Parenteral nutrtion

• GI trauma
• pancreatitis
• ileus
• inflammatory bowel disease
• GI tract malignancy
• GI hemorrhage
• paralytic ileus
• GI obstruction
• short-bowel syndrome
• GI fistula
• severe malabsorption
• CANNOT absorb food from GI tract

• provide energy
• maintain body tissues
• aid body processes (growth, cell activity, enzyme production, temp. regulation)

• catheter infection
• hyperglycemia
• hypokalemia
• must have CV access
• expensive

TPN long term, need central access (high dextrose conc)
PPN for 1-3 weeks, lower dextrose conc; not for use if liver disorders, malnutrition/fat metabolism disorders

• fever
• burns
• trauma
• disease/stress

glycogenolysis: mobilizes and converts glycogen to glucose
adipose tisssue: takes up stored energy
gluconeogenesis: body taps ts store of essential visceral/somatic proteins = negative nitrogen balance

protein energy malnutrition (protein calorie malnutrition)
iatrogenic - inadequate protein/poor calorie intake during hospitalization
Kwashiorkor - severe protein deficiency without a calorie deficit; usually with kids
marasmus - prolonged and gradual wasting

• dietary history - changes/decreased amount of food intake
• physical assessment
• anthropometric measurements
• review pertinent diagnostic tests - visceral protein status, lean body mass, vitamin/mineral balance

dextrose - calories
amino acids - protein
fats - lipid emulsions, calorie needs
electrolytes/minerals - based on serum chemistry profile/metabolic needs
vitamins -ensure normal body functions
micronutrients - trace elements; normal metabolism
water - fluids, electrolyte balance

hypertonic
3 L bag
glucose balance important
slow infusion rate, increase gradually
abrupt stop can cause hypoglycemia

slightly hypertonic
lipid emulsions
either continuous or cyclical administration

PICC line (very conc. must go into central circulation)
CV access device
implanted port
long term = tunneled catheter/implanted port

check order
label container
maintain flow rate as prescribed - monitor often
change tubing/filter/container q24hrs
IV site care/dressing changes
record vitals q4-8 hrs
record glucose levels
I&O, daily weight
monitor lab results/serum triglyceride levels
mouth care
document findings/interventions

clotted cath
dislodged cath
cracked/broken tubing
pneumothorax
sepsis

interrupted flow rate
reposition cath, t-PA to clear

wet dressing, bleeding
sterile gauze pad + antimicrobial ointment on site + pressure

risk of air embolism
padded hemostat above break= keep air out

trauma to pleura during insertion of CV access device
dyspnea, chest pain, cough, diminished breath sounds, sweating/cyanosis
unilateral chest movment
chest tube insertion, chest tube suctioning

fever, chills, red/indurated area around catheter
remove cath/culture tip, antibiotics

hyper & hypoglycemia (blood sugar) & hyperosmolar hyperglycemia nonketotic syndrome
hyper & hypokalemia - formula makpeup, loss in GI Tract, renal disease (+)
hypomagnesemia - not enough in solution
hypophosphatemia - insulin therapy
hypocalcemia - too little calcium, vitamin D deficiency, pancreatitis
metabolic acidosis - increased serum Cl, decrease serum bicarb level
liver dysfunction

air embolism
venous thrombosis
extravasation
phlebitis

apprehension, chest pain, techycardia, hypotension, cyanosis, seizures, loss of consciousness, cardiac arrest
clamp cath, trendelenburgs on left side, O2, CPR

swelling at cath site, swelling of extremity/face on same side as cath
pain at insertion site/along vein, malaise, fever, tachycardia
notify practitioner, heparin, venous flow study

swelling around insertion site/pain
stop infusion, chest x-ray for cardiopulmonary abnormalities

pain, tenderness, redness, warmth at site & along vein
gentle heat @ site, elevate site

nausea, headache, lethargy, heart failure (fluid overload)
check rate, check pump