What does the abnormal color of urine say about your health?

It can be alarming to see red blood color of urine in the bowl, or green, blue, cloudy, or frothy liquid coming out of your body. Most of the time, however, there is a non-threatening explanation for the urine that comes in all the colors of the rainbow.

Experts tell us that a healthy body of urine is straw colored. It’s just a little yellow and transparent. From time to time, however, urine comes in different colors. In general, strange-colored urine is benign in origin, but occasionally it is a sign that it is time to go to the doctor.

Yellow Urine Straw

Healthy urine is 96 percent water, with just a few other waste products. The body excretes an acidic compound called urea when excess amino acids have to be converted to sugar. The sugar remains in the body, and urea, otherwise it causes the blood’s pH to drop.

Urea itself is colorless. The small amount of yellow pigment in the healthy urine is a compound called urochrome, it is made from recycled bile salts. Bile is a liquid produced by the liver to dissolve the fats in the digestive tract. Excess bile salts are eliminated in urine and feces.

If you put urine in a bottle, you should be able to see its true color if you return a white paper or a newspaper. If your urine is dark, it is possible that you are not drinking enough water.

Completely Clear Urine (Clear)

If the urine is completely clear, it is usually the result of excess water being drinking. Athletes who drink lots of water during sports competitions, for example, and people in the ten-cup water tables daily tend to have clear urine. Clear urine usually only means that the urochrome is so diluted that it is not visible. If you stop drinking so much water, and it returns to normal color.

Clear urine is also common in people who take diuretics, in general, for high blood pressure or edema. When the medication is stopped, it returns the color. The doctor will probably carry a urine sample as part of regular health surveillance.

In rare cases, clear urine can result from diabetes insipidus, the pituitary gland’s failure in the brain to make a substance called antidiuretic hormone. This is caused by an injury to the brain or certain metabolic conditions. The kidneys do not get the message to keep it in the middle of the night, so sleep becomes difficult, and dehydration, despite the clear urine, is a constant concern. This condition increases thirst as it increases urination, but it is very difficult to keep up with the hyperactivity of the kidneys for the day. Diabetes insipidus is diagnosed by depriving the patient of water, which should not decrease urine production, as much as expected the opposite.

Urine orange

Orange urine can be dyed by beta carotene, the most generous antioxidant compound in carrots. People who consume large amounts of carrots may have orange urine. Orange urine can also be a sign of hepatitis, as inflammation in the liver makes bile to travel directly to the kidneys. However, dehydration is the most common cause of orange urine. The kidneys work all night long, when they do not lift me to drinking water, and keep urochrome elimination (mentioned above) without removing the water to dilute.

The meaning of other colors abnormal urine

Bright Yellow Urine

Sometimes the urine is bright, almost yellow “Neon”. In general, this is a result of taking vitamins nutritional supplements. The body can not store large amounts of vitamin B2, so it pours into the urine where it has a very noticeable color. As an isolated chemical compound, Vitamin B2 is more yellow orange, but because it also absorbs blue light, it has a bright and yellow appearance in the urine. Vitamin B2 is slightly soluble in water, so the color is generally sensitive first micturition after taking the supplement, in excess tends to be excreted at the same time.

Blue Urine

If you have blue urine, the most likely explanation is that you have consumed foods made with blue dyes, such as icing or candy? The liver processes the staining and sends more or less directly to the kidneys excrete. Blue urine is also caused by the use of methylene blue, which is injected in the event of accidental cyanide poisoning or is used to treat urinary tract infections.

Urine of Green color

Green urine is most commonly a by-product of a type of bacteria called Pseudomonas aeruginosa. This bacteria lives in the gut, but can be transferred into the urinary tract when applied with a toilet paper moving forward instead of with a backward movement. Some people who have liver cancer may also have green urine, such as some people who drink large amounts of green tea. Green urine is sometimes observed after exposure to toxic substances.

Propofol anesthetic can make green urine as well as certain medicines for Parkinson’s disease.

Urine of Purple Color

Purple urine tends to be the result of a disease called porphyria, this affects about 30,000 people, mainly in the UK and South Africa. Porphyria was the cause of the “madness of the infamous King George III” of Great Britain, while now it can be treated.

Urine Red or Pink

Most people are alarmed by the urine of red in the basin. Sometimes discoloration is caused by plant pigments, particularly beet, but is most often due to bleeding in any part of the urinary tract. You need only 1 ml of blood to give the pink urine. Bleeding from the urinary tract can be caused by kidney stones, bladder or kidney blast, the in rare cases, bladder cancer.

