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Good Afternoon, I am looking for answers to the questions on the attachment below. I would greatly appreciate your help. Very busy week in nursing school.Â
Case Study, Chapter 45, Digestive and Gastrointestinal Treatment Modalities
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1. Molly Baker, a patient 35 years of age weighs 72 kg. She was admitted to the burn unit for full-thickness or third-degree burns over 36% of her body surface according to the use of the rule of nines. She has a paralytic ileus and has high residuals with enteral feeding using the nasojejunal tube. The physician ordered a lower rate for the enteral feeding and ordered total parenteral nutrition (TPN) via a subclavian triple lumen catheter to provide the patient’s nutritional needs. When a patient has burns over a large portion of the body, the patient is in a hypermetabolic state and usually requires 35 to 40 kcal/kg/day and needs 25% of the calories each day in high biologic value proteins. (Learning Objective 5)
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a.      What nursing measures should the nurse implement to prevent potential complications related to the patient’s enteral feeding?
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b.     What nursing measures should the nurse implement to prevent potential complications related to the administration of TPN?
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2. The nurse working in a rehabilitation facility receives a patient from the acute care hospital for management after a severe closed-head injury. The patient is in a semiconscious state, and has impaired swallowing. The admission orders call for insertion of a nasogastric (NG) tube for feedings and medication administration. (Learning Objectives 2 and 3)
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a.      What is the correct method for measuring the length of an NG tube for correct placement in the stomach?
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b.     You note that the student caring for Mr. Fields is verifying tube placement by listening when a bolus of air is injected into the NG tube via a syringe. How should you intervene? What other methods can the student use to verify tube placement? What is the rationale?
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c.      What is the correct procedure for administering medications via an NG tube that has a continuous feeding infusing?
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d.     The patient develops diarrhea the second day at the rehabilitation facility. The nurse assesses for which electrolyte abnormalities? What actions can the nurse implement to decrease the diarrhea?
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