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NRSG 302 > Week 4 - TPN > Flashcards

Week 4 - TPN Flashcards

1
Q

describe TPN

A
  • more invasive
  • higher infection risk
  • higher risk of metabolic complications
  • increased cost
  • continuous infusion
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2
Q

does TPN require functioning GI tract?

A

no

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3
Q

does TPN preserve GI function?

A

no

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4
Q

describe enteral feeding

A
  • lower risk of infection/ metabolic complications
  • less expensive
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5
Q

what does enteral feeding help maintain?

A

gut integrity and prevent translocation of bacteria

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6
Q

does enteral feeding require a functioning GI tract?

A

yes

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7
Q

what does enteral feeding reduce?

A

risk for refeeding syndrome

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8
Q

how is TPN given?

A

bloodstream through PICC/ VAD

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9
Q

what are some indications of TPN use?

A
  • paralyzed/ nonfunctional GO tract
  • conditions where GI tract requires rest
  • NPO X +7 days
  • chronic/ extreme malnutrition
  • chronic diarrhea/ vomiting
  • requiring surgery or chemo
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10
Q

when someone is taking TPN their GO tract can’t be used for what?

A
  • ingestion
  • digestion
  • absorption of essential nutrients
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11
Q

what are common conditions that lead someone to using TPN?

A
  • chronic/ severe diarrhea and vomiting
  • complicated surgery/ trauam
  • GI obstruction
  • GI tract fistulas
  • anorexia
  • severe malabsorption
  • short bowel snydrome
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12
Q

what are the major components of TPN?

A
  • carbohydrates (dextrose)
  • protein (amino acids)
  • fat (lipids)
  • electrolytes
  • vitamins
  • minerals
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13
Q

who decides the combination of components for a patient’s TPN order? What does it depend on?

A
  • physician in consult with a dietitian
  • depends on pts metabolic needs, clinical hx and blood work
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14
Q

what does PN stand for?

A

portion of the nutritional needs or component

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15
Q

what are complications of TPN?

A
  • hyperglycaemia
  • dehydration
  • electrolyte imbalance
  • thrombosis
  • infection
  • liver failure
  • micronutrient deficiencies
  • hypersensitivity
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16
Q

what type of infection is common with TPN?

A

catheter related bloodstream infection

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17
Q

what are signs someone is hypersensitive regarding TPN

A
  • fever
  • N&V
  • hives
  • back pain
  • headaches
  • dyspnea
  • chest pain
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18
Q

what signs and symptoms might indicate a hypersensitivity to the fat emulsion?

A
  • dyspnea
  • back and chest pain
  • diaphoresis
  • N&V
  • headache
  • hyper coagulability or thrombocytopenia
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19
Q

when does refeeding syndrome occur?

A

when a client who is severely malnourished suddenly receives nourishment again particularly carbs

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20
Q

what does refeeding syndrome start with?

A

low levels of:
- potassium
- magnesium
- phosphorus

21
Q

what is re-feeding syndrome characterized by?

A
  • fluid retention
  • electrolyte imbalances
  • hyperglycemia
22
Q

what are some conditions that predispose patients to re-feeding syndrome?

A
  • longstanding malnutrition
  • chronic alcoholism
  • vomiting and diarrhea
  • chemotherapy
  • major surgery
23
Q

re-feeding syndrome can occur any time a malnourished patient is what?

A

started on aggressive nutritional support

24
Q

what is a hallmark for re-feeding syndrome?

A

hypophosphatemia

25
Q

what is hypophosphatemia associated with?

A
  • cardiac dysrhythmias
  • respiratory arrest
  • neurological disturbances
26
Q

what is included in the assessment and nursing care for a patient on TPN?

A
  • IV remains patent/ free of infection
  • dressing D/I to IV site
  • monitor for edema/ fluid overload
  • review lab values
  • respiratory assessment
    -mouth care
  • QID BGM for first 3 days
  • I&O monitoring
27
Q

why do we need to monitor a patient’s blood glucose level if they are on TPN?

A
  • adds concentrated dextrose to bloodstream
  • blood glucose often elevated
28
Q

what is often added to TPN? What does this put the patient at risk of?

A
  • insulin
  • HYPERglycemia or HYPOglycemia
29
Q

when someone is on TPN what increase temperature are we monitoring for?

A

> 38.5

30
Q

how many nurses do you need to ensure the TPN matches the doctors order?

A

2

31
Q

how long does TPN infuse for?

A

24 hours

32
Q

what is normally run at the same time as TPN?

A

D10W

33
Q

how often is blood work drawn for someone taking TPN? Why?

A
  • daily
  • determine the TPN components
34
Q

who will contact the doctor with lab results and obtain TPN order?

A

charge nurse

35
Q

what do you confirm TPN orders to?

A
  • order sheet
  • pt. ID
  • expiry
36
Q

If you chose not to use TPN what would be some possible reasons?

A
  • bag is leaking
  • TPN is lumpy
  • light protective bag in place
37
Q

what is used with each new bag of TPN?

A

filtered tubing

38
Q

what is the infusion rate for TPN?

A

based on volume labeled on bag

39
Q

where do you need to document after you start a TPN order?

A
  • MAR
  • I&O flow sheet
40
Q

prior to starting TPN what is required?

A

thorough baseline assessment

41
Q

when TPN is started what does this mean for the initial concentration and volume?

A
  • concentration of solution is lower
  • volume and rate are slower
42
Q

why do we start with a lower concentration and rate when we first start TPN?

A

body needs time to get used to it

43
Q

what must TPN run through?

A

IV pump and be infused through CVAD

44
Q

can you add or co-infused medication with TPN? Why?

A
  • no
  • due to high level of incompatibility
45
Q

why can added dextrose in TPN lead to hyperglycaemia ?

A

body in catabolic state > may not be able to metabolize high concentrations

46
Q

when would you stop TPN?

A
  • requires physicians order
  • after pt is able to get adequate enteral nutrition
  • pt can meet 70% of their protein and calorie needs
47
Q

if TPN has been ordered to stop how do you do this?

A
  • TPN concentration will be slowly decreased over a few days until being stopped
48
Q

if TPN has been ordered to stop but has been transitioned to a tube feed how would you stop this?

A

TPN will be tapered down while the tube feed is slowly increased

49
Q

what does the nurse need monitor after TPN is discontinued?

A
  • hypoglycemia
  • pt is taking in adequate nutrition/ maintaining weight

NRSG 302 (8 decks)

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