sorts and bit remainders, contrasted with anticipated results for steady data. Results from Hayes (left) and Pollack (right) refered to by (Miller, 1956)
Pieces and lumps
Mill operator alludes to a ‘digit’ of data as need might have arisen ‘to settle on a choice between two similarly probable other options’. In this manner a basic either or choice requires the slightest bit of data; with more expected for additional complicated choices, along a twofold pathway (Miller, 1956). Decimal digits are worth 3.3 pieces each, implying that a 7-digit telephone number (what is handily recollected) would include 23 pieces of data. Anyway an evident inconsistency to this is the way that, assuming an English word is worth around 10 pieces and just 23 pieces could be recollected then just 2-3 words could be recalled at any one time, clearly mistaken. The restricting range can all the more likely be figured out concerning the absorption of pieces into lumps. Mill operator recognizes pieces and lumps of data, the qualification being that a lump is comprised of various pieces of data. It is fascinating to take note of that while there is a limited ability to recall lumps of data, how much pieces in every one of those lumps can differ generally (Miller, 1956). Anyway it’s anything but a straightforward instance of having the memorable option enormous pieces right away, fairly that as each piece turns out to be more recognizable, it tends to be acclimatized into a lump, which is then recollected itself. Recoding is the interaction by which individual pieces are ‘recoded’ and appointed to lumps.
Transient memory is the memory for a boost that goes on for a brief time (Carlson, 2001). In down to earth terms visual momentary memory is frequently utilized for a relative reason when one can’t search in two spots without a moment’s delay however wish to look at least two prospects. Tuholski and partners allude to transient memory similar to the attendant handling and stockpiling of data (Tuholski, Engle, and Baylis, 2001). They likewise feature the way that mental capacity can frequently be unfavorably impacted by working memory limit. It means a lot to be sure about the ordinary limit of momentary memory as, without a legitimate comprehension of the unblemished mind’s working it is hard to evaluate whether an individual has a shortfall in capacity (Parkin, 1996).
This survey frames George Miller’s verifiable perspective on transient memory limit and how it tends to be impacted, prior to bringing the exploration forward-thinking and representing a determination of approaches to estimating momentary memory limit. The authentic perspective on transient memory limit