Alphabet Soup
The pt. gets TPN through the PICC line.
What is, "The patient gets Total Parenteral Nutrition through the Peripherally Inserted Central Catheter."?
Provided by carbohydrates and fat, most adults require 25 - 30 per kilogram, but this increases with injury, inflammation and infection.
What are calories?
It is the device used to properly ensure accurate delivery of TPN.
What is an IV pump?
This technique is used when performing central line dressing changes since TPN is the perfect medium for bacteria growth
What is strict sterile technique? The high glucose concentration in TPN provides an excellent growth medium for bacteria, a source for septicemia.
PN may be discontinued once the patient enterally (orally) maintains this percentage of their caloric needs.
What is 75% of caloric requirements (a general guideline, but patient situations differ in this regard(.
He receives his HPN in his rental apartment through a TLCL.
What is, "He receives his Home Parenteral Nutrition in his rental apartment through a Triple Lumen Central Line ."?
When used with TPN, this provides a source of essential fatty acids and can provide up to 60% of non-protein calories for hypermetabolic patients.
What are Lipids, Intralipids or Fat Emulsion?
It is a system for double checking the TPN orders against the infusion label information on the TPN bag.
What is the point of two RN's verifying the TPN formulation together at the bedside?
This is a serious complication associated with the abrupt discontinuation of a hypertonic glucose infusion.
What is hypoglycemia?
Although some increase in this lab value is expected as a patient begins PN, this will moderate. The greatest threat is a rapid drop in this lab value if PN is abruptly discontinued.
What is serum glucose level?
Go ahead and start the PPN in his large bore RAC PIV line.
What is, "Go ahead and start the Peripheral Parenteral Nutrition in his large bore Right Antecubital Peripheral Intravenous line."?
The recommended daily allowance of this TPN additive is 0.8g/kg/day (45-65g/day), but increases to 2.0 g/kg/day (150g/day) in metabolically stressed patients.
What is protein? Metabolically stressed patients (trauma, burns, sepsis) are more challenged to maintain a positive nitrogen balance as they metabolize protein for tissue regeneration. Nitrogen Balance + intake - loss (urine, feces, sweat, skin and hair growth). A negative balance indicates excess protein metabolism compared to protein intake.
This quick, point-of-care lab test is recommended every 4-6 hours, particularly when first starting TPN. Until the patient stabilizes, results may require "regular" follow-up action.
What is finger stick glucose checks (and correctional dose coverage)?
To minimize the risk for CVA and MI from this occurrence, the preferred patient placement is in the left lateral Trendelenburg position
What is air embolism? In addition, clamp the IV access catheter, notify the HCP, and administer O2 as ordered. Air may have entered the vasculature through an open IV line, or through a (CL placement associated) pneumothorax.
During a period of starvation, the body shifts to this metabolic state, deriving energy from available stores of fat and muscle.
What is catabolism?
Dr Ben Dover ordered that the TPN be D/C'd ASAP and then we will stabilize the patient's FSG with an IV of D10 W solution.
What is, "Doctor Ben Dover ordered that the Total Parenteral Nutrition be DisContinued As Soon As Possible and then we will stabilize the patient's Finger Stick Glucose with an IntraVenous of Dextrose 10% and Water solution."?
These key elements of TPN, largely determined by renal and hepatic response to endocrine cues, are adjusted based on the patient's illness / injury and daily laboratory results.
What are electrolytes?
In the event that TPN administration is interrupted by a delay in solution delivery, the nurse is prepared to administer this until TPN delivery can be resumed.
What is D10W?
Signs of this reaction include increased triglyceride levels, fever, chills, flushing dyspnea, and / or cyanosis, chest / back pain, and phlebitis.
What is intolerance or hypersensitivity to fat emulsion?
This metabolic complication results from the sudden shift in metabolism to an anabolic state, where more O2 is required, but O2 carrying capacity (HgB) is diminished.
What is refeeding syndrome? The body scrambles for an energy source with which to metabolize the introduced nutrients. To this end, insulin is rapidly released for quick energy. However, this causes serum electrolytes to suddenly shift to the cellular spaces, and fluid to suddenly shift into vascular space. The weakened cardiac and respiratory systems attempt to respond to these shifts, are unable to maintain the balance and the systems fail.
The HCP left it up to the VNA to administer the HPN as TPN, either CPN via the PICC, or as PPN via the PIV.
What is, "The Health Care Provider left it up to the Visiting Nurses Agency to administer the Home Parenteral Nutrition as Total Parenteral Nutrition, either Central Parenteral Nutrition via the Peripherally Inserted Central Catheter, or as Peripheral Parenteral Nutrition via the Peripherally Intravenous Catheter."?
They are important additives to TPN (usually obtained through a normal diet); "micronutrients" that are essential for absorption and transport of vitamins, proteins, fats and minerals (hint: not electrolytes--but some are found on the Periodic Table used in chemistry class).
What are trace elements?
It is the obtaining initial vital signs, weight, and labs prior to initiating TPN so changes/improvements can be measured.
What is establishing a baseline?
The most common cause of hospital acquired infection (HAI) and accounts for approximately 1/3rd of HAI deaths.
What is Central Line Associated BloodStream Infection (CLABSI)?
They are fabulous clinical groups who are now becoming TPN superstars through their diligence and attention in this Zoom room.
Who are the members of Prof.'s Williams and Hough's clinical groups?