Parenteral Nutrition TPN

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Parenteral NutritionTPN

• D. Tanner, RN, MSN
• NUR 310
• Fall Semester

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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.

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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.

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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.

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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.

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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

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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.

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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.

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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!

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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.