Brown or Black Urine

Equally worrisome is the presence of brown or black urine in the vessel. Fortunately, it usually has a benign cause. Consumption of certain types of beans, especially beans or velvet beans, causes darkening of the urine due to its dopamine content. Certain medicines for Parkinson’s disease also, they have this effect, based on sena laxatives (in the United States and the United Kingdom, Sennecot) you can also darken the urine.

Blurred or White Urine

Turbid urine usually indicates a bacterial infection. When the urinary tract is infected, the immune system sends white blood cells to attack the germs. Some of them appear in the urine after awakening.
Men sometimes have dark or foamy urine after intercourse, or when they do not ejaculate for long periods of time. Semen can be in the urinary tract, and in the prostate, and may appear whitish or opaque in the urine.

Foam Urine

It may be the result of the same white or cloudy urine causes, or may indicate excess protein from severely diseased kidneys. If kidney disease is the problem, there will be other symptoms besides foamy urine.

Epistaxis

The term Epistaxis is the name given to any type of blood loss through the nose, often through the nostrils, or through the nose through the mouth.

There are two types of epistaxis:

Anterior – (approximately 90% cases), that is, closer to the outside of the nose.
Posterior – (approximately 10%), that is, more in the interior: less common, but with more severe effects.

How does bleeding happen?

Epistaxis occurs when small vessels (veins or arteries) that pass through the mucous membranes of the nose rupture.

Why do these little vessels break?

In general, vessels become fragile and more susceptible to rupture by local factors, which can be identified by otorhinolaryngological examination, or by systemic factors as listed below.

Local Factors:

Anatomic deformities Inhalation of chemicals Inflammation (secondary to acute respiratory tract infections such as chronic sinusitis, allergic rhinitis and environmental irritants);
Foreign bodies;
Intranasal tumors;
Use of nasal medications;
Previous Surgeries;
Trauma;

Systemic Factors:

Use of certain medications (aspirin, warfarin, clopidogrel, desmopressin);
Alcohol intoxication;
Allergies;
Blood clotting disorders;
Heart problems;
Tumors of the blood (leukemia);
Arterial hypertension;
Infectious diseases;
Malnutrition (especially anemia);
Use of narcotics;
Vascular diseases;

What to do when you have Epistaxis?

If you have frequent episodes of epistaxis, it is worthwhile to seek the otolaryngologist before even a new event to discover the cause, clarify any doubts and start treatment.

If you are bleeding at this time, initially stay calm, most epistaxis improve spontaneously within a few minutes and do not require urgent medical attention.

Pinch the side of the nose against the septum on the affected side for a few minutes, sit erect, do not lift, and do not lower your head. A cotton swab soaked in vasoconstrictor solution (Afrin, Sorine…) may be placed into the nostril and then continued for at least 5 to 10 minutes. After bleeding stops, do not force the nose to blow because it may cause new bleeding. Do not insert anything into the nostrils. Do not try to clean them with a cotton swab, finger, tweezers, tissues, toilet paper. Use humidifiers or wet towels to humidify the environment.

How is the treatment done?

The otolaryngologist can perform the cauterization (chemical or thermal) of the affected blood vessels and control their healing. Sometimes it is necessary to perform a nasal packing in the most varied forms (cotton, gauze, sponges or expandable materials) for a period of 24 to 48 hours. When removed, wounds are usually already healing. Patients with blood clotting disorders or chronic use of medicinal products that affect coagulation (aspirin, oral anticoagulants or injectables) should be dosed appropriately or suspended momentarily.

Patients on chemotherapy, with leukemia, or post-radiotherapy frequently suffer from epistaxis and should seek the specialist. Bleeds of greater proportions, longer or with maintenance of bleeding even with tampon, can be treated with surgery for ligature or electro cauterization of these arteries under general anesthesia.

Cardinal Sign or Cardinal Symptom

Inflammation is a local defense mechanism, exclusive of damaged mesenchymal tissues (connective tissue, bone and cartilaginous tissue, blood and lymphatic vessels, and tissue).

It is the local response of the damaged vascularized tissue, characterized by alterations of the vascular system, the liquid and cellular components, also by adaptations of the neighboring connective tissue.

There are some basic phenomena common to any type of inflammation and no matter what the inflammatory agent.

