Self-Monitoring for HPN Consumers
Marcia Boatwright, RN, CRNI; Kristyn Maixner, RN
Participants at the recent Oley conference frequently heard speakers discuss the importance of self-monitoring for those on enteral and parenteral nutrition (PEN) therapy. What is self-monitoring? It is the gathering and recording of important health information, and it will enable you to assist your care team in providing optimal nutrition therapy outcomes.
The body provides subtle indicators that when recognized early can prevent potentially serious medical conditions and complications. No one knows your body better than you, which is why self-monitoring is the most important thing you can do for yourself and your well-being.
The following self-monitoring parameters can help you identify your baseline and recognize early the signs your body presents. They will also enhance your participation in your medical plan of care.
While receiving homePN, the important key factors to monitor are weight, temperature, blood glucose, urine output, hydration status, stool/wound/ostomy output, and the appearance of your catheter or port site. Click here for the “Nutrition and You” column of this issue for a discussion on hydration; the other topics are discussed below. HEN consumers: we hope to present more information regarding self-monitoring specific to enteral feeding in a future issue of the LifelineLetter.
Weigh yourself at the same time every day on the same scale, wearing the same amount of clothing (or lack thereof). Should you see a decrease, or even an increase, of more than two pounds in a day, or five pounds in a week, it is important to notify your physician.
Weight is not only a measure of your nutritional status, but it can also be an indicator of your hydration state. Losses or gains as noted above could be a sign of dehydration or overhydration.
As an HPN consumer, it is critical that you check your temperature to monitor for infection. Check your temperature before starting your HPN infusion for the day to determine your baseline. Check your temperature again one to two hours into your infusion period. If your temperature has increased by 1.5 degrees Fahrenheit or more, contact your attending physician immediately. It is important to check your temperature with a thermometer as you cannot accurately “estimate” your temperature, and whether you have a fever.
Do not wait to see if your temperature continues to rise or goes away as a fever alone can be a sign of a life-threatening blood infection. Any episodes of chills or flu-like symptoms during your HPN infusion must be taken seriously; they require immediate medical assessment at the nearest emergency department. A delay in obtaining medical care for a fever, chills, or flu-like symptoms could have serious consequences on your health and may require removal of your vascular access catheter or port.
Note: Mercury thermometers are hazardous (see “Beware Mercury Thermometers”).
Blood Glucose (Blood Sugar)
Parenteral nutrition formulas can contain a high level of dextrose to provide calories. This dextrose is sometimes referred to as “sugar.” It is important to monitor your blood glucose for hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). A recommended time to check your blood glucose level is approximately one hour after beginning your HPN infusion and again one hour after the HPN infusion period has been completed.
Hyperglycemia (blood glucose over 200 for HPN consumers) symptoms may include one or more of the following: drowsiness; nausea; confusion; fruity, sweet-smelling breath; and increased thirst. If your blood glucose is 200 or greater, notify your healthcare provider.
Hypoglycemia (blood glucose under 70 for HPN consumers) symptoms may include one or more of the following: weakness; blurred vision; shakiness; irritability; sweating; and headache. Hypoglycemia can quickly become a serious complication and is most easily treated by taking a simple sugar in the form of glucose gel or dissolving tablets. These are available at any pharmacy; take as directed by your healthcare provider.
Important note: Read and review blood glucose monitor directions carefully. Use the glucose monitor and test strips as directed by the manufacturer. When using test strips, it is important to always close the test strip container tightly immediately after removing a test strip. Keep test strips in the container provided. Never use blood glucose monitoring strips that are outdated.
The amount of urine passed each day is an indication of your body’s hydration status and kidney function. Dehydration stresses the kidneys, and adequate fluid balanceis important to prevent kidney failure. You cannot truly or accurately estimate your urine output when you urinate; you need to measure it.
Record your urine output for a twenty-four–hour period while noting the color and concentration. Urine should be clear and yellow in color, and an adult should have at least 1000 ml. output within a twenty-four–hour period. Notify your attending physician of any urine that is concentrated or darker in color.
Any sudden change in stool, abdominal wound, or ostomy output—whether a decrease or increase in amount, or a change in consistency, color, drainage, or odor—should be recorded and reported to your healthcare provider. These various output changes can be of significance and may affect the amount of urine output on a day-to-day basis.
Make note to discuss with your physician any changes of color or shape, bleeding, protrusion, or retraction of an ostomy stoma bud. Early detection of these changes can decrease potential complications.
Important notes: Avoid having your vascular access catheter dangling or positioned over wounds, a G-tube, or an ostomy. Avoid caring for a vascular catheter site and a wound or ostomy site within a close period of time. These actions can help prevent cross-contamination of bacteria to your vascular catheter. To prevent infections, it is essential that you wash your hands after you’ve handled stool, wound, or ostomy output!
Vascular Access Catheter or Port Site
Complete vascular access catheter or port site care and dressing changes as instructed by your healthcare provider. During site care it is important to feel the catheter track or port pocket for any tenderness, swelling, or drainage, which may indicate an infection. Watch closely for skin irritation, rashes, skin blisters, redness, or oozing at area. Complete dressing changes after swimming, sauna, hot tub, tanning, showering, or heavy perspiration. Avoid adhesive build up on your catheter or port site, but avoid using acetone products near the catheter. These measures will help to prevent catheter or port infections.
Monitor the integrity of your vascular access catheter by watching for cracks, ripples, bulges, or worn clamps on the catheter or the catheter hub. You can help prevent catheter leaks, breakage, or ruptures by promptly reporting any of these catheter defects. Other important observations—such as your catheter looks longer or shorter than usual; the catheter cuff is seen at the exit site; you’re having difficulty accessing the port or flushing the catheter or port needle; any resistance flushing the catheter or port; any discomfort or pain during PN infusion; neck, arm, or shoulder swelling or discomfort—should be reported to your healthcare provider as soon as possible as these experiences require medical evaluation and care.
Last but not least, thorough hand washing is a critical component in the prevention of catheter and port infection.
LifelineLetter, July/August 2010