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Total Parenteral Nutrition or (TPN feeding)is a method of administration of essential nutrients to the body through a central vein. TPN therapy is indicated to a client with a weight loss of 10% 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 requires 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 the home care settings. Nursing Care PlansThe 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 diagnosis:
May be related to
Possibly evidenced by
Desired Outcomes
Recommended ResourcesRecommended nursing diagnosis and nursing care plan books and resources. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.
See alsoOther recommended site resources for this nursing care plan: More care plans related to basic nursing concepts: In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of total parenteral nutrition in order to:
As discussed previously in the section "Providing Client Nutrition Through Continuous or Intermittent Tube Feedings", clients who are not able to get sufficient calories and nutrition are given enteral nutrition through a nasointestinal tube, a nasojejunal tube, a nasoduodenal tube, a jejunostomy tube, a gastrostomy tube, or a percutaneous endoscopic gastrostomy (PEG) tube. Although parenteral nutrition is more costly than enteral nutrition and it also poses a greater risk in terms of infection, it is sometimes indicated when enteral nutrition is contraindicated for the client, when the client is at high risk for aspiration, when the client has a gastrointestinal tract obstruction that would interfere with an enteral tube feeding, and when the client's gastrointestinal tract is not functioning in a manner that can accommodate a less costly and lower risk enteral feeding rather than total parenteral nutrition, which is often referred to as hyperalimentation. Hyperalimentation places the client at high risk for infection for two major reasons; hyperalimentation is an invasive procedure and the hyperalimentation solution contains a high percentage and amount of dextrose. The side effects and adverse events related to TPN include those described below.
Educating the Client On the Need for and Use of TPNClients should be educated and instructed about the purpose of TPN, their need for TPN, the procedure that will be used to insert the TPN catheter, how the total parenteral nutrition feedings will be delivered, how the nurse will care for and maintain these feedings, the necessity to use sterile technique, and the risks, including the complications, of total parenteral nutrition, as discussed immediately above . Total parenteral nutrition, or hyperalimentation, is delivered through one of the body's larger veins such as the subclavian vein. Hyperalimentation can provide for all of the nutritional needs and these feedings contain minerals, electrolytes, vitamins, hyperosmolar glucose, amino acids, and trace elements which are administered through the hyperalimentation catheter which was surgically placed by the physician. Total parenteral nutrition is most often used for clients who are in need of complete bowel rest, those who are in a negative nitrogen balance as the result of a severe burn or another cause, among clients who have a severe medical illness or disease such as cancer or
AIDS/HIV, when the client chooses to have this treatment. Applying a Knowledge of Nursing Procedures and Psychomotor Skills When Caring for a Client Receiving TPNThe nursing process as applied to the nursing procedures and the psychomotor includes assessment, nursing diagnoses, planning, establishing expected outcomes and evaluating the client's responses to this care and treatment. Assessment: The nurse assesses the client, they assess and validate the client's need for hyperalimentation including laboratory diagnostic test results, and they also establish baselines prior to the total parenteral nutrition feedings which include baseline bodily weight, baseline vital signs, baseline levels of glucose, protein and electrolytes, and baselines in terms of the client's intake and output. After the complete assessment of the client, the nurse will establish actual and potential nursing diagnoses for the client such as:
The planning phase of the nursing process in respect to total parenteral nutrition includes the establishment of client goals or expected outcomes and planning interventions. Some appropriate expected outcomes can include:
The evaluation of the total parenteral nutrition for the client is based on comparing the client's baseline data and information to the data and information that is collected during these treatments and after the total parenteral nutrition feedings are completed, as will be discussed just below in the section entitled "Administering Parenteral Nutrition and Evaluating the Client Responses". Some of the psychomotor skills that nurses used when caring for a client receiving TPN include the nurse's application of sterile asepsis techniques, changing the tubings and the total parenteral nutrition feeding bags and bottles, the maintenance of the site of insertion of the total parenteral nutrition catheter, and manipulating and controlling the rate of the infusion of the total parenteral nutrition. More information about these psychomotor procedures will be discussed just below in the section entitled "Administering Parenteral Nutrition and Evaluating the Client Responses." Applying a Knowledge of Client Physiology and Mathematics to TPN InterventionsNurses caring for clients who are receiving TPN must apply their knowledge of the client's physiology into their care of the client. For example, they must apply sterile technique to avoid infection, they must closely monitor the client's blood glucose levels on a continuous basis because the contents of these total parenteral nutrition feedings are high in terms of dextrose content which can lead to hyperglycemia, they must also monitor these levels to determine if the client is being affected by hypoglycemia as a result of the insulin that is administered with these total parenteral nutrition feedings in order to prevent hyperglycemia, and, for example the nurse must monitor the client's intake and output knowing that, physiologically, the high osmolarity of the TPN can lead to osmotic diuresis and fluid imbalances. Mathematic principles are also applied to TPN interventions in terms of flow rate of the solution which is essentially the same as calculating intravenous flow rates which was fully discussed and described in the section entitled "Dosage Calculations: Performing Calculations Needed for Medication Administration". Administering Parenteral Nutrition and Evaluating the Client ResponsesTotal parenteral nutrition is administered in a similar manner to that which is done with intravenous infusions with a few points of emphasis and differences as listed below.
RELATED CONTENT: SEE - Pharmacological & Parenteral Therapies Practice Test Questions Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members. Latest posts by Alene Burke, RN, MSN (see all) What precautions must be used when caring for a client with TPN?Wash your hands before you handle the TPN solution and supplies, or the IV. Store the TPN solution in the refrigerator when you are not using it. Let the solution warm to room temperature before you use it. You can do this by placing the TPN bag on a clean table or kitchen counter for 2 to 3 hours before you use it.
What is the priority nursing consideration when caring for a client receiving TPN?Which of these interventions is the priority when caring for this client? TPN can cause hyperglycemia, so blood glucose levels should be closely monitored. Because of the hypertonicity of the TPN solution, it must be administered via a central venous catheter.
What is the nurse's responsibilities in administering TPN?Educate client on the need for and use of TPN. Apply knowledge of nursing procedures and psychomotor skills when caring for a client receiving TPN. Apply knowledge of client pathophysiology and mathematics to TPN interventions. Administer parenteral nutrition and evaluate client response (e.g., TPN)
When caring for a patient who is receiving TPN?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.
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What intervention should the nurse include in the plan of care for a client receiving TPN?
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