Nutrition and

Electrolytes
Insert herbal therapies

UNIT 4
VITAMINS
01 Vitamins
✓ are organic chemicals that are necessary for
normal metabolic functions and for tissue
growth and healing.
✓ The body needs only a small amount of
vitamins daily, which can be obtained
through one’s diet.
✓ A well-balanced diet has all of the vitamins
and minerals needed for body functioning.
 VITAMINS
The Dietary Reference Intakes (DRI) nutrient recommendations include the following:
is the amount determined to be sufficient in the absence of scientific information. The
1. Adequate intake (AI) AI is based on data about the levels of vitamin intake that seem to maintain a healthy
status

2. Estimated average requirement is the amount thought to provide a sufficient intake in one half of healthy persons in a
(EAR) defined group.

is the amount thought to provide the needs of 98% of well children and adults of
3. Recommended dietary allowance
specific age group and gender. RDAs were developed to prevent deficiencies and
(RDA) may not be reflective of all groups, such as older adults.

is the maximum amount considered not likely to be a risk for healthy persons in a
4. Tolerable upper intake level (UL)
specified group. This is not a recommended level to take.

Vitamin deficiencies can cause cellular and organ dysfunction that may result in slow recovery from illness. Vitamin supplements are
necessary for the vitamin deficiencies
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Choose My Plate

MyPlate is an interactive tool

that helps Americans to eat
more healthfully, and the Super
Tracker assists in the planning,
analyzing, and tracking of
nutrition and physical activity.
The National Academy of Sciences Food and
Nutrition Board publishes the U.S. RDA
The U.S Food and Drug Administration (FDA)
requires that all vitamin products be labeled
according to the amount of vitamin content and
the proportion of the RDA provided by the
vitamin product. Individuals should be
encouraged to check the RDA listed on a vitamin
container to determine whether the product
provides the RDA dose requirements.
 Vitamins
01 02
Fat Soluble vitamins Water Soluble vitamins
Vitamins A, D, E, and K • are the B-complex vitamins and vitamin C.
• They are metabolized • This group of vitamins is not usually toxic unless
slowly; taken in extremely excessive amounts.
• can be stored in fatty • Water-soluble vitamins are not stored by the
tissue, liver, and muscle body, so consistent, steady supplementation is
in significant amounts; required.
• and are excreted in the • Water-soluble vitamins are readily excreted in
urine at a slow rate the urine.
• Protein binding of water-soluble vitamins is
minimal.
 Fat Soluble vitamins
Vitamin A Vitamin D
• has a major role in regulating calcium
• is essential for bone growth and the
and phosphorus metabolism and is
maintenance of epithelial tissues, skin, eyes,
needed for calcium absorption from the
and hair. It has been used for the treatment
intestines.
of skin disorders such as acne;
• Dietary vitamin D is absorbed in the
• IM administration is used only in acutely ill
small intestine and requires bile salts
patients or patients refractory to the oral
for absorption.
route, such as those with gastrointestinal (GI)
• There are two compounds of vitamin D:
malabsorption syndrome. The UL for vitamin
1. vitamin D2, ergocalciferol (a synthetic
A is 3000 mcg daily.
fortified vitamin D),
• the vitamin is absorbed faster than when
2. vitamin D3, cholecalciferol (a natural
there is no deficiency or intestinal
form of vitamin D influenced by
obstruction. A portion of vitamin A is stored
ultraviolet sunlight through the skin).
in the liver, and this function can be inhibited
with liver disease
Vitamin A
● Massive doses of vitamin A may cause hypervitaminosis A, symptoms of which
are hair loss, peeling skin, anorexia, abdominal pain, lethargy, nausea, and
vomiting.

● Excess vitamin A is stored in the liver for up to 2 years.

● Vitamin A taken orally begins to take effect in 1 to 2 hours and peaks in 4 to 5

hours

And the most important thing: An early sign of vitamin A deficiency

(hypovitaminosis A) is night blindness. This may progress to dryness and ulceration
of the cornea and to blindness.
Vitamin D
● Once absorbed, vitamin D is converted to calcifediol (also known as 25-
hydroxycholecalciferol) in the liver.

● Calcifediol is then converted to an active form, calcitriol, in the kidneys

● Calcitriol, the active form of vitamin D, functions as a hormone and, with

parathyroid hormone (PTH)

● Calcitonin, regulates calcium and phosphorus metabolism.

