TPN/PPN
Criteria for a Pt unable to absorb nutrients for _______ to receive TPN
10 days
Always scrub the hub for at least ___
15 seconds
What type of technique is used when handling Parenteral nutrition?
Aseptic technique -Masks are to be worn
It is important to monitor a clients ___ do to the high contents of glucose in TPN
BGL's
What are labs to monitor while receiving TPN therapy?
BUN, electrolytes, CBC, PT, liver function, albumin, once a week
A nurse is aware of the high incidence of catheter-related bloodstream infections in patients receiving parenteral nutrition. What nursing action has the greatest potential to reduce catheter-related bloodstream infections?
Change the dressing no more than weekly.
Indications for Parenteral Nutrition include
IBD, AIDS, COMA, CANCER, Burn victims, Sepsis, Multiple Fractures.
When administering TPN you want to use the ___ lumen everytime, which is the ___
Same, Middle lumen
A pt with greater than or equal to 10% of weight loss show criteria for
TPN
The infusion rate should be monitored
every 3-4hrs
PPN
peripheral parenteral nutrition
TPN infusion tubing needs to be changed every
24hrs
TPN should not be ran over
24hrs
A nurse is caring for a patient who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the patient?
After administration of the PN solution is gradually discontinued, an isotonic dextrose solution is administered for 1 to 2 hours to protect against rebound hypoglycemia.
Criteria for TPN cont.
Albumin levels of less than 3.5 Excessive Nitrogen loss Renal/Hepatic organ failure No GI function for 5-7 days
If the HCP orders TPN to begin at 100ml/hr the Nurse is to?
Begin the infusion at 50ml/hr and gradually increase
A nurse is preparing to administer a patient's scheduled parenteral nutrition (PN). Upon inspecting the bag, the nurse notices that the presence of small amounts of white precipitate are present in the bag. What is the nurse's best action?
Call pharmacy for new bag Before PN infusion is administered, the solution must be inspected for separation, oily appearance (also known as a cracked solution), or any precipitate (which appears as white crystals). If any of these are present, it is not used.
A patient has been discharged home on parenteral nutrition (PN). Much of the nurse's discharge education focused on coping. What must a patient on PN likely learn to cope with?
Changes in life style loss of eating as a social behavior sleep disturbances
The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurse's assessments most directly addresses a major complication of TPN?
Checking the patient's capillary blood glucose levels regularly The solution, used as a base for most TPN, consists of a high dextrose concentration and may raise blood glucose levels significantly, resulting in hyperglycemia.
A patient's health decline necessitates the use of total parenteral nutrition. The patient has questioned the need for insertion of a central venous catheter, expressing a preference for a normal IV. The nurse should know that peripheral administration of high-concentration PN formulas is contraindicated because of the risk for what complication?
Chemical phlebitis
PPN contains 10% dextrose, anything greater will cause
Chemical phlebitis
A lumen should be ___ prior to opening
Clamped
A nurse is creating a care plan for a patient who is receiving parenteral nutrition. The patient's care plan should include nursing actions relevant to what potential complications? Select all that apply.
Clotted or displaced catheter Pneumothorax Hyperglycemia Line sepsis
A client with a debilitating illness for greater than 2 weeks, meet ____
Criteria for TPN
If the infusion has ran out, or your new bag of TPN isn't room temp, you should hang ___ TPN, and ___ for PPN to prevent ___
D10W- TPN D5W- PPN hypoglycemia
Monitor weights with clients receiving TPN, 1lb a day is
Fluid retention
Hyper-osmosis diuresis can occur if infusion is going to fast causing
HA, Nausea, Fever, Chills, Malaise
What risk can occur from d/c TPN, abruptly
Hypoglycemia
A critical care nurse is caring for a patient diagnosed with acute pancreatitis. The nurse knows that the indications for starting parenteral nutrition (PN) for this patient are what?
Inability to take in adequate oral food or fluids within 7 days
A nurse is caring for a patient who is receiving parenteral nutrition. When writing this patient's plan of care, which of the following nursing diagnoses should be included?
Ineffective Role Performance Related to Parenteral Nutrition
Complications of parenteral nutrition
Infection/sepsis Metabolic alterations F&E imbalances Phlebitis Hyperlipidemia Liver and gallbladder disease
A nurse is initiating parenteral nutrition (PN) to a postoperative patient who has developed complications. The nurse should initiate therapy by performing which of the following actions?
Initiating the infusion slowly and monitoring the patient's fluid and glucose tolerance
A nurse is preparing to administer a patient's intravenous fat emulsion simultaneously with parenteral nutrition (PN). Which of the following principles should guide the nurse's action?
Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered.
Enternal feeding are administered through the GI system, Parenteral is administered via
Intravenous route
Are given with PPN to protect the veins from irritation
Lipids
A patient's physician has determined that for the next 3 to 4 weeks the patient will require parenteral nutrition (PN). The nurse should anticipate the placement of what type of venous access device?
NON TUNNELED
Which venous access device can be used for less than 6 weeks, in clients requiring parenteral nutrition?
Non-tunneled
Isotonic solution, & holds lesser concentration, given 5-7 days
PPN
Always check for ___ prior to infusion
Patency, assess the site
A ___ is the only one who can add medications to TPN
Pharmacist
A nurse is preparing to discharge a patient home on parenteral nutrition. What should an effective home care teaching program address?
Preparing the patient to troubleshoot for problems Teaching the patient and family strict aseptic technique Teaching the patient and family how to set up the infusion
A nurse is caring for a patient with a subclavian central line who is receiving parenteral nutrition (PN). In preparing a care plan for this patient, what nursing diagnosis should the nurse prioritize?
Risk for Infection Related to the Presence of a Subclavian Catheter
A nurse is participating in a patient's care conference and the team is deciding between parenteral nutrition (PN) and a total nutritional admixture (TNA). What advantages are associated with providing TNA rather than PN?
TNA is mixed in one container and administered to the patient over a 24-hour period. A 1.5-micron filter is used with the TNA solution. Advantages of the TNA over PN include cost savings. Pharmacy staff must prepare both solutions.
hyper-tonic solution, contains higher concentration, as to why it has to be administered via CVAD
TPN
TPN
Total parenteral nutrition (intravenous solutions are given to maintain nutrition)
TPN is kept refrigerated, but it is important to ___ prior to starting infusion
Warm to room temp
If a client has an triple lumen cath. the distal port is for ___ the middle port is for ___ and the proximal port is for ___
distal- blood draw middle- TPN Fluids- Proximal
If a mask is not provided for the client it is nurses responsibility to have to client to ___
turn head to opposite side, when providing care of cath.
