Total

Parenteral
Nutrition
 Assessment
CONDITIONS REQUIRING ENTERAL FEEDINGS

CONDITION CAUSE

Preoperative needs for Inadequate intake preoperatively,

nutritional support resulting in poor nutritional state

Gastrointestinal problems Fistula, short bowel syndrome,

Crohn’s disease, ulcerative colitis,
nonspecific maldigestion or
malabsorption
Side effects of oncology Radiation, chemotherapy
therapy
Alcoholism, chronic Chronic illness, psychiatric, or
depression, eating disorders neurological disorder
Head and neck disorders or Disease or trauma
surgery
 Diagnose
1. Method of supplying nutrients to the
body by the intravenous route
2. Types of solution
• TPN
• TNA
 Diagnose
3. Methods of administration
a) Peripheral
b) Central
• Peripherally inserted catheter (PIC)
• Percutaneous central catheter
• Triple lumen central catheter
• Single lumen catheter
a) Atrial
• Right atrial catheters
• Subcutaneous port
 Plan/Implementation
1. Initial rate of infusion 50 mL/hr and gradually increased (100-125
mL/hr) as patient’s fluid and electrolyte tolerance permits
2. Infuse solution by pump at constant rate to prevent abrupt change
in infusion rate
a) Increased rate results in hyperosmolar state (headache, nausea,
fever, chills, malaise)
b) Slowed rate results in “rebound” hypoglycemia caused by delayed
pancreatic reaction to change in insulin requirements
 Plan/Implementation
3. Patient must be carefully monitored for signs of complications;
infection and hyperglycemia are common.
COMPLICATIONS OF TPN
COMPLICATION NURSING CONSIDERATIONS
Sepsis • Maintain closed intravenous systems with
filter
• No blood drawn or medications given
through TPN line
• Dry sterile occlusive dressing applied to site
Pneumothorax because of line • TPN to be started only after chest x-ray
placement validates correct placement
Hyperosmolar coma • Monitor glucose level and serum
osmolality
• Monitor urine fractional for glucose and
acetone
 Plan/Implementation
4. Change IV tubing and filter every 24 hours
5. Keep solutions refrigerated until needed; allow to warm to room
temperature before use
6. If new solution is unavailable, use 10 % dextrose and water solution
until available
7. Monitor daily weight, glucose, temperature, intake and output; 3x a
week check for BUN, electrolytes (Ca, Mg); check for CBC c PC, PT,
AST, ALT, serum albumin once a week.
 Plan/Implementation
8. Discontinuation
a) Gradually tapered to allow patient to adjust to decrease levels of
glucose
b) After discontinued, isotonic glucose solution administered to
prevent rebound hypoglycemia (weakness, faintness, diaphoresis,
shakiness, confusion, tachycardia)
 Evaluation
1. Is the client receiving TPN free
from infection?
2. Is the client receiving TPN well
hydrated?