Total Parenteral Nutrition (TPN feeding)is a method of administration of essential nutrients to the body through a central vein. TPN therapy is indicated for a client with a weight loss of 10% of the ideal weight, an inability to take oral food or fluids within 7 days post-surgery, and hypercatabolic situations such as major infection with fever. TPN solutions require water (30 to 40 mL/kg/day), energy (30 to 45 kcal/kg/day, depending on energy expenditure), amino acids (1.0 to 2.0 g/kg/day, depending on the degree of catabolism), essential fatty acids, electrolytes, vitamins, minerals, and trace elements. These solutions can be adjusted, depending on the presence of organ system impairment or the specific nutritional needs of the client. TPN is usually used in hospital, subacute and long-term care, but it is also used in home care settings.
Nursing Care Plans
The major goals for the patient undergoing total parental nutrition may include improvement of nutritional status, maintaining fluid balance, and absence of complications.
Here are four (4) total parenteral nutrition nursing care plans (NCP) and nursing diagnoses:
- Imbalanced Nutrition: Less Than Body Requirements
- Risk for Excess Fluid Volume
- Risk for Deficient Fluid Volume
- Risk for Altered Body Composition
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
- 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.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
More care plans related to basic nursing concepts:
- Cancer (Oncology Nursing) | 13 Care Plans
- End-of-Life Care (Hospice Care or Palliative) | 4 Care Plans
- Geriatric Nursing (Older Adult) | 11 Care Plans
- Prolonged Bed Rest | 8 Care Plans
- Surgery (Perioperative Client) | 13 Care Plans
- Systemic Lupus Erythematosus | 4 Care Plans
- Total Parenteral Nutrition | 4 Care Plans