Weeks 1-3 sessions are not easy but I am trying my best to understand the topics.

For week 1 I

have learned about TPN . Total parenteral nutrition (TPN) is a method of feeding that bypasses the

gastrointestinal tract. Fluids are given into a vein to provide most of the nutrients the body needs. The

method is used when a person cannot or should not receive feedings or fluids by mouth. For the

administration of TPN it is administered ideally in central venous access because it is highly osmotic

solution. If the TPN is a short term intervention less than 4 weeks the subclavian and jugular veins are

commonly used. If TPN is anticipated for an extended period which is greater than 4 weeks a more

permanent catheter such as Peripherally inserted central catheter line. TPN is administered through a

tubing with an in-line filtered and monitored with an electronic infusion device. Clients receiving

parenteral nutrition are at risk of a variety of complications such as infection, fluid overload and

metabolic complications. The purposes of TPN are to provide parenteral nutrition support to

malnourished client and requiring bypass of the GI for prolonged periods and those who have excessive

metabolic needs due to trauma,cancer or hypermetabolic states. There are also indications for TPN

such as insufficient oral or enteral intake,impaired ability to ingest or absorb food orally or enterally,

patient is unable to ingest adequate nutritional needs orally or enterally and lastly preoperative and

postoperative nutritional needs are prolonged. I have also understood how to administer intralipids and

discontinuing of TPN. The gastrointestinal intubation is the Intubation of the digestive tract is the

process of passing a small, flexible plastic tube (nasogastric tube) through the nose or mouth into the

stomach or small intestine. This procedure may be used for diagnostic or treatment purposes. The

following are the purpose of gastrointestinal intubation to decompress the stomach and remove gas

and fluid, to lavage the stomach and remove ingested toxins or other harmful materials, to diagnosed

disorders of GI motility and other disorders. To administer medications and feedings . the nasogastric

tube is a special tube that carries food and medicine to the stomach through the nose. It can be used for

all feedings or for giving a person extra calories. There are indications for Nasogastric tube which are the
aspiration of gastric contents, evaluation of upper gastrointestinal bleeding,identification of the

esophagus and stomach on a chest radiograph, administration of radiographic contrast to the GI tract.

The commonly used gastric tubes are Levin tube and the gastric sump tube. The two differs from the

materials the Levin tube has a single lumen and is made of plastic or rubber while the gastric sump tube

is a clear plastic,double-lumen NG that is passed into the stomach in the same way as Levin tube. The

enteric tube on the other hand is a nasoenteric tube used for providing nutrients and is nasally inserted

feeding tubes placed in the duodenum. To measure the length of the nasogastric tube measure from

the nostril to the tip of the earlobe and from the tip of the earlobe to the tip of the xiphoid process. I

have understood how to administer NGT and how to discontinue it. Stoma is a word of greek meaning

opening . it is the opening of the abdomen that can be connected to either digestive or urinary system

to allow waste to be diverted out of the body . the common conditions that result in the need for

stoma surgery are colorectal cancer, bladder cancer, ulcerative colitis and crohn’s disease. The three

types of ostomaties are colostomy, ileostomy and urostomy. A colostomy is opening in the belly) that's

made during surgery. It's usually needed because a problem is causing the colon to not work properly,

or a disease is affecting a part of the colon and it needs to be removed. It can either be permanent or

temporary. A permanent colostomy are often formed following a removal of rectal cancers while the

temporary colostomy may be formed to divert the fecal output to allow healing of surgical join. The

ileostomy is an opening in the abdominal wall that's made during surgery. It's usually needed because a

problem is causing the ileum to not work properly, or a disease is affecting that part of the colon and it

needs to be removed . the average output from an ileostomy is 200-600Ml/day. The urostomy is an

opening in the abdominal wall that's made during surgery. It re-directs urine away from a bladder that's

diseased, has been injured, or isn't working as it should. The bladder is either bypassed or removed.

Indications that stoma care is essential are to collect feces or urine with an appropriate appliance, to

maintain patient comfort and security and to support psychological adaptation and independence. It is
important when choosing the appropriate management system for the ostomate which are the type of

stoma,type of effluent, patients cognitive ability, manual dexterity , lifestyle , condition of peristomal

skin,siting of stoma, patients preference. There are 2 types of ostomy bag which is the one piece system

that comprises a pouch attached to an adhesive wafer that is removed completely when pouched is

change while the two piece system comprises of a wafer onto which a pouch is clipped or struck.