Which nursing actions are essential when caring for a client receiving total parenteral nutrition?

Overview

Total parenteral nutrition (TPN) is liquid nutrition given through a tube (IV) that is put in a large vein in the arm, neck, or chest. You may need TPN because of a condition that makes it hard to eat or because of a severe illness, such as Crohn's disease or pancreatitis.

TPN is usually given for 12 to 14 hours each day. You may be able to get TPN while you sleep. Your doctor may recommend that a nurse visit you at home to help you get started with TPN.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

To care for your IV

• Follow your doctor's instructions for use and care of your IV. Your doctor, nurse, or other health professional will:
  • Tell you what fluids to give through the IV.
  • Show you how to care for the skin around the IV. Be sure to follow instructions on keeping the area clean.
  • Teach you how to watch for infection or blockage of the IV.

To give TPN

• Follow your doctor's instructions for giving TPN. Do not change the dose or how often you get TPN without talking to your doctor first.
• Wash your hands before you handle the TPN solution and supplies, or the IV.
• Store the TPN solution in the refrigerator when you are not using it. Let the solution warm to room temperature before you use it. You can do this by placing the TPN bag on a clean table or kitchen counter for 2 to 3 hours before you use it. Never microwave the solution.
• Always check each bag of TPN before you use it. If there is a problem with your TPN, save the bag and show it to your doctor or pharmacist.
  • Check the expiration date. Do not use it if it is past the expiration date.
  • Check the bag for leaks. Do not use it if there are any leaks.
  • Check the colour of the TPN solution. Do not use the TPN if it is cloudy or has solid pieces floating in it.
• Follow your doctor's instructions on how to safely dispose of used IV needles, IV tubing, and TPN bags.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).

Call your doctor or nurse call line now or seek immediate medical care if:

• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness around the IV.
  • Red streaks leading from the area where the IV is put in.
  • Pus draining from the IV area.
  • A fever.
• The IV comes out.
• You are dizzy or light-headed, or you feel like you may faint.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

• Your weight goes up or down more than 2.3 kilograms in a week.
• You have any problems with your TPN.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter Y938 in the search box to learn more about "Total Parenteral Nutrition (TPN): Care Instructions".

Total Parental Nutrition (TPN)- ATI video case studyWhat would be the priority nursing consideration/intervention when caring fora client receiving TPN?When caring for a patient receiving TPN the nurse would:1. Monitor vital signs, looking for signs of any infection for instance, hightemperature.2. Monitor blood glucose levels. Observe for signs of hyperglycemia/hypoglycemia and administer insulin as ordered.

Total parenteral nutrition (TPN) is a medical method that is given to clients, bypassing the gastrointestinal system. What are the causes why clients are placed on total parenteral nutrition?

In this section, we’ll be discussing the nursing indications, considerations, and goals, and everything there is to know about TPN.

Defining TPN

Total parenteral nutrition is primarily a client’s entire nutrition in a bag. Inside every packet, there is an exact amount of calories that are necessary for the client’s welfare. Total parenteral nutrition is usually given through a peripherally-inserted central catheter (PICC) line or a central venous catheter mainly due to TPN’s contents, which is very sugary and liquefied.

Nursing Considerations

When taking care of a client who has a TPN line, healthcare providers, especially nurses, should give high regard to the following:

1. The Nature of the Contents

Total parenteral nutrition is broken down food that is turned into a liquid form. It’s very thick and viscous which is why it is necessary to deliver it through either a PICC line or an essential venous catheter to have the contents introduced into the vein and have the body utilize it.

1. The Type of Syringe

Due to the nature of its contents, total parenteral nutrition should be put through an 18 gauge syringe, intravenously. However, this risks the client for infiltration and phlebitis because the vein has to endure too much TPN contents that it won’t have the capability to handle what is introduced and might burst.

Indications for TPN

Why do clients go on with total parenteral nutrition? This is usually because the client has been on NPO for too long that the body is no longer receiving the right amount of nutrients required for proper functioning. Therefore, it is expected that these NPO clients will be given a particular type of sugar, commonly with D5 half normal saline.

What are the disorders or diseases that usually receive TPN?

1. Clients with pancreatic abnormalities like pancreatitis. Eating can cause stress to the pancreas. Therefore, TPN is necessary.
2. Ulcerative colitis clients are also given total parenteral nutrition.
3. Clients who are suffering from small bowel obstructions and are unable to consume anything are also candidates for TPN.

The Main Goal

What’s the primary goal of providing total parenteral nutrition to clients? The primary purpose of the method is to maintain a positive nitrogen balance. But what does positive nitrogen balance mean?

Positive nitrogen balance means that the body is at an anabolic or growing state and not experiencing a catabolic breakdown situation. The intention is to keep the client at a proper weight through adequate feeding, preventing deterioration.

Aside from keeping positive nitrogen balance, TPN also aims at:

• Keeping the client’s nutrition at a healthy state.
• Preserving muscle mass; thus, lessening body fat.
• Managing proper metabolism.
• Sustaining continuous circulation inside the body.

Advantages of TPN

One of the main advantages of total parenteral nutrition is that it’s cost-effective, especially for medical institutions. Aside from that, TPN also decreases the risk for developing gut-related sepsis because the stomach is no longer used as the primary route for nutrition, especially with clients who have a small bowel obstruction or are on NPO.

In our next lecture, we’ll be talking more about TPN and how to wean off clients.

What are the nursing responsibilities required for patients with TPN?

What nursing measures must be carried out when a patient is receiving total parenteral nutrition?

What would be the priority nursing consideration when caring for a client receiving TPN?

When caring for a patient who is receiving TPN?