Indications
List 3 indications for parenteral nutrition
Nonfunctional Gi tract, Small-bowel resection, Small-bowel surgery or GI bleed, Paralytic ileus, Intestinal obstruction, Trauma to abdomen, head, or neck, Severe malabsorption, Intolerant of slow rates of enteral tube feeding, Chemotherapy, radiation therapy, bone marrow transplantation, Severely catabolic patients when GI tract is not functioning for more than 7 days, Enterocutaneous fistula, Inflammatory bowel disease, Severe diarrhea, Moderate-to-severe pancreatitis, Preoperative bowel rest, Severe malnutrition before surgery
What is TPN?
Parenteral Nutrition (PN) is a form of nutrition support that requires the delivery of nutrients through an intravenous catheter into a large central vein (e.g. superior vena cava) or a peripheral vein
Parenteral nutrition (PN) is a high-alert medication. An _______________shall be performed prior to administration
independent double check
What is a patient's ideal weight gain per week when receiving parenteral nutrition?
Patient's ideal weight gain is between 0.5 and 1.5 kg (1 to 3 lb) per week. Weight is indicator of patient's nutritional status and determines fluid volume. Weight gain greater than 0.5 kg (1 lb) per day indicates fluid retention
What are the signs and symptoms of hyperglycemia?
Excessive thirst, urination, blood glucose greater than 8.9 mmol/L, confusion
True/false
PN is also intended for the purpose of meeting hydration or fluid needs
False- PN is not intended for the purpose of meeting hydration or fluid needs
List 3 of the components of TPN
The components of the PN solution are amino acids, glucose, and lipids as energy sources, with the addition of electrolytes, minerals, trace elements, vitamins, and water
What if the PN needs to be disconnected and reconnected for any reason?
Interruptions for PN therapy should be avoided. PN should be administered continuously for its ordered duration (i.e., 24 hours or cycled)
What is the maximum amount of time the dextrose and amino acid solutions can hang?
PN containing dextrose and amino acids alone or with fat emulsion added as a 3:1 formulation should have a hang time not to exceed 24 hours.
what are the signs and symptoms of a central line infection?
swelling, inflammation, drainage, redness, warmth, tenderness, or edema at the central venous access site
Why would a patient be ordered preoperative parenteral nutrition?
Preoperative bowel rest
Severe malnutrition before surgery
What is peripheral parenteral nutrition?
Nutrition delivered into a peripheral vein
What IV administration set is used to administer lipids?
1.2 micron filter for lipid emulsion
Fat emulsions alone should have a hang time not to exceed 12 hours.
List 2 ways the patient can reduce the risk for infection of the central line?
Hang hygiene
keep the vascular site clean and dry
True/ False
Enteral nutrition is preferred over PN for nutritional support
True- Enteral nutrition is preferred over PN for nutritional support
What is the most common complication of parenteral nutrition?
The most frequent complication is a catheter-related bloodstream infection
What IV administration set is used to administer the amino acid dextrose solution?
0.22 micron filter IV administration set for Amino Acid Dextrose Solution)
What percentage of nutritional needs should be met by the oral or enteral route prior to termination of PN?
PN should not be terminated until at least 50% of nutritional needs are being met by the oral or enteral route
What are the signs and symptoms of hypoglycemia?
Patient is shaky, dizzy, nervous, anxious, hungry; blood glucose level less than 4.4 mmol/L
PN should be initiated only if the duration of administration is anticipated to be greater than or equal to ______ days
PN should be initiated only if the duration of administration is anticipated to be greater than or equal to 7 days.
Explain why hyperglycemia is a common complication of parenteral nutrition
Parenteral nutrition contains increased levels of dextrose that are being infused directly into the blood, because hyperglycemia has also been linked to increased infection rates, monitoring blood glucose levels during a PN infusion is important
Who can administer parenteral nutrition?
Administration of PN is a restricted activity- Registered Nurses- Licensed Practical Nurses- Psychiatric Registered Nurses
How often should blood glucose levels be monitored?
Monitor patient's glucose levels every 6 hours or as prescribed. (typically, glucose every 6 hours until within normal limits for 48 hours, then daily)
What is parenteral nutrition used for? (explain as if you were talking to a patient)
It is used to aid diet needs. It is used to give nutrition to the body.