Total Parenteral Nutrition (TPN)

Question 1

What is parenteral nutrition (PN)?

Answer 1

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.

Question 2

What are some medical conditions where a client would need to be started on parenteral nutrition?

Answer 2

• burns
• severe diarrhea
• celiac disease
• cancer with severe malnutrition

Question 3

What should be administered temporarily if the next back of parenteral nutrition (PN) is not available yet?

Answer 3

Dextrose 10%

(D10)

D10 is given to prevent hypoglycemia.

Question 4

What nutrients are included in parenteral nutrition (PN)?

Answer 4

• dextrose (sugar)
• fats
• proteins
• vitamins
• minerals
• electrolytes
• water

Question 5

What allergy should be assessed for with fat emulsion/lipids?

Answer 5

Allergy to eggs.

Question 6

What is added to PN to control glucose level?

Answer 6

Insulin

Question 7

What is the difference between PPN and TPN?

PPN: partial parenteral nutrition

TPN: total parenteral nutrition

Answer 7

• 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.

Question 8

What may be added to parenteral nutrition (PN) to prevent blood clots from forming in the tip of the central line catheter?

Answer 8

Heparin

Question 9

How should parenteral nutrition (PN) be discontinued?

Answer 9

Discontinue PN gradually over 1-2 hours to prevent sudden hypoglycemia.

Question 10

How often is a new bag of parenteral nutrition (PN) administered?

Answer 10

Once every 24 hours the client gets new IV tubing and a new bag of PN.

Question 11

Why are electrolytes checked daily before administration of parenteral nutrition (PN)?

Answer 11

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.

Question 12

How is refeeding syndrome prevented?

Answer 12

Monitor for signs of electrolyte imbalances, especially respiratory, neuro and CV changes

Notify HCP if symptoms occur.

Question 13

Why is the blood glucose checked daily before parenteral nutrition (PN) administration?

Answer 13

Because there is glucose in PN and the complications of hypoglycemia or hyperglycemia need to be monitored.

Question 14

How is hyperglycemia prevented with PN?

Answer 14

• begin infusion at slow rate
• check blood sugars and give insulin as needed

Question 15

How is hypoglycemia prevented with parenteral nutrition (PN)?

Answer 15

• discontinue gradually
• monitor blood sugars, especially 1 hour after discontinuation

Question 16

How often is blood glucose checked with parenteral nutrition (PN)?

Answer 16

A minimum of every 4 - 6 hours while on PN.

Question 17

Why are the liver labs (ALT and AST) and renal labs (BUN and creatinine) checked before administering PN?

Answer 17

To see if there is a problem with metabolizing the proteins or fats in the PN.

Question 18

Why would a client get hypervolemia as a result of parenteral nutrition (PN)?

Answer 18

Because the fluids were given too quickly.

This can occur more frequently for clients with renal failure, heart failure or liver failure.

Question 19

How is hypervolemia prevented with parenteral nutrition (PN)?

Answer 19

• 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

Question 20

How would a client get an infection from parenteral nutrition (PN)?

Answer 20

When there is contamination of the solution, catheter or due to poor aseptic technique when cleaning the catheter hub.

Question 21

How is infection during parenteral nutrition (PN) prevented?

Answer 21

• 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

Question 22

Why is only one IV line dedicated to total parenteral nutrition (PN)?

Answer 22

The line needs to always be available for PN and nothing else - no blood or meds through that line.

This is to assure that there is always a usable line available.

Question 23

Within how many hours should parenteral nutrition (PN) be used from initially being mixed?

Answer 23

Within 24 hours of being mixed.

Question 24

Where should parenteral nutrition (PN) be stored before using?

Answer 24

The refrigerator.

Take it out 30 minutes to 1 hour before administration to prevent discomfort.

Question 25

Can a client be on parenteral nutrition (PN) at home?

Answer 25

Yes.

The client gets teaching on how to manage the central line used for PN.

Question 26

Teaching:

Parenteral Nutrition

Answer 26

• 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

Question 27

What is PPN?

(Partial Parenteral Nutrition)

Answer 27

PPN contains less nutrients and is given through a large peripheral or CVAD.

Question 28

What is TPN?

(Total Parenteral Nutrition)

Answer 28

TPN contains more nutrients and is always given through a CVAD.