"NURSING PROCESS FOCUS Clients Receiving Total Parenteral Nutrition"
NURSING PROCESS FOCUS Clients Receiving Total Parenteral Nutrition Assessment Potential Nursing Diagnoses Prior to administration: ■ Infection, Risk for ■Obtain a complete health history including allergies, drug history, and possi- ■ Nutrition, Imbalanced: Less than Body Requirements ble drug interactions. ■ Fluid Volume, Imbalanced, Risk for ■Obtain a complete physical examination. ■ Knowledge, Deficient, related to drug therapy ■Assess for the presence or history of nutritional deficits such as inadequate ■ Injury, Risk for oral intake, GI disease, and increased metabolic need. ■Obtain the following laboratory studies: total protein/albumin levels, creati- nine/blood urea nitrogen (BUN), CBC electrolytes, lipid profile, and serum iron levels. Planning: Client Goals and Expected Outcomes The client will: ■Exhibit improvement or stabilization of nutritional status. ■Be free of infection or injury related to TPN. ■Demonstrate an understanding of the drug’s action by accurately describing drug side effects and precautions. ■Immediately report side effects such as symptoms of hypoglycemia or hyperglycemia, fever, chills, cough, or malaise. Implementation Interventions and (Rationales) Client Education/Discharge Planning ■ Monitor vital signs, observing for signs of infection such as elevated tempera- ■ Instruct client to report fever, chills, soreness or drainage of the infusion site, ture. (Bacteria may grow in high-glucose and high-protein solutions.) cough, or malaise. ■ Use strict aseptic technique with IV tubing, dressing changes, and TPN solution, ■ Instruct client that infusion site has high risk for infection development; and refrigerate solution until 30 min before using. (Infusion site is at high risk hence, sterile dressings and aseptic technique with solutions and tubing are for development of infection.) needed. ■ Monitor blood glucose levels. Observe for signs of hyperglycemia or hypo- Instruct client to report symptoms of: glycemia and administer insulin as directed. (Blood glucose levels may be ■ Hyperglycemia (excessive thirst, copious urination, and insatiable hunger). affected if TPN is turned off, if the rate is reduced, or if excess levels of insulin ■ Hypoglycemia (nervousness, irritability, and dizziness). are added to the solution.) ■ Monitor for signs of fluid overload. (TPN is a hypertonic solution and can ■ Instruct client to report shortness of breath, heart palpitations, swelling, or create intravascular shifting of extracellular fluid.) decreased urine output. ■ Monitor renal status. (Intake and output ratio, daily weight, and laboratory Instruct client to: studies such as serum creatinine and BUN are used to assess renal function.) ■ Weigh self daily. ■ Monitor intake and output. ■ Report sudden increases in weight or decreased urine output. ■ Keep all appointments for follow-up care and laboratory testing. ■ Maintain accurate infusion rate with infusion pump, make rate changes grad- Instruct client: ually, and never discontinue TPN abruptly. (Abrupt discontinuation may cause ■ About the importance of maintaining the prescribed rate of infusion. hypoglycemia, and a sudden change in flow rate can cause fluctuations in ■ Never to stop the TPN solution abruptly unless instructed by the healthcare blood glucose levels.) provider. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that client goals and expected outcomes have been met (see “Planning”). ■The client demonstrates improved nutritional status. ■The client is free of infection or injury related to the TPN. ■The client demonstrates an understanding of the drug’s action by accurately describing drug side effects and precautions. ■The client verbalizes the importance of immediately reporting side effects such as symptoms of hypoglycemia, hyperglycemia, fever, chills, cough, or malaise.