Parenteral Nutrition TPN - PowerPoint PPT Presentation

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Parenteral Nutrition TPN

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TPN is a hypertonic solution of dextrose and proteins in the form of amino acids, ... Enteral Nutrition- nutrition thru GI tract- oral, tube feeding ... – PowerPoint PPT presentation

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Title: Parenteral Nutrition TPN


1
Parenteral NutritionTPN
  • D. Tanner, RN, MSN
  • NUR 310
  • Fall Semester

2
What is this Stuff???
  • TPN is a hypertonic solution of dextrose and
    proteins in the form of amino acids,
    electrolytes, vitamins, minerals and trace
    elements infused through an IV- peripheral or
    central line. If peripheral it is referred to as
    PPN.
  • Enteral Nutrition- nutrition thru GI tract-
    oral, tube feeding
  • Parenteral Nutrition-nutrition needed/required by
    a route other than GI tract.

3
What is this Stuff???
  • Each solution is customized- will have a specific
    protocol based on pt. needs. Prepared by Pharmacy
    but Dietician, MD and Nursing collaborate.
  • May have a yellow tint and will be in an IV bag
    2-3xs larger than normal ( 2,000-3,000 mL).
  • Lipids (Fat Emulsions) are also a component of
    TPN- 10, 20, 30. Give slowly over 12 hours.
    Caution if pt has allergy to eggs or at risk for
    fat embolism.

4
Indications for TPN
  • Pt. with intake less than body requirements and
    require sustained nutritional support severe
    burns, malnutrition (anorexia), AIDS, CA, severe
    sepsis, post-op (especially bowel), trauma.
  • Pt. cannot tolerate food orally or by gastric
    feeding tube
  • excessive/chronic diarrhea or vomiting,
    intestinal obstruction, paralytic ileus,
    pancreatitis, malabsorption.
  • Require 1500 calories/day to keep the body from
    using up its own storage of protein. Those with
    hypermetabolic states may require up to 10,000
    additional calories/day.

5
Nursing Assessment
  • We assess for
  • 10 deficit in body weight.
  • Inability to take oral food and fluids for longer
    than a week.
  • Significant protein loss- indicated by decreased
    serum albumin levels.
  • Muscle Wasting.
  • Decreased Tissue Healing.

6
Nursing Diagnoses
  • Alteration in Nutrition, less than body
    requirements
  • Hyper/Hypoglycemia
  • Electrolyte Imbalance
  • Anxiety
  • Knowledge Deficit
  • Risk for Infection
  • Risk for Fluid Volume Deficit/Excess

7
Planning
  • Goal for TPN is to achieve optimal level of
    nutrition.
  • Maintain appropriate fld volume- goal is to
    provide adequate caloric intake in small fld
    volume.
  • Keep pt free infection and other complications.
  • Maintain electrolyte balance.

8
Nursing Interventions
  • Administer and Monitor TPN continuously over 24
    hours using pump (or cyclic if appropriate).
  • Daily wt.- we want to see a gradual increase.
  • Strict I O.
  • Monitor vital signs.
  • Monitor lab values - electrolytes, albumin, CBC.
  • Accuchecks AC/HS, or per protocol- bc of high
    glucose content. May be on SS.

9
Nursing Interventions
  • Do not add anything to TPN.
  • Must be refrigerated until time to use.
  • Encourage activity as tolerated.
  • Change Central line dressings per protocol-
    usually qod- sterile procedure!!!
  • Educate pt and family on TPN administration-
    frequently they may go home on it!

10
Complications
  • Hyper/Hypoglycemia- attempt to avoid this by
    infusing TPN at a gradually increasing rate.
  • Phlebitis/Iv infiltration or catheter related
    infections.
  • Electrolyte imbalances such as hyperK, hypoK,
    etc.
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