1
Q
What are the components of TPN?
A
- glucose
- lipids (fats)
- mineral
- vitamins
- amino acids (proteins)
- medications sometimes
2
Q
what are the indications for TPN?
A
- burns
- malnutrition (chemo)
- ARF, hepatic failure
- major surgeries
- NPO pt for indefinite time period
- to promote wound healing
- to reduce activity gi system
3
Q
what is PPN?
A
- PPN has lower dextrose content
- Can be infused via peripheral vein access or cvad bcz low content in glucose
- Helps with weight maintenance, not weight gain
- short term
- less hypertonic solutions than TPN
- May cause phlebitis
4
Q
what is the solution component of PPN?
A
- D5W to D10W
- Electrolytes, minerals, vitamins, trace elements as ordered.
- Lipid emulsion 10% or 20%
- Amino acids ( 3.5%)
5
Q
what are complications of TPN?
A
- Hyper/hypoglycemia
- Re-feeding syndrome
- Catheter related infection (sepsis)
- Allergic reaction to additives in the TPN
- Pulmonary edema & emboli
- F and E imbalance
6
Q
what are adverse reactions to lipid infusion?
A
- Diaphoresis
- Back ache &chest pain
- Dyspnea & headaches
- Irritation at infusion site
- Lethargy & syncope
- Nausea &vomiting
- Cyanosis
7
Q
interventions r/t TPN d/c ?
A
- Do not abruptly D/C TPN, may lead to hypoglycemia.
- If D/C suddenly, administer D10W at the same infusion rate. (tpn) and D5w if ppn
8
Q
interventions/considerations r/t TNP solutions?
A
- take out of fridge 30 min before
- protect from light to prevent multivitamin oxidation
- if solution is unavailable, administer D10W meanwhile
9
Q
what is refeeding syndrome?
A
shift in fluids and electrolyte by rapid infusion
10
Q
clinical manifestations of re-feeding syndrome?
A
fluid retention
electrolyte imbalances;
- hypokalemia
- hypophosphatemia
- hypomagnesemia
- hyperglycemia
11
Q
what lab work do you need before and during administration of TPN?
A
- CBC
- liver function
- SMA14
- iron studies