● Calcitriol and PTH stimulate bone reabsorption of calcium and phosphorus.

And the most important thing: Excretion of vitamin D is primarily in bile; only a small
amount is excreted in the urine.

Excess vitamin D ingestion (>40,000 international units) results in hypervitaminosis D

and may cause hypercalcemia (an elevated serum calcium level). Anorexia, nausea,
and vomiting are early symptoms of vitamin D toxicity.
 Fat Soluble vitamins
Vitamin E Vitamin K
• has antioxidant properties that protect Vitamin K occurs in four forms.
cellular components from being oxidized and 1. Vitamin K1 (phytonadione) is the most
red blood cells from hemolysis. active form
• Vitamin E depends on bile salts, pancreatic 2. vitamin K2 (menaquinone) is synthesized by
secretion, and fat for its absorption. intestinal flora;
• Vitamin E is stored in all tissues, especially 3. vitamin K3 (menadione) and
the liver, muscle, and fatty tissue. 4. vitamin K4 (menadiol) have been produced
• About 75% of vitamin E is excreted in bile. synthetically.
• It has its antioxidant effects (i.e., it inhibits • Vitamin K2 is not commercially available.
the oxidation of other compounds by Vitamins K1 and K2 are absorbed in the
blocking a group of harmful chemicals called presence of bile salts.
free radicals • Vitamins K3 and K4 do not need bile salts for
• Iron and vitamin E should not be taken absorption.
together because iron can interfere with the
body’s absorption and use of vitamin E.
Vitamin K
● After vitamin K is absorbed, it is stored primarily in the liver and in other tissues.
● Half of vitamin K comes from the intestinal flora, and the remaining portion comes
from one’s diet.
● Vitamin K is needed for synthesis of prothrombin and the clotting factors VII, IX, and X.
● For oral anticoagulant overdose, vitamin K1 (phytonadione) is the only vitamin K form
available for therapeutic use and is most effective in preventing hemorrhage.
● Newborns are vitamin K deficient; thus, a single dose of phytonadione is
recommended immediately after delivery.

And the most important thing: Vitamin K is used for two reasons:
(1) as an antidote for oral anticoagulant overdose and
(2) to prevent and treat the hypoprothrombinemia of vitamin K deficiency
 Water Soluble Vitamins
✓ B vitamins may promote a Vitamin B Complex
sense of well-being and
Four of the vitamin B-complex members:
increased energy as well as
1. Vitamin B1 (thiamine)
decreased anger, tension, and
2. vitamin B2 (riboflavin)
irritability.
3. vitamin B3 (nicotinic acid, or niacin)
✓ Citrus fruits and green
4. vitamin B6 (pyridoxine)
vegetables are high in vitamin
C.
It is a common group of vitamins administered in the clinical
✓ If the fruits and vegetables are
setting, especially to patients with alcoholism.
cut or cooked, a large amount
of vitamin C is lost.
Thiamine deficiency can lead to the polyneuritis and cardiac
pathology seen in beriberi or to Wernicke’s encephalopathy
that progresses to Korsakoff’s syndrome, conditions most
commonly associated with alcohol abuse.
 Water Soluble Vitamins
Vitamin B Complex
❑ Thiamine must be given before giving any glucose to avoid aggravation of symptoms.
❑ Riboflavin may be given to manage dermatologic problems such as scaly dermatitis, cracked corners of the mouth,
and inflammation of the skin and tongue. To treat migraine headache, riboflavin is given in larger doses than for
dermatologic concerns
❑ Niacin is given to alleviate pellagra and hyperlipidemia, for which large doses are required. Also use to reduce
cholesterol levels.
❑ Pyridoxine is administered to correct vitamin B6 deficiency. It may also help alleviate the symptoms of neuritis
caused by isoniazid (INH) therapy for tuberculosis. Vitamin B6 is an essential building block of nucleic acids, red
blood cell formation, and synthesis of hemoglobin. Pyridoxine is used to treat vitamin B6 deficiency caused by lack
of adequate diet, inborn errors of metabolism, or drug-induced deficiencies secondary to INH, penicillamine, or
cyclosporine (or hydralazine) therapy. It is also used to treat neonates with seizures refractive to traditional
therapy.
❑ Pyridoxine is readily absorbed in the jejunum and stored in the liver, muscle, and brain. It is metabolized in the
liver and excreted in the urine.
 Vitamin C
(ascorbic acid)
o is absorbed from the small intestine.
o Vitamin C aids in the absorption of iron and in the conversion of folic acid.
o Vitamin C is not stored in the body and is excreted readily in the urine.
o A high serum vitamin C level that results from excessive dosing of vitamin C is excreted by the
kidneys unchanged.
o The recommended daily dose of vitamin C for an adult is 50 to 100 mg/day.
Pharmacodynamics Vitamin C is needed for
Pharmacokinetics Vitamin C is absorbed readily
carbohydrate metabolism and protein and lipid
through the GI tract and is distributed throughout the
synthesis. Collagen synthesis also requires vitamin C
body fluids. The kidneys completely excrete vitamin C,
for capillary endothelium, connective tissue and tissue
mostly unchanged.
repair, and osteoid tissue of the bone.