Although these phenomena are divided into five phases they all happen as a single, joint process, which makes inflammation a dynamic process.

Check out what these stages are and what happens most important in each one of them:

Irritative phase: Morphological and functional modifications of the damaged tissues occur that promote the release of chemical mediators, which will trigger the other inflammatory phases.
Vascular phase: hemodynamic changes of the circulation and vascular permeability at the site of the aggression.
Exudative phase: This phase is characteristic of the inflammatory process, and is formed by the cellular and plasma exudates (migration of fluids and cells to the inflammatory focus) from increased vascular permeability.
Degenerative-necrotic phase: composed of cells with reversible or non-reversible degenerative changes (in this case, originating a necrotic material), derived from the direct action of the aggressor agent or from the functional and anatomical modifications consequent to the previous three phases.
Productive-reparative phase: increase in the quantity of the tissue elements – mainly cells, result of the previous phases. The objective is to destroy the aggressor agent and repair the battered tissue.

Clinical Manifestations

There are also five classic signs of the inflammatory process, called Flogistic or Cardinal Signs.

They are: edema, heat, redness, pain and loss of function.

Edema is caused mainly by the exudative and productive-reparative phase, because of the increase of liquid and of cells.

The heat comes from the vascular phase, where there is arterial hyperemia (which is the increase of the blood volume in the local) and, consequently, increase of the local temperature.

Redness is redness, which also results from hyperemia.

Pain is caused by more complex mechanisms including compression of local nerve fibers due to edema, direct aggression to nerve fibers and pharmacological action on nerve endings. It involves at least three phases of inflammation (irritative, vascular and exudative).

Finally, loss of function is due to edema (especially in joints, preventing movement) and pain, which hamper local activities.

Nursing Care with the presence of Cardinal Sign

Health-care-related infections are considered preventable by simple measures, with proper hand washing (considered the most efficient measure of prevention) before and after all procedures.

They are the hands that carry the largest number of microorganisms to patients, through direct contact, procedures or the handling of objects. Employee training can improve the knowledge of techniques, increase the quality of care provided to the patient, and decrease the rate of infections related to peripheral or central catheters.

The catheter may be colonized by microorganisms on its external surface, by the subcutaneous tunnel of the surrounding skin or by the microbiota itself, by the hands of contaminated professionals and antiseptics, as the higher the number of bacteria, the greater the likelihood of infection .

There are important risk factors associated with the use of intravascular catheters, which may be related to the host such as: primary diagnosis (baseline disease), comorbidities, antibiotic therapy (dose and duration), use of immunosuppressants and length of stay. And related to the catheter: the type of catheter implanted, technique of insertion of the catheter, length of stay, place of insertion and care with the catheter (with the dressing).

In the presence of a suspicion of infection related to a peripheral or central catheter, the tip of the catheter should be removed, upon request of a medical prescription (when polyurethane, teflon or silicone, which are more recommended because they are thrombogenic materials) and request order to examine catheter tip cultures and refer them to the laboratory.

It can be done through the exudate with staining by the Gram method and submitted to culture, if there are phlogistic signs at the insertion of the catheter.

Performing a dressing with aseptic technique in place removed the catheter in order to prevent the proliferation of bacterial infection in other locations.

Acute Respiratory Distress Syndrome (ARDS)

Acute Respiratory Distress Syndrome (ARDS) is a type of pulmonary insufficiency caused by various disorders that cause fluid accumulation in the lungs (pulmonary edema). This syndrome is considered a medical emergency that can occur even in people who previously had normal lungs. Although it may sometimes be called adult respiratory distress syndrome, this disorder may also occur in children.

What are the causes?

The cause may be any disease that directly or indirectly causes lung injury. Approximately one-third of individuals with the syndrome develop it due to a widespread and serious infection (sepsis). When the alveoli and pulmonary capillaries are damaged, blood and fluid escape into the interalveolar spaces and finally into the alveoli. Subsequent inflammation can lead to the formation of scar tissue. As
consequently, the lungs can not function normally.

What are the Symptoms and Diagnosis?

Typically, acute respiratory distress syndrome occurs 24 or 48 hours after the injury or the original illness. Initially, the individual is short of breath, almost always accompanied by a superficial and rapid breathing. With the help of a stethoscope, the doctor may hear crackling sounds or wheezing in the lungs. Due to the low levels of oxygen in the blood, the skin may become mottled or bluish and the function of other organs, such as the heart and brain, may be compromised.

