TPN Complications Week 7 Flashcards
(22 cards)
What are some of the 10 major complications associated with TPN administration?
- Sepsis
- Electrolyte imbalance
- Hyperglycemia
- Hypoglycemia
- Hypervolemia
- Hyperosmolar Diuresis
- Hepatic Dysfunction
- Hypercapnea
- Lipid intolerance
- Lipid Particulate Aggregation
What is the cause of TPN associated sepsis?
- High Glucose content in fluid
- VAD contamination
What are the three main nursing assessments/interventions for TPN associated Spesis?
- Monitor Temp
- Monitor WBCs
- INspect Insertion site for signs of infection
What are some causes of electrolyte imbalance associated with TPN?
- Introgenic effects of underlying disease (Vomiting, diarrhea)
- Refeeding syndrome
What are the 4 main nursing assessments/interventions/considerations for TPN associated electrolyte imbalance?
- Monitor Electrolytes daily initially then every 2-3 days
- Monitor for signs of imbalance
- Treat underlying cause
- Change concentration of electrolytes in TPN
What are some causes of Hyperglycemia associated with TPN?
- TPN has a high glucose content
- Patient may have insufficient insulin secretion
What are the 3 main nursing assessments/interventions/considerations for TPN associated hypoglycemia?
- Monitor blood glucose
- Decrease glucose concentration in TPN
- Increase insulin
What are some causes of TPN associated hypoglycemia?
-An abrupt discontinuation of TPN administered through a central line
What is the main intervention for TPN associated hypoglycemia?
Start D10W after discontinuation of centrally administered TPN
What are some causes of TPN associated hypervolemia?
- Intragenic
- Underlying disease (CHF, Renal failure)
What are the 6 main nursing assessments/interventions/considerations for TPN associated hypervolemia?
- Monitor I&O
- Daily Weights
- CVP
- Breath sounds
- Observe for Peripheral Edema
- Increase concentration of TPN
What is the cause of TPN associated Hyperosmolar Diuresis?
-High Osmolarity of TPN
What are the 4 main nursing assessments/interventions/considerations for TPN associated hyperosmolar Diuresis?
- Monitor I&O
- Daily weight
- CVP
- Decrease concentration of TPN fluid
What is the main cause of TPN associated Hepatic Dysfunction?
The high concentration of carbohydrates and/or fats relative to protein in TPN
What are the 3 main nursing assessments/interventions/considerations for TPN associated Hepatic Dysfunction?
- Monitor Liver function tests and tryglyceride levels
- Check for presence of jaunduce
- Change formula content
What are some causes of TPN associated Hypercapnea?
-The high carbohydrate content of TPN fluid
What is the main nursing assessments/interventions/considerations for TPN associated hypercapnea?
-Change formula to increase the proportion of fat relative to carbs
What are some causes of TPN associated lipid intolerance?
- History of low weight or premature infant
- History of liver disease
- History of elevated triglycerides
What are the 6 main nursing assessments/interventions/considerations for TPN associated lipid intolerance?
- Monitor for fat overload syndrome
- Monitor for bleeding
- Monitor O2 for impaired oxygenation
- Check Triglycerides levels, liver function, hepatosplenomegaly, discreased coagulation, cyanosis, dyspnea
- monitor for allergic reactions: Nausea, vomiting, headache, chest pain, back pain, fever
- Admin lipid solutions slowly, initally, while observing for symptons
What is the cause of TPN associated Lipid particulate aggregation?
an unstable mixture of dextrose solution with lipid emulsion
What is the main nursing assessments/interventions/considerations for TPN associated lipid particulate aggregation?
observe for cracking or creaming of fluid and avoid use of fluid with these characteristics
Explain the steps of refeeding syndrome
- Malnutrition
- Protein & Fat Catabolism begin
- Electrolytes begin to decrease
- PN or Eating Begins and increases insulin production
- Electrolytes begin to shift into cells at a rapid rate
- The rapid shift leads to seizures, HF, and possible Death
