Total Parenteral Nutrition Flashcards
How many calories per day does a patient require?
A patient requires 2000 calories per day. Critically ill patients may require 3000-5000 calories per day or more.
What can delay of nutrition for 5 days for a client with trauma or neuro damage lead to?
Poor wound healing
Increased risk of infection
May become malnourished if NPO for extended periods of time.
Are D5W, NS, and LR nutritional supports?
D5W, NS, and LR are not nutritional support. They provide fluids and some electrolytes.
What are four modalities for delivery of intravenous nutritional support?
Peripheral Parenteral Nutrition (PPN)
Peripheral Nutrition (PN)
Total Nutrition Admixture (TNA)
Cyclic Therapy
What is the cost of parenteral nutrition compared to enteral nutrition?
More costly (3x more) than enteral
What are some negative aspects of parenteral nutrition?
More costly (3x more) than enteral Higher infection rate Does not promote GI integrity, liver function or body weight gain.
What is a positive effect of parenteral nutrition?
Can enhance wound healing and prevent cellular catabolism (destructive phase of metabolism)
What are some indications for parenteral nutrition?
GI tract is incapacitated or needs complete rest. Intestinal obstruction. Uncontrolled vomiting. High risk for aspiration. Supplement to inadequate oral intake. Severe burns with negative nitrogen balance. Debilitating diseases. Metastatic cancer. AIDS 10% weight loss from pre-illness weight Inability to take oral foods or fluids within 7 days after surgery Hypercatabolic situations Major infections with fever Burns Short gut syndrome Enterocutaneous Fistulas Renal failure Hepatic failure Serum albumin <35 (normal 35-50)
What is an important question when considering the indications of parenteral nutrition?
What’s the goal of treatment and how should this influence the type of interventions offered?
What is Parenteral Nutrition?
AKA Hyperalimentation
Infusion of hyperosmolar glucose, amino acids, vitamins, electrolytes, minerals and trace elements.
May contain 20%-60% glucose and 3.5%-10% protein (in form of amino acids)
Can meet client’s total nutritional needs (thus the name).
What are some advantages of parenteral nutrition?
Dextrose solution administered as calorie source
- Beneficial for long term use (greater than 3 weeks)
- Useful for patients with large caloric and nutrient needs
- Provides calories, restores nitrogen balance, and replaces essential vitamins, electrolytes, and minerals
- Promotes tissue synthesis, wound healing and normal metabolic function
- allows bowels rest and healing
- improves tolerance to surgery
- is nutritionally complete
What are some disadvantages of parenteral nutrition?
Minor surgical procedure for insertion of tunneled cath or implanted port (central line).
May cause metabolic complications (glucose intolerance, electrolyte imbalance, EFAD).
Fat emulsions may not be utilized effectively in some severely stressed patients (esp. burn patients)
Risk of pneumothorax or hemothorax with central line insertion procedure,
What are the components of parenteral nutrition (PN)?
Carbohydrates (CHO) Fats (Lipids) Proteins (Amino acids) Electrolytes Vitamins Trace elements
What are some additives in parenteral nutrition?
Insulin
Heparin
Histamine 2 (H2) inhibitors
Minerals
What kind of insulin may be included in parenteral nutrition?
Regular insulin only
What is the most common complication of TPN therapy?
Hyperglycemia is most common complication of TPN therapy (due to high concentration of glucose).
What dose of heparin is given in TPN, and why?
1000 to 3000 U/L sometimes added to decrease potential formation of a fibrin sleeve which can lead to venous thrombosis.
What are some types of histamine 2 (H2) inhibitors given in TPN?
Cimetidine
Pepcid
Reglan
Zantac
What is the reason for giving histamine 2 (H2) inhibitors in TPN?
To prevent stress ulcers
What are some catheter related risks associated with parenteral nutrition?
Pneumothorax Air embolism Vein thrombosis Catheter malposition Cardiac dysrhythmias Nerve injury
What are some metabolic complications associated with parenteral nutrition?
Rebound hypoglycemia Hyperglycemia EFAD Hyperammonemia Electrolyte imbalances
What kind of infectious and septic complications are associated with parenteral nutrition?
Catheter related sepsis
What are some nutrition alterations associated with parenteral nutrition?
Refeeding syndrome
Altered mineral balance
Altered vitamin balance
What are four types of risks and complications associated with parenteral nutrition?
Catheter related
Metabolic (avoidable or controllable)
Infectious and septic
Nutrition alterations
Are peripheral parenteral nutrition solutions hypotonic, hypertonic, or isotonic? Why?
PPN solutions must be isotonic to prevent damage to veins.
What do isotonic parenteral nutrition solutions contain?
Isotonic parenteral nutrition solutions usually contain 5-10% dextrose and 3-5% amino acids plus electrolytes, vitamins and mineral and fat as needed.
What is peripheral parenteral nutrition used for?
PPN is used for short term nutrition support in non-hypermetabolic conditions.
What are some advantages of peripheral parenteral nutrition (PPN)?
No need for central line
Less hypertonic solution
Reduced chance of metabolic complications
Increases calorie source along with fat emulsion
What are some disadvantages of peripheral parenteral nutrition (PPN)?
Can’t be used in nutritionally depleted patients
Can’t be used in volume reduced patients
Does not usually increase a patient’s weight
May cause phlebitis
What are some important nursing assessments of patients on parenteral nutrition?
Verify correct placement of central line Monitor vital signs Monitor blood glucose Weigh daily Accurate I & O Monitor for infection Physician order Assess solution Tubing and solution changes
What are some nursing interventions related to parenteral nutrition?
Dressing changes Tubing, filters, and IV pumps Lab tests Storing Documentation Maintain vascular access Prevent infection Rate monitoring
What is Total Nutrient Admixture (TNA)?
Dextrose, amino acids and fat emulsions in one container. Usually milky white and opaque; may have yellow hue if vitamins added.
What are some advantages of using total nutrient admixture (TNA)?
Cost effective
Nursing time saved (only one solution to hang)
What are some complications of total nutrient admixture (TNA)?
Cholestasis may develop
Long-chain triglycerides may depress the immune system
Catheter occlusion from fat deposits
Bacterial/fungal growth
Why must total nutrient admixture (TNA) be administered via 1.2 micron filter?
Because of mean particle size of fat deposits.
Is parenteral nutrition administered centrally or peripherally?
Can be administered peripherally or centrally.
What colour is parenteral nutrition solution normally?
Usually yellow unless mixed with fats.
What kind of tubing should be used for parenteral nutrition?
Use filtered tubing
How often should tubing and solution for parenteral nutrition be changed?
Change solution and tubing every 24 hours and/or with every bag change unless different agency policy.
What is one important thing to monitor regularly with patients on parenteral nutrition?
Blood glucose
Should a patient on parenteral nutrition have parenteral nutrition therapy stopped abruptly?
Never stop abruptly (plan ahead for next bag), D10 if desperate (or per agency guidelines).
Wean the patient on and off.