Arterial blood gases reveal low levels of oxygen in the blood and radiographies indicate the presence of fluid in the spaces that should be filled with air. Sometimes other tests are needed to confirm that the cause of the problem is not heart failure.

Main causes of Acute Respiratory Distress Syndrome

Severe disseminated infection (septicemia);
Pneumonia;
Severe arterial hypotension (shock);
Aspiration of food into the lungs;
Multiple blood transfusions;
Pulmonary injury resulting from elevated oxygen concentrations;
Pulmonary embolism;
Thoracic injury;
Burns;
Drowning;
Cardiopulmonary bypass surgery;
Inflammation of the pancreas (pancreatitis);
Excessive dose of some type of drug, such as heroin, methadone, propoxyphene or aspirin.

What are the complications and prognosis?

The lack of oxygen caused by this syndrome can produce complications in other organs soon after the onset of the condition or, when there is no improvement in the condition, over days or weeks. Prolonged lack of oxygen can cause serious complications, such as kidney failure. Without immediate treatment, severe oxygen deprivation caused by the syndrome causes death in 90% of patients.

However, with proper treatment, about 50% of affected individuals survive. As individuals with acute respiratory distress syndrome are less resistant to lung infections, they commonly develop bacterial pneumonia at some point in the course of the disease.

How is the treatment done?

Patients with acute respiratory distress syndrome are treated in the intensive care unit. Oxygen therapy is essential for the correction of low oxygen levels. If oxygen administered with the use of a face mask does not correct the problem, a ventilator should be used. It delivers oxygen under pressure through a tube inserted into the nostril, mouth, or trachea. This pressure helps force the passage of oxygen to the blood.

The pressure is adjusted to help keep the small airways and alveoli open, and to ensure that the lungs do not receive an excessive concentration of oxygen. This is important because too much oxygen concentration can injure the lungs and aggravate acute respiratory distress syndrome. It is also important to institute other adjuvant treatments, such as the administration of liquid or nutrients through the intravenous route, since dehydration or malnutrition increases the likelihood of disruption of the functioning of multiple organs (multiple organ failure).

Additional treatment crucial to success depends on the underlying cause of acute respiratory distress syndrome. For example, antibiotics are given to fight an infection. Patients who respond normally to treatment regain well with little or no long-term pulmonary change. For those patients whose treatment depends on long periods under assisted breathing (with the aid of a ventilator), the possibility of pulmonary scar formation is greater. However, these scars may improve a few months after the patient has stopped using the ventilator.

What are Nursing Care with the patient in ARDS?

Reassure the client in psychological support;
Encourage semi – Fowler or Fowler position for better ventilation;
Perform Hydrolitic control;
Observe distension of the jugular vein (peripheral edema);
Provide adequate nutritional support;
Provide assisted diet;
Maintain calibrated venous access, pulse oximeter and cardiac monitor;
Maintain oral (tracheobronchial) and body hygiene;
Assist the physician in endotracheal or orotracheal intubation, and in mechanical ventilation;
Administer medications according to medical prescription;
Check vital signs;
Observe, communicate and note intercurrences.

Plegia, Paralysis and Paresis: The Differences

The terms can be very confusing, when making a note, and even the evaluation that the doctor and the nurse can do, during an anamnesis.

The term paralysis (where Plegia is synonymous) refers to the loss of capacity for voluntary muscular contraction, functional or organic disruption at any point of the motorway, which can go from the cerebral cortex to the muscle itself; paralysis is spoken when any movement in these proportions is impossible.

Already, paresis refers to when the movement is only limited or weak. The term paresis comes from the Greek PARESIS and means relaxation, weakness. In cases of paresis, the motility occurs only in a below-normal pattern, regarding muscle strength, movement precision, range of motion and localized muscular resistance, ie, it refers to a partial impairment, to a semi-paralysis.

Know the Types of Insulins: The Beginning, Peak and Duration

Like all medicines used, once you know your characteristics better, treatment and adherence become easier and more enjoyable.

The main function of insulin is to carry glucose into cells, where it is used as energy.

When we feed, the pancreas is stimulated to produce insulin, thus carrying excess glucose into the various organs of the human body for use and storage.

And when are we fasting?

During the fast, insulin is also produced. Remembering that also during the fasting the insulin must load the glucose into the cells, so that they have energy. In this period, glucose comes from deposits present, mainly in the liver and muscles.

