Week 4 - TPN Flashcards
describe TPN
- more invasive
- higher infection risk
- higher risk of metabolic complications
- increased cost
- continuous infusion
does TPN require functioning GI tract?
no
does TPN preserve GI function?
no
describe enteral feeding
- lower risk of infection/ metabolic complications
- less expensive
what does enteral feeding help maintain?
gut integrity and prevent translocation of bacteria
does enteral feeding require a functioning GI tract?
yes
what does enteral feeding reduce?
risk for refeeding syndrome
how is TPN given?
bloodstream through PICC/ VAD
what are some indications of TPN use?
- paralyzed/ nonfunctional GO tract
- conditions where GI tract requires rest
- NPO X +7 days
- chronic/ extreme malnutrition
- chronic diarrhea/ vomiting
- requiring surgery or chemo
when someone is taking TPN their GO tract can’t be used for what?
- ingestion
- digestion
- absorption of essential nutrients
what are common conditions that lead someone to using TPN?
- chronic/ severe diarrhea and vomiting
- complicated surgery/ trauam
- GI obstruction
- GI tract fistulas
- anorexia
- severe malabsorption
- short bowel snydrome
what are the major components of TPN?
- carbohydrates (dextrose)
- protein (amino acids)
- fat (lipids)
- electrolytes
- vitamins
- minerals
who decides the combination of components for a patient’s TPN order? What does it depend on?
- physician in consult with a dietitian
- depends on pts metabolic needs, clinical hx and blood work
what does PN stand for?
portion of the nutritional needs or component
what are complications of TPN?
- hyperglycaemia
- dehydration
- electrolyte imbalance
- thrombosis
- infection
- liver failure
- micronutrient deficiencies
- hypersensitivity
what type of infection is common with TPN?
catheter related bloodstream infection
what are signs someone is hypersensitive regarding TPN
- fever
- N&V
- hives
- back pain
- headaches
- dyspnea
- chest pain
what signs and symptoms might indicate a hypersensitivity to the fat emulsion?
- dyspnea
- back and chest pain
- diaphoresis
- N&V
- headache
- hyper coagulability or thrombocytopenia
when does refeeding syndrome occur?
when a client who is severely malnourished suddenly receives nourishment again particularly carbs
what does refeeding syndrome start with?
low levels of:
- potassium
- magnesium
- phosphorus
what is re-feeding syndrome characterized by?
- fluid retention
- electrolyte imbalances
- hyperglycemia
what are some conditions that predispose patients to re-feeding syndrome?
- longstanding malnutrition
- chronic alcoholism
- vomiting and diarrhea
- chemotherapy
- major surgery
re-feeding syndrome can occur any time a malnourished patient is what?
started on aggressive nutritional support
what is a hallmark for re-feeding syndrome?
hypophosphatemia
what is hypophosphatemia associated with?
- cardiac dysrhythmias
- respiratory arrest
- neurological disturbances
what is included in the assessment and nursing care for a patient on TPN?
- IV remains patent/ free of infection
- dressing D/I to IV site
- monitor for edema/ fluid overload
- review lab values
- respiratory assessment
-mouth care - QID BGM for first 3 days
- I&O monitoring
why do we need to monitor a patient’s blood glucose level if they are on TPN?
- adds concentrated dextrose to bloodstream
- blood glucose often elevated
what is often added to TPN? What does this put the patient at risk of?
- insulin
- HYPERglycemia or HYPOglycemia
when someone is on TPN what increase temperature are we monitoring for?
> 38.5
how many nurses do you need to ensure the TPN matches the doctors order?
2
how long does TPN infuse for?
24 hours
what is normally run at the same time as TPN?
D10W
how often is blood work drawn for someone taking TPN? Why?
- daily
- determine the TPN components
who will contact the doctor with lab results and obtain TPN order?
charge nurse
what do you confirm TPN orders to?
- order sheet
- pt. ID
- expiry
If you chose not to use TPN what would be some possible reasons?
- bag is leaking
- TPN is lumpy
- light protective bag in place
what is used with each new bag of TPN?
filtered tubing
what is the infusion rate for TPN?
based on volume labeled on bag
where do you need to document after you start a TPN order?
- MAR
- I&O flow sheet
prior to starting TPN what is required?
thorough baseline assessment
when TPN is started what does this mean for the initial concentration and volume?
- concentration of solution is lower
- volume and rate are slower
why do we start with a lower concentration and rate when we first start TPN?
body needs time to get used to it
what must TPN run through?
IV pump and be infused through CVAD
can you add or co-infused medication with TPN? Why?
- no
- due to high level of incompatibility
why can added dextrose in TPN lead to hyperglycaemia ?
body in catabolic state > may not be able to metabolize high concentrations
when would you stop TPN?
- requires physicians order
- after pt is able to get adequate enteral nutrition
- pt can meet 70% of their protein and calorie needs
if TPN has been ordered to stop how do you do this?
- TPN concentration will be slowly decreased over a few days until being stopped
if TPN has been ordered to stop but has been transitioned to a tube feed how would you stop this?
TPN will be tapered down while the tube feed is slowly increased
what does the nurse need monitor after TPN is discontinued?
- hypoglycemia
- pt is taking in adequate nutrition/ maintaining weight
