Parentral nutrition for nursing student

1. PARENTRAL NUTRITION
ANCY T F
MSC NURSING
GOVT COLLEGE OF NURSING
THIRUVANANTHAPURAM

2. MEANING
 Parenteral nutrition, or intravenous feeding, is a method of
getting nutrition into patient’s body through veins. Depending
on which vein is used, this procedure is often referred to as
either total parenteral nutrition (TPN) or peripheral parenteral
nutrition (PPN).

3. TYPES
Total parenteral nutrition
Peripheral parenteral nutrition

5. INDICATIONS
 Newborns with gastrointestinal anomalies such as
tracheoesophageal fistula, massive intestinal atresia,
complicated meconium ileus, massive diaphragmatic
hernia, gastroschisis, omphalocele and neglected pyloric
stenosis.
 Failure to thrive in infants with short bowel syndrome,
malabsorption, inflammatory bowel disease, enzyme
deficiencies and chronic idiopathic diarrhea
 Other pediatric indications include necrotizing
enterocolitis, intestinal fistulae, severe trauma, burns,
postoperative infections and malignancies

6. CONT..
 Adults with short bowel syndrome secondary to massive
small-bowel resection or internal or external enteric fistulae.
 Malnutrition secondary to high intestinal obstruction for
example achalasia, esophageal strictures and neoplasms,
pyloric obstruction and gastric neoplasms.
 Prolonged ileus due to medical or surgical causes (for example
post-operative, following abdominal trauma or polytrauma).
 Malabsorption secondary to sprue, enzyme & pancreatic
deficiencies, regional enteritis, ulcerative colitis,
granulomatous colitis, and tuberculosis enteritis.

7. CONT.
 Functional gastrointestinal disorders like idiopathic diarrhoea,
psychogenic vomiting, anorexia nervosa.
 Patients with depressed sensorium (for example following
head injury or intracranial surgery) in whom tube feeding is
not possible.
 Hyper catabolic states secondary to severe sepsis, extensive
full thickness burns, major fractures, polytrauma, major
abdominal operations etc.

8. Cont..
 patients with malignancies in whom
malnutrition may jeopardize successful
delivery of a therapeutic option (surgery,
chemo- or radiotherapy).
 Paraplegics/quadriplegics with pressure sores
in pelvic or perinal regions where fecal soiling
is a problem.

9. Components of parenteral Nutrition
 Carbohydrate:
 Amino acids ( protein )
 Fat emulsion (lipid)
 Vitamins
 Minerals and trace elements
 Water ,insulin and heparin

11. COMPLICATIONS
 Air embolism
 Hyperglycemia
 Hypervolemia
 Hypoglycemia
 Infection
 Pneumothorax

12. NURSING ACTION
Before the PN administration
 Assess the need for parenteral nutrition by
performing nutritional assessment
 Check the physician’s order
 Explain the procedure in detail to the patient and
relatives.
 Remove the bag of parenteral nutrition from
refrigerator at least 1 hr before administration
 Inspect the fluid for presence of creamy or any
changes in constitution
 Check the vitals

13. During the procedure:
 Wash hands, put mask and gloves
 Using strict aseptic technique, attach tubing with bag and
purge out air
 Close all clamps on new tubing and insert tubing into volume
control infuser.
 Place the patient in a supine position ,connect the tubing in to
hub of catheter ,make sure that the connection is secured
 Open all clamps and regulate the flow
 Monitor the vitals hourly ,assessing the patient tolerance.
 Record the procedure.

14. After care
 Monitor the vital signs
 Monitor the allergic reactions such as vomiting , headache
chest pain, back pain and fever
 Monitor blood glucose frequently
 Monitor intake and output, daily weight , CVP , breath sounds,
and peripheral edema
 Maintain strict aseptic technique when changing the dressing
and tubing .
 monitor any complications