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13 Cards in this Set

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Define Total Parenteral Nutrition
I. Definition: a form of IV therapy that provides complete nutrition for patients who are unable to take in or assimilate nutrients through the GI tract.
A. Also called TPN
B. Nutrients infused directly into blood stream (bypassing the GI tract)
C. Includes: carbohydrates, protein, vitamins and minerals-may also include a fat emulsion.
Total Parenteral Nutrition
Indications for use
A. Inability to digest due to serious illness, injury or abnormalities of GI tract. For instance cancer patients during chemotherapy, burns, intractable vomiting or diarrhea, inflammatory bowel disease. If patient is simply unable to chew or swallow, but is able to digest via GI tract enteral feedings (NG or gastrostomy tube) is preferable.
Total Parenteral Nutrition
Solution content
A. Glucose (5-50%)
B. Amino acids (3-15%)
C. Vitamins
D. Minerals
E. Electrolytes
F. Trace elements
G. Lipids (derived from egg yolks, soy, or safflower oils.)
Total Parenteral Nutrition
A. Strict aseptic technique
B. Requires: PICC line or other form of central line
C. Must have in-line filter. (0.2-micron filter)
D. If lipids are added use a 1.2-micron filter
E. Solution infused over 24 hours maximum.
F. Tubing changed every 24 hours.
G. Always use pump
H. Monitor glucose-may increase levels.
I. Daily weights
J. Store at 4 degrees Centigrade
K. Do not add to TPN bag
L. Use a designated port for TPN only
M. Complications:
N. Infection; solution provides excellent growth medium for microorganisms as well as an invasive route to body.
O. Metabolic: Hyper or hypoglycemia, fluid volume overload, dehydration, electrolyte disturbances, elevated ammonia levels.
P. Venous: phlebitis.
Q. Central line complications: pneumothorax, thromboembolism, hematoma formation, and air embolism.
Total Parenteral Nutrition
Nursing Process
A. Assessment
1. Determine baseline including: VS, lab (electrolytes, glucose, CBC,
albumin, prealbumin, liver function, renal function)
2. Allergies: soy, eggs.
3. Central line placement confirmation.
4. Risk factors: cardiac, renal, liver, or respiratory dysfunction.
Diabetics must be monitored carefully.
Total Parenteral Nutrition
B. Planning and Analysis: (read Lamone & Burke p535)
1. Imbalanced Nutrition: less than body requirements
2. Risk for infection
3. Risk for fluid volume deficit
4. Risk for impaired skin integrity
Total Parenteral Nutrition
C. Intervention
1. Medication administration
1. Medication administration:
a. remove TPN from refrigerator 1 hour before use
b. inspect for particulate matter
c. compare label to dr. order with another nurse.
d. Use infusion pump at constant rate
e. Use dedicated line with filter that is not used for medications, blood, or any other purpose.
f. Discard remaining TPN every 24 hours.
Total Parenteral Nutrition
2. Glucose control
3. Patient/Family teaching:
a. accu checks
b. sudden cessation may result in hypoglycemia (assess & evaluate for these signs)
c. if replacement TPN is not readily available hang a dextrose solution at the same rate.
3. Patient/Family teaching:
a. explain procedure before starting
b. instruct to notify staff immediately of unusual sensations or symptoms (especially chills, pain at site, difficulty breathing, or a feeling of apprehension or restlessness)
Total Parenteral Nutrition
4. Observe for adverse effects:
4. Observe for adverse effects:
a. fever
b. hypoglycemia
c. hyperglycemia
d. sudden weight gain or loss
e. change in cardiovascular or respiratory status
f. lab (CBC, albumin, triglycerides, BUN & creatinine.)
Total Parenteral Nutrition
D. Evaluation
D. Evaluation
patient should demonstrate improved nutritional status, including weight gain (if needed), improved energy and activity tolerance and normal lab values
Nursing points of care: total parenteral Nutrition
8 points
1. TPN must be administered through a central line because of its hypertonic nature
2. Strict asceptic technique must be maintained when performing site care, cap or dressing changes
3. The container of TPN must not infuse beyond a 24 hour period of time
4. TPN should be initiated slowly, increasing at a rate of 25 ml/hr increments until the desired rate of infusion is achieved.
5. Vital signs and blood glucose should be monitored every 4-6 hours until stable.
6. Daily weights track patterns of weight gain
7. An electronic infusion Device (EID) should be used to infuse the TPN
8. The rate of infusion should be kept within 10 percent of the prescribed rate.
Appropriate hand hygiene should be used when caring for the client with TPN.
Advantages of TPN
1. Dextrose solution of 20-70% administered as a calorie source
2. Beneficial for long term use (usually longer than 3 weeks)
3. Useful for patients with large caloric and nutrient needs
4. Provides calories; restores nitrogen balance; and replaces essential vitamins, electrolytes, and minerals.
5. Promotes tissue synthesis, wound healing, and normal metabolic function
6. Allows bowel rest and healing
7. Improves tolerance to surgery
8. is nutritionally complete.
Disadvantages to TPN
1. May require a minor surgical procedure for insertion of a tunneled catheter or implanted port.
2. May cause metabolic complications, including glucose intolerance, electrolyte imbalances, and EFAD.
3. Fat emulsions may not be used effectively in some severely stressed pts (especially burn patients).
4. Risk of pneumothorax or hemothorax with central line insertion procedure.