FUNDAMENTALS OF NURSINGNUTRITION
Parenteral Nutrition
-aka Intravenous hyperalimentation or TPN
-delivered through high pressured central
veins (Subclavian veins)
-dextrose, water, fats, proteins, electrolytes,
vitamins and trace elements.
-10% to 50% dextrose in water plus mixture
of amino acids and vitamins, minerals and
elements
- Goal: To achieve anabolic state for those
unable to maintain a normal nitrogen
balance.
Indications
Severe malnutrition
Severe burns
Bowel disease disorders
(Ulcerative colitis and enteric
fistula)
Acute renal failure
Hepatic failure
Metastatic cancer
Major surgeries
NPO for MORE THAN 5 DAYS
Nursing Responsibilities:
Infection control
Surgical aseptic technique.
Monitor fluid, electrolyte and
glucose imbalances.
Infuse the solution gradually to
prevent hyperglycemia
Wean gradually or slowly to
prevent hyperinsulinemia or
hypoglycemia (48 hours or 6
hours if given carbs orally or IV)
Do not give IV meds and blood
in the PN line
Do not draw blood from the
central venous access site.
Blood studies done every other
day or 3 times per week during
PN
Blood glucose monitoring every
4 hours.
PN should be refrigerated and
administered within 24 hours
after preparation.
When changing tubing or cap.
Place on Trendelenburg and
advise to perform Valsalva
Clam tubing when not in use.
NOTE!
1000 mL of 5% glucose
contains 50 grams of sugar.
Thus, a Liter of solution is
less than 200 kcal.
Before PN try Oral and NGT
feeding.
Cloudy and dark solutions
are not used and returned to
pharmacy.
Additions of PN substances
done at PHARMACY not
nursing units.
DO NOT give fat
emulsification with those egg
allergi
WATCH OUT FOR
Peripheral parenteral nutrition (PPN)
-delivered into smaller peripheral veins
-accommodate lipids
-safe and convenient
- given for short time nutrition or those
inaccessible central veins.
Goal: To prevent nutritional deficits than
correct them.
Disadvantage: Phlebitis
Mngt:
Dextrose is replaced with glycerol.
NOTE!
Fat emulsion is white and
opaque. Fat globules and
accumulation of froth in the
solution is not given and must
be returned to pharmacy.
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