As we can see, even in our body, insulin acts in different ways, with an action that is continuous, which is that of fasting, and another that happens in peaks, which is that which happens in the meal.

In order to try to mimic what happens in the body without diabetes, the used insulins also have different characteristics: according to the beginning period of their action (when they begin to act), their maximum action (called peak action) and time in which it remains acting (duration of action).

Fast and Ultrafast Insulin

Insulins used for the bolus are fast and ultra fast calls. They have as action the feeding period, promoting a good glycemic control in the periods close to feeding.

Fast or regular insulin begins to act in 30 to 60 minutes and has its peak of action in 2 to 3 hours and duration of action of 6 hours and 30 minutes. Therefore, it should be used 30 to 45 minutes before the meal. Ultrafast insulin – lispro, aspart or glulisine – begins to act in 10 to 15 minutes, has its peak of action in 1 to 2 hours and duration of action of 3 to 5 hours. Therefore, it should be used in less than 15 minutes before the meal, or even during the meal. The latter has a lower risk of hypoglycemia than the rapid one.

Slow and Ultra slow insulins

The insulins used for the basal role are the slow and ultralent. Its main goal is to maintain stable glycemia between meals.

NPH insulin is the only representative of slow insulins. It begins to act in 1 to 3 hours, has its peak action in 5 to 8 hours and duration of action of up to 18 hours. Ultralent insulin is represented by Insulin Detemir – with onset of action in 1 to 2 hours, discrete peak of action in 2 hours and duration of action of 16 to 24 hours – and Insulin Glargine – with onset of action in 1 to 2 hours , absence of peak action and duration of action of up to 24 hours.

Use of Insulin in Type 1 and Type 2 Diabetes

Patients with type 1 diabetes, as they do not produce any insulin, should always use both types of insulin – called full insulinization. When feeding, they should use fast or ultra-fast insulins, respecting their application times. If your capillary glycemia (or dextro) is elevated before feeding, you should use a larger dose to correct this value, in addition to that required for feeding. For basal insulin, they should use the slow or ultralast, even if fasted, to maintain adequate levels of their blood glucose. Users of the subcutaneous insulin pump use ultrafast insulin continuously for this purpose.

In patients with type 2 diabetes, full insulinization is only performed in later stages of disease progression, when what is called “pancreas failure” occurs. That is, the pancreas, over time, fails to produce enough insulin to fulfill its functions of maintaining glycemia during fasting and covering the excess glucose from the diet. In earlier stages, use may be necessary when blood glucose levels are very high, or in situations where oral medications are contraindicated, such as during surgery or serious illness.

Heart Attack: Acute Myocardial Infarction (AMI)

The medical term for most known heart attack is Myocardial Infarction. It can also be called myocardial infarction, ischemic heart disease, coronary obstruction, cardiac crisis. In our setting, the most commonly used term is infarction.

But what is myocardial infarction?

Myocardial infarction occurs when the blood supply to a part of the heart muscle is reduced or cut completely. This happens when a coronary artery is contracted or obstructed, partially or totally.

With the total or partial suppression of the supply of blood to the heart muscle, it suffers an irreversible injury and stops functioning, which can lead to sudden death, late death or heart failure with consequences ranging from severe limitations of physical activity to complete recovery.

There are more than 150 thousand cases of AMI in Brazil. Myocardial infarction may also occur in people who have normal coronary arteries. This happens when the coronary arteries have a spasm, contracting violently and also producing a partial or total deficit of blood supply to the heart muscle irrigated by the contracted vessel.

This type of spasm can also occur in vessels already compromised by atherosclerosis.

What are the risk factors?

Age: Men aged 45 years and over and women over 55 years old are at high risk.
Smoking: Prolonged exposure to other people’s smoke gives you a high risk of cardiovascular disease.
High cholesterol levels: If you have high levels of triglycerides and low HDL (high density lipoprotein), you are likely to have a higher risk of heart attack.
Diabetes, especially if it is not treated.
Family history of heart attack: If someone in your family has a history of a heart attack, you may also have it.
Sedentary lifestyle: Not being physically active leads to high levels of bad cholesterol that can cause plaque formation.
Obesity: If you lose 10% of your body weight, it will also reduce your risk of heart attack.
Stress: German researchers have found that when you have stress, white blood cell levels increase. They, in turn, increase the risk of developing atherosclerosis and plaque rupture.
Use of illicit drugs: The use of cocaine or amphetamines can cause coronary artery spasm.
Pre-eclampsia history: If you had high blood pressure during pregnancy, your risk of having a heart attack is high.
History of autoimmune disease, such as rheumatoid arthritis or lupus.

