COMPLICATIONS OF PARENTERAL NUTRITION

Complications Air embolism Possible Cause • Opened catheter system • Disconnected IV isconnected tubings • Air on IV tubings Signs and Symptoms Apprehension Chest Pain Dyspnea Hypotension Rapid and weak pulse Respiratory distress Loud churning sound over pericardium Coma Confusion Diaphoresis Elevated blood glucose level (≥200mg/dL) ≥200mg/dL) Excessive thirst Fatigue Kussmaul’s Respiration Restlessness Weakness Bounding pulse Crackles on lungs Headache Increase blood pressure Jugular vein distension Weight gain Nursing Intervention • Clamp the catheter when not in use. • Place the client of left side lying position with head lower than the feet. • Administer oxygen • Instruct client in the Valsalva manuever for tubing and cap changes. . • Slowed infusion rate • Administration of Regular Insulin as prescribed • Monitor blood glucose levels • Use aseptic technique

Hyperglycemia

• Clients receiving solution too quickly • Not enough insulin • infection

Hypervolemia

• Excessive fluid administration • Administration of fluid rapidly • Renal dysfunction • Heart failure • Hepatic failure

• • • • • • • •

Slow or stop IV infusion Restrict IV fluids Administer diuretics Use dialysis in extreme cases Monitor intake and output Weigh patient daily Administer fluid via infusion pump Assess client’s history for s risk of hypervolemia

Hypoglycemia

• Parenteral Nutrition abruptly discontinued • Too much insulin administration

Anxiety Diaphoresis Low blood pressure Weakness Shakiness

• Monitor blood glucose • Administration of intravenous dextrose • Gradual decrease of PN prior to discontinue • Infuse 10% dextrose at the same rate of PN • Removal of catheter • Obtain blood cultures • Administer antibiotic as prescribed • Use strict aseptic technique • Monitor vital signs • Change site dressing, solution and tubing as specified by agency policy • Assess IV site for signs of infection • Monitor for sign of Pneumothorax • Obtain chest X ray after insertion of catheter placement is verified.

Infection

• Poor aseptic technique • Catheter contamination • Contamination of solution

Chills Fever Elevated WBC Erythema or discharges at insertion site

Pneumothorax

• Incorrect pl placement of catheter

Absence of breath sounds on affected side Chest or shoulder pain Sudden shortness of breath Tachycardia Cyanosis

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