Describe the gradual increase of TF with the accompanying ...

[cool]

Describe the gradual increase of TF with the accompanying decrease of TPN and tell how long you would expect to take before meeting Mrs. S's requirements with TF alone.

Question 2

Describe right side heart failure.

[kkenney]

Answer to Question 1

One important observation is to be aware that the TPN should not be stopped suddenly and the tube feeding started full strength at the final flow rate. After not feeding by GI, food needs to be introduced gradually to prevent diarrhea. First, decide on the tube feeding to be started, then decide on the strength. The flow rate would probably be about 25 cc/hr with  strength for most feedings. Since there are many ways to determine the rate of increase, the answer here should be within the framework of your teaching. Another important point is to calculate the kcals and protein the patient is receiving from the tube feeding and decrease the TPN by the appropriate amount so that there is no change or little change in the total kcal/protein intake. As the tube feeding is increased, decrease the TPN. Without complications, Ms. S should be to her final flow rate at full strength by about the fifth day.

Answer to Question 2

This is failure of the proper functioning of the right ventricle with subsequent engorgement of the systemic veins. Pitting edema, enlargement of the liver, and ascites can be the result.