TPN: Nursing Indications, Considerations, and Goals

Total parenteral nutrition (TPN) is a medical method that is given to clients, bypassing the gastrointestinal system. What are the causes why clients are placed on total parenteral nutrition?

In this section, we’ll be discussing the nursing indications, considerations, and goals, and everything there is to know about TPN.

Defining TPN

Total parenteral nutrition is primarily a client’s entire nutrition in a bag. Inside every packet, there is an exact amount of calories that are necessary for the client’s welfare. Total parenteral nutrition is usually given through a peripherally-inserted central catheter (PICC) line or a central venous catheter mainly due to TPN’s contents, which is very sugary and liquefied.

Nursing Considerations

When taking care of a client who has a TPN line, healthcare providers, especially nurses, should give high regard to the following:

  1. The Nature of the Contents

Total parenteral nutrition is broken down food that is turned into a liquid form. It’s very thick and viscous which is why it is necessary to deliver it through either a PICC line or an essential venous catheter to have the contents introduced into the vein and have the body utilize it.

  1. The Type of Syringe

Due to the nature of its contents, total parenteral nutrition should be put through an 18 gauge syringe, intravenously. However, this risks the client for infiltration and phlebitis because the vein has to endure too much TPN contents that it won’t have the capability to handle what is introduced and might burst.

Indications for TPN

Why do clients go on with total parenteral nutrition? This is usually because the client has been on NPO for too long that the body is no longer receiving the right amount of nutrients required for proper functioning. Therefore, it is expected that these NPO clients will be given a particular type of sugar, commonly with D5 half normal saline.

What are the disorders or diseases that usually receive TPN?

  1. Clients with pancreatic abnormalities like pancreatitis. Eating can cause stress to the pancreas. Therefore, TPN is necessary.
  2. Ulcerative colitis clients are also given total parenteral nutrition.
  3. Clients who are suffering from small bowel obstructions and are unable to consume anything are also candidates for TPN.

The Main Goal

What’s the primary goal of providing total parenteral nutrition to clients? The primary purpose of the method is to maintain a positive nitrogen balance. But what does positive nitrogen balance mean?

Positive nitrogen balance means that the body is at an anabolic or growing state and not experiencing a catabolic breakdown situation. The intention is to keep the client at a proper weight through adequate feeding, preventing deterioration.

Aside from keeping positive nitrogen balance, TPN also aims at:

  • Keeping the client’s nutrition at a healthy state.
  • Preserving muscle mass; thus, lessening body fat.
  • Managing proper metabolism.
  • Sustaining continuous circulation inside the body.

Advantages of TPN

One of the main advantages of total parenteral nutrition is that it’s cost-effective, especially for medical institutions. Aside from that, TPN also decreases the risk for developing gut-related sepsis because the stomach is no longer used as the primary route for nutrition, especially with clients who have a small bowel obstruction or are on NPO.

In our next lecture, we’ll be talking more about TPN and how to wean off clients.

Pancreatitis: Nursing Assessment & Lab Tests that Matter

In this pancreatitis piece, we’ll go through different nursing assessments and interventions.

The pancreas is an important gland that is situated next to the gut and is responsible for releasing essential digestive enzymes and hormones.

A usual scenario for clients with pancreatitis is a complaint of pain originating from the left upper quadrant of the abdomen. However, not all complaints of left upper quadrant pain automatically equate pancreatitis; some conditions are also related to that.

Anatomical Analysis

The pancreas sits at the left upper quadrant of the abdomen, adjacent to the spleen and kidneys. When analyzing what a client might be having, you have to ask a series of questions concerning the location of the pain. Therefore, OPQRST assessment must take place.

When assessing for pancreatitis, you have to consider a couple of things:

  • The quality of pain
  • What provoked the pain
  • The onset of the pain

The Main Provoker

With pancreatitis, the main provoker would be food. Eating triggers the pancreas to shoot out specific enzymes that, instead of going into the duodenum, they explode within the pancreas. Such enzymes are protease, lipase, and amylase. Once these enzymes get activated inside the pancreas, they cause inflammation; thus, pancreatitis happens.

Pancreatitis Signs and Symptoms

A client who is suffering from pancreatitis would display the following signs and symptoms:

  • Increased respiratory rate that is rapid and shallow due to the presence of pain.
  • Increased heart rate, also because of the pain.
  • Abdominal distention
  • A tender left upper quadrant
  • Decreased or absent bowel sounds caused by the activation of enzymes inside the pancreas instead of the small intestine which leads to undigested and unabsorbed food.
  • Diarrhea

Pancreatitis Labs

Healthcare providers looking after clients with pancreatitis should be wary of the following laboratory results:

  • Increased amylase (carbohydrate enzyme)
  • Increased lipase (fat enzyme)
  • Increased blood sugar due to the absence of insulin
  • Grey Turner Sign and Cullen sign (abdominal bruising caused by internal bleeding due to an inflamed pancreas)
  • Decreased albumin
  • Hypocalcemia due to a liver issue
  • Increased phosphorus or phosphate
  • Hyperlipidemia
  • Decreased coagulating factors

Pancreas Imaging

The following imaging tests are done to pancreatitis clients:

  1. X-ray – results will reveal an enlarged pancreas and liver.
  2. CAT scans or computerized tomography – a type of x-ray that enables a 360 image result.
  3. MRI or magnetic resonance imaging – to check for soft tissue injuries.
  4. Ultrasound – aside from evaluating the pancreas, an ultrasound will also check for gallbladder involvement.

Effective and reliable diagnosis depends on laboratory and imaging results. These tests tend to either rule out or confirm that the client is experiencing pancreatitis.

Involvement of Other Organs

When dealing with pancreatitis clients, you always have to consider the connection and proximity of the pancreas to its neighboring structures like the gallbladder and liver because these organs share pathways. Meaning, if the bile or hepatic duct gets stuck due to, for example, a stone, backing up of fluid and blood will happen and so will inflammation.

For videos concerning pancreatic enzymes and liver functions, you can check out Simple Nursing’s website and YouTube channel.