Prior to administration:
■ Obtain a complete health history including allergies, drug history, and possible drug interactions.
■ Obtain a complete physical examination.
■ Assess for the presence or history of nutritional deficits such as inadequate oral intake, GI disease, and increased metabolic need.
■ Obtain the following laboratory studies: total protein/albumin levels, creatinine/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.
Interventions and (Rationales)
■ Monitor vital signs, observing for signs of infection such as elevated temperature. (Bacteria may grow in high-glucose and high-protein solutions.)
■ Use strict aseptic technique with IV tubing, dressing changes, and TPN solution, and refrigerate solution until 30 min before using. (Infusion site is at high risk for development of infection.)
■ Monitor blood glucose levels. Observe for signs of hyperglycemia or hypoglycemia and administer insulin as directed. (Blood glucose levels may be affected if TPN is turned off, if the rate is reduced, or if excess levels of insulin are added to the solution.)
■ Monitor for signs of fluid overload. (TPN is a hypertonic solution and can create intravascular shifting of extracellular fluid.)
■ Monitor renal status. (Intake and output ratio, daily weight, and laboratory studies such as serum creatinine and BUN are used to assess renal function.)
■ Maintain accurate infusion rate with infusion pump, make rate changes gradually, and never discontinue TPN abruptly. (Abrupt discontinuation may cause hypoglycemia, and a sudden change in flow rate can cause fluctuations in blood glucose levels.)
Client Education/Discharge Planning
1. Instruct client to report fever, chills, soreness or drainage of the infusion site, cough, or malaise.
2. Instruct client that infusion site has high risk for infection development; hence, sterile dressings and aseptic technique with solutions and tubing are needed.
3. Instruct client to report symptoms of:
■ Hyperglycemia (excessive thirst, copious urination, and insatiable hunger).
■ Hypoglycemia (nervousness, irritability, and dizziness).
4. Instruct client to report shortness of breath, heart palpitations, swelling, or decreased urine output.
5. Instruct client to:
■ 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.
6. Instruct client:
■ About the importance of maintaining the prescribed rate of infusion.
■ Never to stop the TPN solution abruptly unless instructed by the healthcare provider.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that client goals and expected outcomes have been met.
■ 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.