TPN
What is TPN?
Total Parenteral Nutrition- intravenous infusion of amino acids, carbohydrates, fats, electrolytes, vitamins, and minerals.
Two uses for NG tubes.
Tube feedings and suction to remove abdominal pressure/contents
Another name for tube feedings
Enteral nutrition
No residue, liquid at room temp.
clear liquid diet
Types of bariatric surgery
Restrictive, malabsorptive, combination
Reasons a patient would require TPN
Trauma, surgery, unable to get nutrition from oral consumption or Enteral feeding
Confirmation of NG placement
Initailly X-ray, Mark or line on tubing, aspiration of contents- check Ph.
Reasons a patient would require tube feedings.
unresponsive, intubated, difficulty swallowing, neck or oral surgery, anorexia, trauma, GI tract impairment
Liquid at room temp. Can be sufficient for energy and nutrient requirements.
full liquid diet
Definition of obesity
BMI > 30
True or False: TPN can administered by calculating the drip rate if a pump is unavailable.
False- A pump is necessary to ensure the correct rate of infusion.
What is the external tube length used for?
Knowing if the tube is still in the right place
Tube feedings can be administered through these types of tubes.
Nasogastric, Nasojejunal (nasoduodenal), gastrostomy, jejunostomy
Diet required for patient with a wired jaw.
pureed diet
You are getting bedside report and the nurse states she just hung a new bag of TPN an hour ago. The patient is complaining of new headache, nausea. You check the TPN rate and notice it is going at three times the ordered rate. What is the first step you take and why?
Stop the TPN- pt is hyperosmolar
What puts people receiving TPN at high risk for infection?
Disruption of the skin, at the IV site, and infusion high in glucose. This can be local or systemic.
Head position while inserting NG.
Neutral or forward
Aspiration and Diarrhea
First intervention for patients not consuming nutrient requirements.
High calorie foods
Ways to administer tube feedings
Gravity, bolus, or continuous through pump
Other complications of TPN
glucose tolerance, metabolic acidosis, fluid overload, and dehydration
Your patient is admitted for a bowel obstruction, an NG is placed in the ED, placement is confirmed via X-ray and they are sent to the floor. You attach your patient to LIS, but then the MD orders some medications to be given. What do you do about the NG?
Turn off suction or clamp for 20-30 minutes after medication administration.
Important nursing assessments while patients are receiving tube feedings
tube placement, residual, HOB, site, intake and output, fluid status
What are the signs and symptoms of dysphagia?
drooling, pocketing, choking, gagging, coughing after eating
How often should you change the tubing for TPN and tube feedings?