#15

15. Lewis P.989-999 and Techniques P. 616

Assessment of TPN (Total Parenteral Nutrition)

*cHECK FOR ALLERGIES TO ANY OF THE CONTENTS IN THE SOLUTION. (water, protein, carbohydrates, electrolytes, minerals, and vitamins)
*Vital signs should be monitored ever 4-8 hrs (if fever or vital signs are abnormal, notify physician; an elevated temp is one of the earliest signs of catheter-related sepsis)
*Daily wts. give indication of hydration status
-Body wt. is considered the changes in protein, fat, and water.
-On a daily basis, body water fluctuates more that protein and fat.
-Analysis must be made of whether gains or losses in wt. are caused by fluid gained from edema, fluid loss through diuresis, or an increase or decrease in tissue wt.
*Measure daily fluid intake and output an calorie intake
*Blood levels of glucose, electrolytes, and BUN; a CBC; and a hepatic enzyme studies are followed 3x per week until stable and the weekly.
*Observe site under dressing for signs of inflammation and infection.
-Phlebitis can readily occur in the vein as a result of the hypertonic infusion, & area can become infected.
(FYI: Many patients on TPN are receiving chemotherapy, corticosteroids, or antibiotics, which can mask signs of infection)
*If sutures are used to anchor catheter, they may become infected
-If an infection is suspected a culture specimen of the site and drainage should be sent for analysis, and notify Physician
*Blood glucose levels should be checked every 4-6 hrs with a glucose testing meter (TPN patients are at RF Hyperglycemia)
*Check the amt. infused and the rate every 30 min-1 hr.
-too fast of an infusion can put a lrg. amt. of glucose into blood causing hyperglycemia and too slow an infusion rate can cause hypoglycemia.
- An infusion pump must be used during admin. of TPN
*Before setting up and administering TPN, the nurse must check the label and ingredients in the solution to see that they are what the health care provider ordered.
*Examine solutions for contamination, such as cloudy appearance.
*Discontinue TPN and replace with a new solution bag every 24 hr.
*Catheter-related infection and septicemia can occur.