TPN Med Surg: GI - Gastrointestinal Pathophysiology Total Parenteral Nutrtion It's basically the client’s entire nutrition in a IV bag (right into the blood) bypassing the normal process of digestion in the GI tract. Since it's very thick, only give TPN through a central line. Carbohydrate Fat Protein Central line CVC (Central Venous Catheter) Water Internal jugular line Mineral PICC line Subclavian CVC Internal jugular line Vitamin Indication Subclavian CVC PICC Nursing Care Pancreatitis / Crohn's Disease (NPO) Glucose levels Hyperglycemia Severe burns, Trauma (hypercatabolic state) Oncology Chronic malabsorption issues >180 Daily weights (maintain muscle) Carbohydrate Fat Catabolic Hormones Water Protein Mineral Vitamin 40 kg Day 3 Day 2 Day 1 NCLEX TIP Increased Urination (Polyuria) Excessive THIRST (Polydipsia) Nausea, Headache, Abdominal pain Administration KAPLAN TPN line NO IV meds (push or piggyback) Start & stop slowly Never abruptly stop TPN Change bag & tubing every 24 hours Complications NCLEX TIP Priority action: Hang 10% dextrose in water ● Administer dextrose 10% in water until the new bag arrives Hypoglycemia Refeeding Syndrome NCLEX TIP Deadly complication with severely malnourished clients! Giving too MUCH nutrition too QUICKLY - pulls electrolytes from the blood & into the tissues, resulting in deadly low electrolytes. Enteral Feedings TPN Priority action when a client’s TPN bag is empty and a new one is not readily available: 60 (NGT, PEG, G-tube) NCLEX TIP Anorexia nervosa Chronic Alcoholism Mg Na K Mg Ca K Ca Na K Ca Na 24 - 48 hours Enteral Feedings (NGT, PEG, G-tube) starting Enteral or Parenteral Nutrition A - Aspiration A - Airway Obstruction TPN P M Magnesium KEY POINT P NCLEX TIP Displaced PEG tube less than 7 days old Torsades de Pointes Causes: Post MI, Hypoxia, Low magnesium Notify the HCP who inserted it HCP 2.4 - 4.4 mg/dL K Mg 1 Phosphorus 3.5 - 5.0 mEq/L 1.3 - 2.1 mEq/L REQUEST continuous feedings to prevent aspiration P Potassium Torsades de Pointes Vfib Treatment: Magnesium Sulfate NCLEX TIP V Fib & Cardiac Arrest Low potassium in this case Below 3.5