Nursing Fundamentals - Total Parenteral Nutrition (TPN)
Parenteral Nutrition (PN) is the delivery of nutrients directly into the bloodstream through an IV, bypassing the digestive system. It is used for clients who cannot eat, digest, or absorb nutrients due to medical conditions like gastrointestinal disorders or swallowing difficulties
What is parenteral nutrition (PN)?
When nutrients are given to the client through an IV.
The client is given PN because they are unable to eat, tolerate any food in the stomach or unable to swallow.
Key Terms
What is parenteral nutrition (PN)?
When nutrients are given to the client through an IV.
The client is given PN because they are unable to eat, tolerate any food in the stomach...
What are some medical conditions where a client would need to be started on parenteral nutrition?
burns
severe diarrhea
celiac disease
cancer with severe malnutrition
What should be administered temporarily if the next bag of parenteral nutrition (PN) is not available yet?
Dextrose 10%
(D10)
D10 is given to prevent hypoglycemia.
What nutrients are included in parenteral nutrition (PN)?
dextrose (sugar)
fats
proteins
vitamins
minerals
electrolytes
water
What allergy should be assessed for with fat emulsion/lipids?
Allergy to eggs.
What is added to PN to control glucose level?
Insulin
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| Term | Definition |
|---|---|
What is parenteral nutrition (PN)? | When nutrients are given to the client through an IV. The client is given PN because they are unable to eat, tolerate any food in the stomach or unable to swallow. |
What are some medical conditions where a client would need to be started on parenteral nutrition? | burns severe diarrhea celiac disease cancer with severe malnutrition |
What should be administered temporarily if the next bag of parenteral nutrition (PN) is not available yet? | Dextrose 10% (D10) D10 is given to prevent hypoglycemia. |
What nutrients are included in parenteral nutrition (PN)? | dextrose (sugar) fats proteins vitamins minerals electrolytes water |
What allergy should be assessed for with fat emulsion/lipids? | Allergy to eggs. |
What is added to PN to control glucose level? | Insulin |
What is the difference between PPN and TPN? PPN: partial parenteral nutrition TPN: total parenteral nutrition | PPN: contains less nutrients and is given through a large peripheral or venous central line. TPN: contains more nutrients and is always given through a venous central line. |
What may be added to parenteral nutrition (PN) to prevent blood clots from forming in the tip of the central line catheter? | Heparin |
How should parenteral nutrition (PN) be discontinued? | Discontinue PN gradually over 1-2 hours to prevent sudden hypoglycemia. |
How often is a new bag of parenteral nutrition (PN) administered? | Once every 24 hours the client gets new IV tubing and a new bag of PN. |
Why are electrolytes checked daily before administration of parenteral nutrition (PN)? | Because the client can get refeeding syndrome which is when there is a sudden increase of electrolytes in the blood. Sudden electrolyte imbalances (such as potassium) can kill the client. |
How is refeeding syndrome prevented? | Monitor for signs of electrolyte imbalances, especially respiratory, neuro and CV changes Notify HCP if symptoms occur. |
Why is the blood glucose checked daily before parenteral nutrition (PN) administration? | Because there is glucose in PN and the complications of hypoglycemia or hyperglycemia need to be monitored. |
How is hyperglycemia prevented with PN? | begin infusion at slow rate check blood sugars and give insulin as needed |
How is hypoglycemia prevented with parenteral nutrition (PN)? | discontinue gradually monitor blood sugars, especially 1 hour after discontinuation |
How often is blood glucose checked with parenteral nutrition (PN)? | A minimum of every 4-6 hours while on PN. |
Why are the liver labs (ALT and AST) and renal labs (BUN and creatinine) checked before administering PN? | To see if there is a problem with metabolizing the proteins or fats in the PN. |
Why would a client get hypervolemia as a result of parenteral nutrition (PN)? | Because the fluids were given too quickly. This can occur more frequently for clients with renal failure, heart failure or liver failure. |
How is hypervolemia prevented with parenteral nutrition (PN)? | don’t increase infusion rate monitor for fluid volume overload monitor intake and output monitor daily weight - goal is about 1-2 lbs (0.5-1 kg) weight gain per week |
How would a client get an infection from parenteral nutrition (PN)? | When there is contamination of the solution, catheter or due to poor aseptic technique when cleaning the catheter hub. |
How is infection during parenteral nutrition (PN) prevented? | use aseptic technique scrub the hub for 15 seconds with alcohol before use monitor temp for infection assess IV site for redness, swelling, drainage new IV tubing and bag every 24 hours |
Why is only one IV line dedicated to total parenteral nutrition (PN)? | The line needs to always be available for PN and nothing else - no blood or meds through that line. This is to ensure that there is always a usable line available. |
Within how many hours should parenteral nutrition (PN) be used from initially being mixed? | Within 24 hours of being mixed. |
Where should parenteral nutrition (PN) be stored before using? | The refrigerator. Take it out 30 minutes to 1 hour before administration to prevent discomfort. |
Can a client be on parenteral nutrition (PN) at home? | Yes. The client gets teaching on how to manage the central line used for PN. |
Teaching: Parenteral Nutrition | how to administer change a sterile dressing get a daily weight monitor blood glucose symptoms of complications: especially edema of arm or a fluid leak |
What is PPN? | (Partial Parenteral Nutrition) | PPN contains less nutrients and is given through a large peripheral or CVAD. |
What is TPN? | (Total Parenteral Nutrition) | TPN contains more nutrients and is always given through a CVAD. |