TPN Flashcards
(27 cards)
Does TPN need to titrated (AKA started at a lower rate and then sped up later).
Yes, usually the TPN rate needs to be titrated.
Does stopping TPN suddenly cause hypoglycemia?
Yes, there is a high concentration of dextrose in TPN, if you stop the infusion suddenly, the patient can experience hypoglycemia.
What are the most important things to be monitoring while a patient is on TPN?
Daily weights and I/O because we are infusing a lot of fluid. Check for edema and adventitious lung sounds, sign of fluid overload.
Temperature and vital signs for signs of infection. Protein, electrolytes, glucose in labs and WBC in labs. Signs of infection like increased temp, elevated WBC and malaise. Monitor infusion site, IV tubing and dressing. Compare to baseline before starting treatment. Flow rate of TPN.
How often do we check the patient’s blood glucose when they are on TPN?
Every 4-6 hours
What are we charting when patient are on TPN?
-weight
-edema
-VS
-ways to facilitate PO intake
-nutritional status
-abnormal labs (report to physician)
-site assessment
-site care
-dressing changes
-date, time, rate, site and 2 RN signatures in MAR (double check)
-patient and family teaching
-patient tolerance of procedure
What do we need to teach patients about TPN?
What NPO status is, what TPN is, how long they’re on it, why they are on it, that they are at increased risk for infection.
What are some complications that can occur with TPN?
Infection, phlebitis, infiltration, pneumothorax, air embolus, thromboembolism, hyperglycemia, hypoglycemia, fluid imbalance, electrolyte imbalance, acid-base imbalances, hyperlipidemia.
What are some things we can do to prevent infection when patients are on TPN?
Change tubing (every 24hr-96hr, 24 for lipids, 96 for TPN, depends on facility). Use in-line filter. Assess site for infection. Temp every 4 hours. Do not administer anything else in a line/lumen used for TPN to prevent reactions.
What are the S+S of hyperglycemia?
thirst, headache, lethargy, headache, increased urination
What are the S+S of hypoglycemia?
sweating, shaking, confusion, loss of consciousness.
Can I run TPN using gravity, no pump?
No, you need to use a pump.
Do lipids go through the antibacterial filter?
No, they are too thick, will clog the filter, connect lipids below the filter.
Are lipids a part of TPN mixture?
No, lipids come in their own container and set up separately.
Do I need to use sterile technique when caring for central and PICC lines?
Yes.
Should I use a solution if there are a layer of fat droplets on the surface or it seems abnormal?
No.
Is there a way I can suddenly stop TPN safely?
Yes, you can prevent hypoglycemia by running a dextrose 10 solution after.
What role is supportive staff allowed to play?
Supportive staff cannot administer TPN. They can report alarms, wet dressings, abnormal vitals, patient complaints. They can perform blood glucose checks.
What would be pertinent in the medical history, or what could suggest a risk of malnutrition and an indication to use TPN?
Weight loss, muscle loss, muscle weakness, edema, lethargy, failure to get of ventilator, chronic illness, hasn’t eaten in 6 days or more, lab values (albumen, protein, transferrin, prealbumin, triglycerides, electrolytes), kidney function, heart function, liver function, allergies.
What do we check for in our site assesment?
inflammation, swelling, pain, patency.
What do we need to assess on the patient (not chart) before we start TPN?
Weight, lung sounds, VS, blood glucose, site assessment.
Describe the steps of initiating TPN.
Ensure privacy, NOD, identify patient, ensure safety/cleanliness of tubing, do medication checks, ensure safety of mixture (is it separated), hand hygiene, clean gloves, attach filter to tubing, spike bag, prime line, swab port to be used, flush if needed, connect line, label line, open clamps, set pump (may need to titrate), hand hygeine, document.
Can the TPN be interrupted for other care.
No, it should not be interrupted.
What do I need to notify the provider of it it happens?
S+S of infection, occlusion, fluid retention, infiltration.
How can we avoid phlebitis of a peripheral site?
Change the location of the site frequently.
