Nasogastric Tube Feeding

Rhenelyn Delos Reyes BSN 3
Total Parenteral Nutrition

 Total parenteral nutrition (TPN) is a method of feeding that bypasses the
gastrointestinal tract. A special formula given through a vein provides most
of the nutrients the body needs. The method is used when someone can't or
shouldn't receive feedings or fluids by mouth.
 Is a complete nutrition delivered intravenously to people who can’t use their
digestive systems at all.
Indications for Total Parenteral

Nutrition
 Inadequate absorption resulting from short bowel syndrome
 Gastrointestinal fistula
 Bowel obstruction
 Prolonged bowel rest
 Severe malnutrition, significant weight loss and/or hypoproteinaemia
when enteral therapy is not possible
 Other disease states or conditions in which oral or enteral feeding are not
an option
 Some stages of ulcerative colitis
 Certain pediatric GI disorders (eg, congenital GI anomalies, prolonged
diarrhea regardless of its cause)
 Short bowel syndrome due to surgery
Importance:
Complete or total nutrition is especially important for the growth and
development of infants, children, and teens. If a child does not get all of the
nutrients he or she needs, then he or she may have developmental or growth
delay. This means that he or she would not grow and develop like you would
expect. If your child is not getting proper nutrition, then he or she may not
be as tall or weigh as much as other children of the same age. Infants
especially may not reach developmental milestones like rolling over and
crawling. TPN will help your child get the nutrition he or she needs needs to
grow and develop.
Adults, children, and newborns can all benefit from TPN in certain cases.
Adult patients and children may need TPN when they cannot get proper
nutrition through normal eating or via a tube passed into the stomach. This
may be due to inflammatory bowel diseases like Crohn’s disease or ulcerative
colitis that cause severe diarrhea. It may also be due to short bowel
syndrome after a large part of the small intestine is removed through
surgery, due to a disease of the intestine. TPN is used when an infant is
unable to receive food or liquids by mouth that will be delivered directly to
the stomach. Infants may require TPN if they are sick or born prematurely.
Nursing Responsibilities
Before :
Prior to administration:
 Obtain a complete health history including allergies, drug history, and
possible drug interactions.
 Obtain a complete physical examination.
 Assess for the presence or history of nutritional deficits such as inadequate
oral intake, GI disease, and increased metabolic need.
 Obtain the following laboratory studies: total protein/albumin levels,
creatinine/blood urea nitrogen (BUN), CBC electrolytes, lipid profile, and
serum iron levels.
During :
 Monitor vital signs, observing for signs of infection such as elevated
temperature. (Bacteria may grow in high-glucose and high-protein
solutions.)
 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. (Blood glucose levels may
be affected if TPN is turned off, if the rate is reduced, or if excess levels of
insulin are added to the solution.)
 Monitor for signs of fluid overload. (TPN is a hypertonic solution and can
create intravascular shifting of extracellular fluid.)
 Monitor renal status. (Intake and output ratio, daily weight, and laboratory
studies such as serum creatinine and BUN are used to assess renal
function.)
 Maintain accurate infusion rate with infusion pump, make rate changes
gradually, and never discontinue TPN abruptly. (Abrupt discontinuation
may cause hypoglycemia, and a sudden change in flow rate can cause
fluctuations in blood glucose levels.)
After :
1. Instruct client to report fever, chills, soreness or drainage of the infusion site, cough,
or malaise.
2. Instruct client that infusion site has high risk for infection development; hence, sterile
dressings and aseptic technique with solutions and tubing are needed.
3. Instruct client to report symptoms of:
■ Hyperglycemia (excessive thirst, copious urination, and insatiable hunger).
■ Hypoglycemia (nervousness, irritability, and dizziness).
4. Instruct client to report shortness of breath, heart palpitations, swelling, or decreased
urine output.
5. Instruct client to:
■ Weigh self daily.
■ Monitor intake and output.
■ Report sudden increases in weight or decreased urine output.
■ Keep all appointments for follow-up care and laboratory testing.
6. Instruct client:
■ About the importance of maintaining the prescribed rate of infusion.
■ Never to stop the TPN solution abruptly unless instructed by the healthcare provider.

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Rhenelyn Delos Reyes BSN 3

Total Parenteral Nutrition

Indications for Total Parenteral

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