Excessive doses of vitamin C can cause a false-

negative occult (blood) stool result and false-positive
sugar result in the urine when tested by the Clinitest
method.
 Vitamin B12
▪ is essential for DNA synthesis.
▪ Vitamin B12 aids in the conversion of folic acid to its active form.
▪ With active folic acid, vitamin B12 promotes cellular division.
▪ It is also needed for normal hematopoiesis (development of red blood cells in bone marrow) and to
maintain nervous system integrity, especially the myelin.
▪ The gastric parietal cells produce an intrinsic factor that is necessary for the absorption of vitamin
B12 through the intestinal wall.
▪ Without the intrinsic factor, little or no vitamin B12 is absorbed. After absorption, vitamin B12 binds
to the protein transcobalamin II and is transferred to the tissues. Most vitamin B12 is stored in the
liver.
▪ Vitamin B12 is slowly excreted, and it can take 2 to 3 years for stored vitamin B12 to be depleted
and a deficit noticed.
▪ Vitamin B12 deficiency is uncommon unless there is a disturbance of the intrinsic factor and
intestinal absorption.
▪ Pernicious anemia (lack of the intrinsic factor) is the major cause of vitamin B12 deficiency.
▪ Vitamin B12 deficiency can also develop in strict vegetarians who do not consume meat, fish, or
dairy products.
Vitamin B12 Deficiency
● B12 deficiency is commonly seen with metformin and proton pump inhibitors (e.g.,
omeprazole).
● Symptoms may include numbness and tingling in the lower extremities, weakness, fatigue,
anorexia, loss of taste, diarrhea, memory loss, mood changes, dementia, psychosis,
megaloblastic anemia with macrocytes (over enlarged erythrocytes [red blood cells]) in the
blood, and megaloblasts (over enlarged erythroblasts) in the bone marrow.
● To correct vitamin B12 deficiency, cyanocobalamin in crystalline form can be given
intramuscularly for severe deficits.
● It cannot be given intravenously because of possible hypersensitive reactions. Cyanocobalamin
can be given orally and is commonly found in multivitamin preparations.
● It can also be given as a subcutaneous injection.
Nursing Process Patient-Centered Collaborative
Care Vitamins
ASSESSMENT DIAGNOSIS PLANNING
■ Check patient for vitamin ■ Imbalanced nutrition
deficiency before start of
■ Patient will eat a well- related to inadequate intake
therapy and regularly
balanced diet. of food sources of vitamins
thereafter.

■ Patient with vitamin

■ Deficient knowledge
■ Obtain 24- and 48-hour deficiency will take vitamin
related to food sources of
diet history analysis supplements as
prescribed. vitamins

■ Readiness for enhanced

■ Patient will demonstrate
decision making related to food
knowledge of food
choices and vitamin
sources of vitamins
supplementation
 Nursing Process
Intervention
■ Storedrug in light-resistant container.
■ Use the supplied calibrated dropper for accurate dosing when
administering vitamins in drop form. Solution may be administered
mixed with food or dropped into the mouth.
■ Administer IM primarily for patients unable to take by PO route (e.g.,
GI malabsorption syndrome).
■ Recognize need for vitamin E supplements for infants receiving vitamin
A to avoid risk of hemolytic anemia.
■ Monitor for vitamin A therapeutic serum levels (80 to 300 international
units/mL)
■ Alert patient not to take megadoses of vitamin C with aspirin or
sulfonamides because crystals may form in the kidneys and urine.
■ Alert patient to avoid excessive intake of alcoholic beverages. Alcohol
can cause vitamin B-complex deficiencies
 02
MINERALS
iron, copper, zinc, chromium, and selenium,
are needed for body function
 Essential minerals

