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.

GI Disorders: Crohn’s Disease and Colitis

Inflammatory bowel disease (IBD) is entirely different from irritable bowel syndrome (IBS). Having an irritable bowel syndrome means that there is the presence of pain and irritation. Mainly, there is irritability; however, there is no presence of inflammation. Therefore, inflammation and irritation are two separate things.

Inflammatory bowel disease is broken down into two different categories, namely:

  • Crohn’s disease
  • Colitis/Ulcerative Colitis

Crohn’s Disease

As a test tip reminder, you can easily remember Crohn’s disease as “Crown’s disease” because of the granulomas that are present inside the gastrointestinal tract which looks like jewels to a crown. To further explain, let’s get into a quick roundup of the pathophysiology.

Crohn’s disease is a condition that can happen anywhere in the gastrointestinal tract – from the mouth to the rectum. The primary concern with Crohn’s disease is the presence of granulomas.

Granulomas

Granulomas happen when macrophages seclude bacteria like a small block and result in a protective covering, usually around a bacteria, foreign body, or virus; in most cases, tuberculosis viruses.

Upon detection of harmful, foreign bodies, macrophages will surround the infection and block it, which causes the appearance of little lumps. With a tuberculosis client, these little lumps are present during an X-ray scan. The presence of little lumps inside the lungs indicates that the client has tuberculosis or has a history of the disease.  

As for Crohn’s disease (Crown’s disease), the small granulomas attached to the bacteria are the ones causing the pain, distention, and inflammation of the gastrointestinal tract.

Colitis/Ulcerative Colitis

In colitis and ulcerative colitis, the large intestine or the colon is the main concern.

Ulcers are openings inside the gut that causes bloody stool (at least 15 episodes a day); this is the usual diagnosis of ulcerative colitis. The suffix, “-itis” means that there is the presence of inflammation. Therefore, with ulcerative colitis, there is an open source of bleeding inside the colon that also causes inflammation.

Colitis, on the other hand, is not about granulomas but scar formations with an inflamed colon. Due to the edema in the colon, there is a loss of colon absorption and elasticity.

Causes of Inflammatory Bowel Disease

The causes for inflammatory bowel diseases like Crohn’s disease and colitis or ulcerative colitis are the three S’s, namely:

  • Stress
  • Sickness
  • Smoking

When the body has inflamed bowel disease, it attacks itself which is also known as an autoimmune disorder like myasthenia gravis. In this situation, the body thinks that it is its foreign enemy.

Nursing Considerations

When dealing with a client with a heightened immune system, the main goal is to decrease the elements that cause the condition to worsen. Therefore, the nurse has to make sure that the client:

  • Is not be exposed to stressful events or situations
  • Refrains from getting sick
  • Stops smoking 

These three causes are the main culprits for the outburst of this type of autoimmune disorder.

If you’re having a hard time studying for major nursing exams and the NCLEX®, head on to Simple Nursing’s website and YouTube channel to get a more simplified, concise approach to memorizing and remembering every single nursing-related topics.