Nurses Role in TPN

Nurses Role in TPN

1. assess

   • allergies, drug history, drug interactions
   • presence or history of nutritional deficits
   • physical exam
   • TPN solution is appropriate for patient age and organ function status
   • lab studies: protein/albumin, creatinine/BUN, CBC electrolytes, lipid profile, serum iron levels

2. goals

   • no adverse reaction to TPN
   • lab studies stay within normal ranges/improve
   • nutritional status improves
   • patient can state possible s/e and adverse reactions and will report immediately if any occur
   • patient will not develop an infection and will keep site clean

3. interventions

   • monitor vital signs
   • daily weights
   • monitor fluid I&O's continuously
   • monitor glucose levels q6h or as ordered
     • monitor for signs and symptoms of hyperglycemia and hypoglycemia
       • give insulin subq PRN
   • monitor lab studies
     • liver function tests, plasma proteins, prothombin time, plasma and urine osmoality; Ca, Mg and phosphate levels
     • CBC, electrolytes, BUN daily
   • keep site sterile and change dressing q48h
   • monitor for fluid overload
   • monitor for adverse reactions
     • dyspnea, nausea, headache, back pain, sweating, dizziness

4. patient teaching

   • s/s of infection: chills, fever, tenderness at infusion site
   • s/s of hyperglycemia: polydipsia, polyphagia, polyuria
   • s/s of hypoglycemia: nervousness, irritability, dizziness
   • importance of daily weights
   • monitor I&Os
   • report: increase in weight, decrease in urine output, shortness of breath, swelling, heart palpitations
   • never stop infusion abruptly unless HCP instructs to

5. evaluate

   • patient's nutritional status has improved
   • patient verbalizes importance of reporting side effects and adverse reactions immediately
   • patient doesn't acquire infection or adverse reaction related to TPN

6. MELISSA FERRELL 1/24/2015