Page 36 - Critical Care Notes

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BASICS
Indications
■ Severe malnutrition
■ Burns
■ Bowel disorders (inflammatory disorders, total bowel obstruction, short
bowel syndrome)
■ Severe acute pancreatitis
■ Acute renal failure
■ Hepatic failure
■ Metastatic cancer
■ Postoperative major surgery if NPO >5 days
Nursing Care
■ Each bag of TPN should be changed at least every 24 hr with tubing change.
■ Monitor intake and output and weigh the patient daily.
■ Monitor glucose levels, including finger stick blood sugars every 4 to 6 hr.
Cover with regular insulin as necessary. If poor control of serum glucose,
consider adding insulin to TPN and continue sliding scale coverage.
■ Monitor serum electrolytes including magnesium, phosphate, triglycerides,
prealbumin, transferrin, CBC, PT/PTT, and urine urea nitrogen.
■ Assess IV site for redness, swelling, and drainage.
■ Change gauze dressing around IV site every 48 to 72 hr, as per protocol.
Transparent dressings may be changed every 7 days.
■ If TPN is temporarily unavailable, hang 10% D/W at the same rate as TPN.
Monitor for hypoglycemia.
■ Place TPN on infusion pump. Monitor hourly rate. Never attempt to “catch
up” if infusion not accurate.
Complications
Complications from TPN may be catheter related, mechanical, or metabolic.
Complications of TPN Signs and Symptoms
Infection, catheter-related Leukocytosis; fever; glucose intolerance;
sepsis, septicemia, septic catheter site red, swollen, tender; drainage
shock
Hypoglycemia blood Shaking, tachycardia, sweating, anxiety,
glucose <70 mg/dL dizziness, hunger, impaired vision, weak-
ness, fatigue, headache, irritability
Hyperglycemia blood Extreme thirst, frequent urination, dry skin,
glucose >200 mg/dL hunger, blurred vision, drowsiness, nausea
Prerenal azotemia ↑ BUN and serum Na + , signs of dehydration,
lethargy, coma
Continued
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