TPN W3 Flashcards
what is parenteral nutrition (PN)/(TPN)
- administration of nutrients by route other than the GI tract (e.g. bloodstream)
- used when the GI tract cannot be used for ingestion, digestion, and absorption of essential nutrients
- customized to meet the needs of a pt
- pharmacy usually adds prescribed electrolytes to meet the needs of pt
what are common indications for parenteral nutrition
- chronic severe diarrhea and vomiting
- complicated surgery or trauma
- GI obstruction
- GI abnormalities and fistuals
- intractable diarrhea
- severe anorexia nervosa
- severe malabsorption
- short bowel syndrome
complications/contraindications of TPN
-nausea, vomiting, and elevated temperature may occur
esp when lipids are infused quickly
-fat emulsions are contraindicated in pts w/ a disturbance in fat metabolism (hyperlipidemia)
-caution if pt is at risk for fat embolism (fractured femur), pt w/ allergy to eggs or soybeans, pancreatitis, bleeding disorders, liver failure or respiratory disease
methods of administration of TPN
may be administered as central parenteral nutrition (CPN) or peripheral parenteral nutrition (PPN)
what is central parenteral nutrition?
indicated when long-term support is necessary or when pt has high protein and caloric requirements
- administered through a central venous catheter or peripherally inserted central catheter (PICC)- tip lies in the superior vena cava
- solutions are usually hypertonic
- these solutions must be infused in a large central veins so that rapid dilution can occur
what is peripheral parenteral nutrition?
nutrition administered through a peripherally inserted catheter or vascular access device, which uses a large vein
PPN is used when nutritional support is needed for only a short time
-or when protein and caloric requirements are too high
-or when the risk of central catheter is too great
-or is used when PN is used to supplement inadequate oral intake
complications of PPN
PPN contains fewer nutrients compared to CPN
- increase risk for phlebitis b/c osmolality is 800mmol/L
- fluid overload
complications of parenteral nutrition- not specific
- infection (fungal, gram-positive bacteria, gram-negative bacteria)
- metabolic (hyperglycaemia, hypoglycaemia, hyperosmolar)
- altered renal function
- essential fatty acid deficiency
- electrolyte and vitamin excesses and deficiencies
- dylipidemia
- air embolus
- pneumothorax, hemothorax, and hydrothorax
- hemorrhage
- dislodegment
- thrombosis of vien
- phlebitis
what is refeeding syndrome?
- metabolic disturbances that occur as a result of reinstituting nutrition) because cations such as potassium, magnesium, and phosphate move intracellularly during enteral nutrition or parenteral nutrition therapy.
- characterized by fluid retention and electrolyte imbalances
- associated w/ serious outcomes-cardiac dysthymia’s, respiratory arrest, and neurological disturbances
what is the purpose of total parental nutrition?
It aims to prevent and restore nutritional deficits, allowing bowel rest while supplying adequate caloric intake and essential nutrients, and removing antigenic mucosal stimuli
- TPN may be short-term or long-term nutritional support.
- The caloric requirements of each patient are individualized according to the degree of stress, organ failure, and percentage of ideal body weight.
- TPN is used with patients who cannot orally ingest or digest nutrition
- TPN may be administered as peripheral parenteral nutrition (PPN) or via a central line, depending on the components and osmolality.
- Central veins are usually the veins of choice because there is less risk of thrombophlebitis and vessel damage
complications of parenteral nutrition?
- infection
- hyperglycemia
- hypoglycemia
- electrolyte & vitamins excess/deficients
- dyslipidemia
what are nursing management of pt w/ TPN?
- daily weight
- monitor serum glucose, electrolytes, urea nitrogen
- assess TPN vascular access sit
- check the label and ingredients in the TPN solution against the TPN order
- never stop TPN abruptly (risk of hypoglycaemia)
- follow doctors order on rate and which solution is used and when
-To avoid hyperglycemia at the initiation of PN, PN infusion rates are gradually increased in the first 24 hours.
If the TPN is running out and the new TPN solution is not available from Pharmacist, nurse should infuse D10W at the same rate of TPN to prevent rebound hypoglycemia.
assessment of pt w/ TPN
- CVC/peripheral IV line
- daily or biweekly weights
- capillary or serum blood glucose levels
- monitor intake and output
- daily to weekly blood work
- mouth care
- vital signs
what is TPN made of?
amino acids/dextrose and a lipid emulsion solution