Iron Iron Iron

Iron (ferrous sulfate, One of the causes of anemia
Food and antacids slow the
gluconate, or fumarate) is is iron deficiency.
absorption of iron, and
vital for hemoglobin A normal diet contains 5 to
vitamin C increases iron
regeneration. 20 mg of iron per day.
absorption.
Sixty percent of the iron in Foods rich in iron include
the body is found in liver, lean meats, egg yolks,
The dose of iron for infants
hemoglobin. dried beans, green
and children 6 months to 2
vegetables (e.g., spinach),
years of age is 1.5 mg/kg of
Therefore one tablet of and fruit.
body weight. For the adult,
ferrous sulfate is sufficient as
50 mg/ day is needed for
a daily iron dose when
hemoglobin regeneration.
indicated.
Pharmacodynamics
The onset of action for iron therapy takes days, and its peak action does not occur for days or
weeks; therefore the patient’s symptoms are slow to improve.

Increased hemoglobin and hematocrit levels occur within 3 to 7 days.

Iron toxicity is a serious cause of poisoning in children. As few as 10 tablets of ferrous sulfate
(3 g) taken at one time can be fatal within 12 to 48 hours. Hemorrhage due to the ulcerogenic
effects of unbound iron leads to shock. Parents should be cautioned against leaving iron
tablets that look like candy
 COPPER
❖ Copper is needed for the formation of RBCs and connective tissues.
❖ a cofactor of many enzymes, and its function is in the production of the neurotransmitters
norepinephrine and dopamine.
❖ Excess serum copper levels may be associated with Wilson’s disease, which is an inborn error of
metabolism that allows for large amounts of copper to accumulate in the liver, brain, cornea
(brown or green Kayser Fleischer rings), or kidneys.
❖ A prolonged copper deficiency may result in anemia, which is not corrected by taking iron
supplements. Abnormal blood and skin changes caused by a copper deficiency include a decrease in
white blood cell count, glucose intolerance, and a decrease in skin and hair pigmentation.
❖ Mental retardation may also occur in the young.
❖ The RDA for copper is 1.5 to 3 mg/day. Most adults consume about 1 mg/day.
❖ Foods rich in copper are shellfish (crab, oysters), liver, nuts, seeds (sunflower, sesame), legumes,
and cocoa
 Zinc
Zinc is important to many enzymatic reactions and is essential for
normal growth and tissue repair, wound healing, and taste and smell.
The use of zinc has greatly increased in the past few years; some
believe zinc can alleviate symptoms of the common cold and shorten
its duration. Individuals may take as much as 200 mg/day. The adult
RDA is 12 to 19 mg/ day. Foods rich in zinc include beef, lamb, eggs,
and leafy and root vegetables.

✓ Patients taking zinc and an

antibiotic should not take them
together;
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✓ zinc should be taken at least 2
hours after taking an antibiotic.
 Chromium
● helpful in the control of type 2 diabetes (non–insulin-dependent
diabetes).
● It is thought that this mineral helps to normalize blood glucose
by increasing the effects of insulin on the cells.
● If a patient is taking large doses of chromium and an oral
hypoglycemic agent or insulin, the glucose level should be
monitored closely for a hypoglycemic reaction
● chromium claims to promote weight loss and muscle building.
Multivitamin and mineral preparations contain chloride salt of
chromium.
● There is no RDA for chromium; however, 50 to 200 mcg/ day is
considered within the normal range for adults and children older
than 6 years of age.
● Foods rich in chromium include meats, whole-grain cereals, and
brewer’s yeast.
 Selenium
Selenium acts as a cofactor for an antioxidant enzyme that protects protein
and nucleic acids from oxidative damage.

Selenium works with vitamin E. It is thought that selenium has an

anticarcinogenic effect, and doses lower than 200 mcg may reduce the risk
of lung, prostate, and colorectal cancer.

Excess doses of more than 200 mcg might cause weakness, hair loss,
dermatitis, nausea, diarrhea, and abdominal pain. Also, there may be a
garlic-like odor from the skin and breath.

the RDA for selenium is 40 to 75 mcg (lower dose for women, higher dose
for men).