If you have any of these risk factors, I suggest you visit your doctor to keep you protected against heart attacks or any cardiovascular disease.

Signs and symptoms of a heart attack

Some people may have mild symptoms or no symptoms of heart attack – this is called a silent heart attack. It happens mostly in people with diabetes.

To avoid premature death related to heart disease, note other common symptoms of this fatal problem:

Chest pain or discomfort: This is the most common symptom when having a heart attack. Some people may have a sudden sharp pain, while others may have only mild pain. This can last for a few minutes or a few hours.
Upper Body Discomfort: You may feel pain or discomfort in the arms, back, shoulders, neck, jaw or upper stomach.
Shortness of breath: Some people may have only this symptom, or it may happen along with chest pain.
Cold sweat, nausea, vomiting and sudden dizziness: These symptoms are more common among women.
Unusual tiredness: You may feel tired for unknown reasons and sometimes this can last for several days.

Older people who have one or more of these symptoms usually ignore them, thinking that they are the only signs of aging. However, if you experience one or more of these symptoms, have someone call an ambulance immediately.

How to avoid a heart attack?

Most cardiovascular disease can be prevented. I recommend these lifestyle practices to help you avoid a heart attack or heart disease:

Have a healthy diet;
Exercise regularly;
Stop smoking;
Avoid alcohol consumption;
Feel as little as possible;
Improve your vitamin D levels;
Try to walk barefoot;
Get rid of stress.

The Importance of Constant Sanitization of Manual Resuscitators

Do you know that manual resuscitator (bag valve mask-BMV, commonly called “Ambu bag”), which in many hospitals stays on the countertops waiting to be reused for days, including for manual hyperinsufflation maneuvers?

Yes, they can contribute (and a lot!) To increase the risk of pneumonia!

A paper presented in the Society of Critical Care Medicine (SCCM) 42nd Critical Care Congress, por Rasnake et al, with rescuers of 147 patients found that bacterial cultures increased every two days, although they visually appeared clean.

They also observed that the more the device is manipulated, the greater the colonization.

One more reason to think about carrying out the hygienization and constant sterilization of these devices, and also to perform the same patient swapping!

Nasogastric and Nasoenteric: Differences in Enteral Nutrition

Not everyone can get food through their mouths. In this case, one option is enteral nutrition, which works with a probe implanted in the stomach, jejunum, or duodenum. In liquid or powder form, the diet is made in this system to balance nutrients, proteins, carbohydrates, fats, vitamins and minerals of the diet.

This feature is widely used by people who needed to be hospitalized and, after some surgical procedure or treatment, can no longer perform the feeding in the conventional way.

For there to be no organic imbalance, weight loss or infections, proper nutrition is critical. Therefore, enteral nutrition is very important to maintain balance and ensure quality of life for patients.

It is necessary to know how to differentiate the use of both types, for cases of drainage of gastric contents, infusion of enteral diets, and until where its lease is carried out.

Gastric lavage is a procedure that aims to prepare the digestive system for examinations or surgeries, stagnate gastric or esophageal bleeding using ice liquids and remove from the stomach excessive or harmful gastric contents. For the accomplishment of this procedure it is necessary initially the passage of a orogastric or nasogastric of great caliber probe.

Although the polling procedure appears to be relatively simple, this technique requires scientific knowledge and technical skill to the extent that it is not risk free. The most common complications are the incorrect insertion, misalignment of the catheter, accidental removal, the type of external fixation, and the length of time the catheter is present, and include excoriations, hyperemias, perforations in the digestive system, infections in the upper and lower airways, nausea, abdominal distension and partial or total catheter obstruction.

Within the nursing team, it is incumbent upon the nurse to perform the procedure of establishing the enteral nutrition route, same way adopted for the gastric lavage procedure, thus, the nursing technician is responsible for:

a) To participate in training, according to established programs, guaranteeing the training and updating regarding the good practices of Nutrition Therapy;

b) Promote general patient care according to the prescribed nursing prescription or protocol;

c) Communicate to the Nurse any intercurrence resulting from Parenteral Nutrition Therapy;

d) Record the actions taken, in the patient’s chart, in a clear, precise and timely manner.