4 Total Parenteral Nutrition (TPN Feeding) Nursing Care Plans

Imbalanced Nutrition: Less Than Body Requirements

• Imbalanced Nutrition: Less Than Body Requirements

May be related to

• GI tract function alterations
• Lengthy NPO status
• Increased metabolic rate or other conditions necessitating increased intake such as burns, infections, chemotherapy
• Refusal to eat due to psychological reasons

Possibly evidenced by

• Reduced muscle mass
• Reduced total protein, transferrin, and serum albumin levels
• Electrolyte imbalances
• Poor skin turgor
• Poor wound healing
• Weight loss below 20% ideal

Desired Outcomes

• The client will achieve an adequate nutritional status, as evidenced by stable weight or weight gain and by improved albumin levels.

Nursing Assessment and Rationales

1. Assess skin integrity and wound healing.
Skin integrity changes and wound healing are used as parameters in monitoring the effectiveness of TPN feeding.

2. Measure intake and output accurately; Monitor weight daily; Monitor calorie counts, including calories provided by TPN.
TPN composition is based on the calculated nutritional needs of the client. Before the therapy is started, a thorough baseline assessment will be completed by healthcare members which includes physicians, nurses, dieticians, and pharmacists is done. Changes in fluid balance, weight, and caloric intake are used to assess TPN effectiveness. Daily weights are done to determine if nutritional goals are being met. Weight is also used to assess fluid volume status. Weight gain of more than 1/2 pound per day may indicate fluid retention.

Nursing Interventions and Rationales

1. Assist with the insertion and maintenance of central venous or peripherally inserted central catheters (PICC).
Since the osmolality of TPN solution is high, it is administered into the vascular system using a catheter inserted into a central vein with a high-volume blood flow. The tip of the catheter is usually placed in the superior vena cava. X-ray confirmation of accurate catheter placement is necessary before TPN administration is initiated. Normal saline or other isotonic solutions may be infused through the central catheter until placement is confirmed.

2. Encouraged additional oral fluid intake as indicated.
Additional oral fluids may be given to a client receiving TPN to maximize nutritional support. Clients may benefit psychologically from having oral intake, especially at shared mealtimes with family members.

3. Administer the prescribed rate of TPN solution via an infusion pump.
Electronic infusion pumps are used during the therapy to maintain an accurate rate of administration. A delayed administration time of TPN withholds the client of needed nutrition; Rapid administration can precipitate a hyperglycemic crisis because the hormonal response (i.e., insulin) may not be available to allow the use of the increased glucose load.

4. Collaborate with other nutritional support teams, dieticians, pharmacists, and home health nurses.
The risk for most complications that occur in the hospital is decreased when the administration of parenteral nutrition is supervised by an experienced nutritional support team.