1. The client/caregiver can define total parenteral nutrition or hyperalimentation.
   1. It is a hypertonic solution consisting of dextrose, amino acids, lipids, and select electrolytes and minerals. It is
      given through a central line to provide all nutrients for the body.
   2. The solution is a sterile mixture that is prepared by a pharmacist.
   3. The client will need to be monitored by ongoing assessments and laboratory testing.
2. The client/caregiver can list possible reasons for receiving total parental nutrition therapy.
   1. Reduced intake of calories because of
      1. Inability to absorb or digest food (i.e., severe vomiting or diarrhea, obstruc- tion, severe burns, trauma, and cancer)
   2. Prolonged alteration in gastrointestinal function because of
      1. Disease, requiring the bowel or other organs to rest (pancreatitis, severe inflammatory bowel disease, etc.)
   3. Weight loss of 10% or more of usual body weight
   4. Reduction in values for
      • Prealbumin
      • Serum albumin
      • Total lymphocyte count
      • Total iron-binding capacity
   5. Intolerance to food or enteral feedings
3. The client/caregiver can demonstrate how to care for the TPN solution.
   1. Keep TPN solution in the refrigerator.
   2. Take the next bag of solution from the refrigerator 4 to 6 hours before using, and allow the solution to reach room
      temperature before using.
   3. Keep supplies in a clean, dry place.
   4. Keep solution away from children.
   5. Check solution bag before use.
      1. Solution should be clear and free of floating material. If lipids are added, the solution may appear milky but free of
         floating material.
      2. Make sure that the bag has no leaks or damage.
      3. Make sure that the bag is labeled with contents and expiration date.
4. The client/caregiver can demonstrate the administration of the solution.
   1. Clean work area. Wash hands. Assemble equipment.
   2. Read the label carefully to be sure that it is exactly what the physician prescribed.
   3. Inspect solution and warm solution to room temperature.
   4. Prepare solution and tubing as instructed.
   5. Set the pump to infuse solution at the rate ordered by the physician.
   6. Flush the catheter as ordered when the solution is finished.
5. The client/caregiver can list general care measures to prevent complications.
   1. Prevent infection by using the strict techniques as instructed.Inspect the catheter insertion site daily for signs of redness, warmth, swelling, or drainage.
   2. Inspect the catheter insertion site daily for signs of redness, warmth, swelling, or drainage.
   3. Monitor for fluid overload by checking for any swelling in arms, legs, hands, and so forth.
   4. Weigh at the same time every day.
   5. Check urine for glucose and acetone as ordered.
   6. Provide good oral care frequently.
   7. Change dressing as ordered.
   8. Flush catheter as ordered.
   9. Take temperature as ordered.
   10. Use your solution exactly as directed.
   11. Have contact numbers for physicians, pharmacists, nurses, and any other health care provider available to call if
       problems or questions occur.
   12. It is important to keep all appointments with your doctor and the laboratory.
6. The client/caregiver can list signs and symptoms of complications when receiving TPN.
   1. Report these side effects if they are severe or do not go away:
      • Mouth sores
      • Poor night vision
      • Skin changes
   2. Call physician or health care provider if any of the following symptoms occur:
      • Fever or chills
      • Stomach pain
      • Difficulty breathing
      • Rapid weight gain or loss
      • Increased urination
      • Upset stomach or vomiting
      • Confusion or memory loss
      • Muscle weakness, twitching, or cramps
      • Swelling of hands, feet, or legs
      • Extreme thirst
      • Fatigue
      • Changes in heartbeat
      • Convulsion or seizures
   3. Call if there is a catheter occlusion or partial occlusion: lack of flow or decreased flow of solution.

Resources

Home health agency

Medical equipment company

References

Ackley, B. J., & Ladwig, G. B. (2006).Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.
Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.
Lutz, C., & Przytulski, K. (2001).Nutrition and diet therapy. Philadelphia: F. A. Davis Company.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Taylor, C., Lillis, C., & LeMone, P. (2005). Fundamentals of nursing . Philadelphia: Lippincott, Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.