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Parenteral Nutrition Basic IVT Nov 2008
Parenteral Nutrition Basic IVT Nov 2008
(ANSAP)
means of providing protein, carbohydrates, fats, vitamins, and minerals to those who are unable to assimilate nutrients provided via the gastrointestinal tract.
safe and effective when delivered according to strict protocols by nutritional support team or other trained person.
Parenteral Solution
Nutrition
- Hyperalimentation - IV Hyperalimentation
-may contain two or more of the following elements:
Carbohydrates Proteins Lipids Electrolytes Vitamins and Minerals Trace Elements Water
Long term therapy (2 weeks or more) Supply large quantities of nutrients and calories (2,000 to 3,000 calories/day or more)
Deficient or absent oral intake for longer than 7 days , as in cases of multiple trauma, severe burns, or anorexia nervosa.
Serum albumin level below 3.5g/dl. Chronic vomiting or diarrhea. GI disorders that prevent or severely reduce absorption.
Short term Therapy (3 weeks or less) is used to: Maintain nutritional state in patients who can tolerate relatively high fluid volume.
Who usually resume bowel function and oral feedings in a few days, and who arent candidates for CV catheter.
Methods of Administration
Peripheral Infusion
-short term parenteral nutrition (1-3 weeks)
Proper use of infusion pump. Check the written order against the written label on the bag.
Proper labeling.
Watch out for swelling at the peripheral insertion site. Maintain the infusion rate and care for the tubing, dressing, infusion rate and I.V. devices.
Monitor patient for signs and symptoms of sepsis: -glucose in urine -altered level of consciousness -chills -malaise -hyperglycemia -leukocytosis -elevated temperature
Change the tubing and filter every 24 hours, using strict aseptic technique. Make sure that all tubing junctions are secure.
Perform IV site care and dressing changes. Check the infusion pumps volume meter and time tape to monitor for irregular flow rate. Gravity should never be used to administer TPN.
Record the patients vital signs when you initiate therapy. Be alert for increased body temperature- one of the earliest signs of catheter-related sepsis. Monitor your patients glucose levels.
Accurately record the patients daily fluid intake and output. Assess the patients physical status daily. Weigh him at the same time each morning. Suspect fluid imbalance if the patient gains more than 1lb. per day. Monitor the results of routine laboratory tests .
Handling PN Hazards
Catheter Related Metabolic Mechanical
Dislodge catheter
Place a sterile gauze pad treated with antimicrobial agent on the insertion site and apply pressure.
Pneumothorax
Assist with chest tube insertion. Maintain chest tube suction as ordered.
Sepsis
Remove the catheter and culture the tip. Give appropriate antibiotics as ordered.
Metabolic Complications
Hyperglycemia
Start insulin therapy as ordered. Adjust the TPN flow rate as ordered.
Hypoglycemia
Infuse dextrose as ordered.
Metabolic acidosis
Adjust the formula and assess for contributing factors.
Mechanical Complications
Air Embolism
Clamp the catheter. Place the patient in trendelenburgs position on the left side. Give oxygen as ordered. If cardiac arrest occurs, initiate cardiopulmonary resuscitation.
Venous Thrombosis
Notify the doctor. Administer heparin as ordered. Venous flow studies may be done.
Extravasation
Stop the I.V. infusion. Assess the patient for cardiopulmonary abnormalities.
Phlebitis
Apply gentle heat to the insertion site. Elevate the insertion site, if possible.
Assess patient and familys level of understanding. Inform the patient and family everything about all that they need to know regarding parenteral nutrition in a manner that they comprehend.
Secure inform consent about the procedure if the patient needs to have a central line for total parenteral nutrition. Inform patient regarding the proper regulation of the parenteral nutrition.
Inform the patient to report any unusual feelings such as chest pain, tachycardia, pain at the insertion site and the likes that may indicate air embolism. Inform the patient regarding the importance of blood sugar monitoring while on parenteral nutrition.
Inform the patient the signs and symptoms of hyper and hypoglycemia and report it if ever experienced.
Documentation
Problem
Goal of Care
Planned Intervention
Response
At the end of the 8 hours interventions, -the client may be able to understand the importance of the therapy -prescribed volume of infusion should be administered to the client. -prevent complications that the therapy might cause.
-assess clients level of understanding. -explain the importance of the therapy to the client and family. -start the TPN as ordered using infusion pump for proper regulation. -watch out for signs and symptoms of adverse effects. -assess the infusion site for signs and symptoms of infection or phlebitis. -teach client/family regarding the proper way of doing hand washing.
-client verbalized understanding of the importance of the therapy. -correct volume of infusion administered. -demonstrate correct way of doing handwashing.
Date
Focus Problem
Progress Notes
D- BMI of 18 -unable to eat orally due to body weakness, nausea and vomiting. -To start TPN 2300kcal/day via central line. A- Assessed clients level of understanding. -Explained the importance of the therapy to the client and relatives. -Explained the procedure to the client. -catheter site inspected for signs and symptoms of infection. -TPN started aseptically as ordered. -Infused proper volume of infusion as ordered via infusion pump. -Watched out for signs and symptoms of adverse reactions. -Client and relatives instructed on how to do proper handwashing. R- client verbalized understanding of the therapy -no signs and symptoms of infection or adverse effect from the therapy -400cc of TPN infused to client. -client understand importance of handwashing to prevent infection.