Enteral Feeding II:

Parenteral Nutrition
 Introduction

• J. A. was involved in a motor vehicle accident [MVA] and

sustained abdominal injuries. J. A. developed peritonitis and
is unable to eat or drink.
• How will J. A. nutritional needs be met?
 Aka Hyperalimentation, Total Parenteral
Nutrition [TPN] or Parenteral Peripheral
Nutrition [PPN]

Parenteral
Administration of IV nutrition when
Nutrition: Total nutritional and metabolic needs cannot be
via enteral nutrition or nonfunctioning GI
Nutrition tract
Admixture

Prepared to meet individual needs

Indications

• Bowel disorders
• Intense, long-term nutritional support
• Treatment of malignant disorders
• Trauma or surgery
• Hypermetabolic needs
• Unable to consume sufficient calories to meet metabolic needs
• Eating disorders
 Goals

WEIGHT PRESERVING CORRECTING OR AVOIDING AVOIDING F/D

MANAGEMENT OR LEAN BODY MASS PREVENTING VITAMIN AND ABNORMALITIES
PROMOTING & VISCERAL NUTRITIONAL TRACE ELEMENT
GROWTH PROTEINS DEFICIENCIES ABNORMALITIES
Parenteral Nutrition
• Composition
• Base solutions contain dextrose and protein in the form of amino acids
• Prescribed electrolytes, vitamins, and trace elements are added to customize
• Calories mainly from CHO in form of dextrose
• IV fat emulsion is added to complete the nutrients [Solutions: 10%, 20% & 30%]
• Baseline: ___________________
• Infusion time:______________
• Contraindication: ________________
• Cautious use: _________________ & Allergies: __________________

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 Route of Administration

• TPN [_________ PN]

• Type of access: ______________
• Anatomical location of catheter tip: _____________
• Tonicity of solution:_____________
• Confirmation of placement:___________
• Check for: ________________ &
_______________
• Peripheral Parenteral Nutrition [PPN] {______________}
• Type of access: _______________
• Location: ____________
• Tonicity:_____________
When complications occur with PN?
• ___________________
• ___________________
• Position:________________
• __________________
• ___________________
• ___________________
• ___________________
• ___________________
• Refeeding syndrome
• _____________________
• _____________________
• ______________________
• Dislodgement
• Occlusion
• Hemorrhage
Evaluation of Patient
Case
• PN components must be adjusted individually to
each patient according to
• Clinical status
• Nutritional requirements and status
• Underlying pathological states
• Level of metabolic stress
• Organ functions
 Is the client a candidate for PN?

Current dx, Complete health history

Baseline
Assessment Dietary history

Prior to PN
Baseline parameters:______________________

_____________
______________
Evaluation of laboratory ______________
findings ______________
______________, _____________
Nursing Management
1. Must be on an ______________________
2. Never __________________; Must be ________________
3. Follow ______________
4. Change ___________________
5. Requires a _________________
6. Ensure all bags are labeled accurately
7. Do not ______________________
8. Follow agency protocol for dsg. changes under ________________:
______________ [Key]
Nursing Management
1. Monitor all clinical parameters; evaluate for allergies to components of lipids
2. May require _______________added to bag
3. Bag unavailable or late administration: Infuse __________________
4. Monitor for complications
5. Observe PN solution for _______________ & ________________
6. Remove from refrigeration & bring to ________________ before infusing
7. Verify provider order for prescribed solution
8. Prepare for transitioning to oral nutrition if indicated

9. Prepare client for transitioning home

Parenteral Nutrition
• Home transition
• Educate: patient and caregiver
• Catheter or tube care
• Mixing and handling of solutions and tubing
• Side effects and complications
• Discharge planning needed

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 • Lewis, Chp. 39

Read & Review • ATI M/S & Nutrition

• Recordings, notes, read