Foods rich in selenium include meats (especially liver), seafood, eggs, and
dairy products.
 Nursing Process
Patient-Centered Collaborative Care
Antianemia, Mineral: Iron
ASSESSMENT
■ Obtain a history of anemia or health problems that may
lead to anemia.
■ Assess patient for signs and symptoms of iron-deficiency
anemia, such as fatigue, malaise, pallor, shortness of breath,
tachycardia, and cardiac dysrhythmia.
■ Assess the patient’s RBC count, hemoglobin, hematocrit,
iron level, and reticulocyte count before the start of and
throughout therapy
 ■ Imbalanced nutrition related to
NURSING inadequate intake of food sources of iron
■ Deficient knowledge of food sources of
DIAGNOSIS iron
■ Readiness for enhanced decision
making related to food choices and
vitamin/mineral supplementation
■ Patient will name at least six foods
high in iron content.
■ Patient will consume foods rich in
iron.
■ Patient with iron-deficiency anemia
or with low hemoglobin will take iron
replacement as recommended by
PLANNING
health care provider, resulting in
laboratory results within the desired
range.
 INTERVENTION

■ Store drug in light-resistant container.

■ Administer IM injection of iron by the Z-track method to avoid leakage
of iron into the subcutaneous tissue and skin, resulting in irritation and
stains to the skin.
■ Advise patient to take the tablet or capsule between meals with at least
8 ounces of juice or water to promote absorption. If gastric irritation
occurs, instruct the patient to take with food.
■ Advise patient to swallow the tablet or capsule whole.
 NURSING INTERVENTION
1 ■ Encourage patient to maintain upright position for 30 minutes after taking oral iron
preparation to prevent esophageal corrosion from reflux.

■ Do not administer the iron tablet within 1 hour of ingesting antacid, milk, ice
2 cream, or other milk products.

■ Advise patient to increase fluids, activity, and dietary bulk to avoid or relieve constipation.
3 Slow-release iron capsules decrease constipation and gastric irritation.

■ Encourage patient to take only the prescribed amount of drug to avoid iron poisoning. Be
alert to iron in many multivitamin preparations.

4 ■ Be alert that iron content varies among iron salts; therefore do not substitute one for
another
Nutritional Support
 There are two routes for administering
nutritional support:
1. Enteral nutrition, which involves the GI tract, can be given orally or by feeding tubes (tube feeding).
If the patient can swallow, nutrient preparations can be taken by mouth;
if the patient is unable to swallow, a tube is inserted into the stomach or small intestine.

2. Parenteral nutrition involves administering high-caloric nutrients through large veins, for example, the
subclavian vein.
This method is called total parenteral nutrition (TPN), hyperalimentation (HA), or intravenous
hyperalimentation (IVH).

Parenteral nutrition is more costly (approximately three

times more expensive) than enteral nutrition, and the
benefits are not significant.
 Routes for Enteral Feedings

The three groups of solutions for enteral nutrition

are:

1. blenderized
2. polymeric (milk-based and lactose-free)
3. and elemental or monomeric.
 Components of the enteral solutions include:
(1) carbohydrates in the form of dextrose, sucrose, lactose, starch, or dextrin (the first three are simple
sugars that can be absorbed quickly);
(2) protein in the form of intact proteins, hydrolyzed proteins, or free amino acids; and
(3) fat in the form of corn oil, soybean oil, or safflower oil (some have a higher oil content than others).
With all enteral nutrition, sufficient water to maintain hydration is essential.
Methods for Delivery
1. The bolus method was the first method used to deliver enteral feedings. With the bolus method, 250
to 400 mL of solution is rapidly administered through a syringe or funnel into the tube four to six times a
day. This method takes about 10 minutes each feeding, and may not be tolerated well by the patient
because a massive volume of solution is given in a short period.

2. Intermittent enteral feedings are administered every 3 to 6 hours over 30 to 60

minutes by gravity drip or pump infusion. At each feeding, 300 to 400 mL of solution is
usually given. A feeding bag is commonly used.
 Methods for Delivery cont.

3. Intermittent infusion is considered an inexpensive method for administering

enteral nutrition.

4. Continuous feedings are prescribed for the critically ill or for those who receive feedings into the
small intestine. The enteral feedings are given by an infusion pump such as the Kangaroo set to
control the flow at a slow rate over 24 hours. Approximately 50 to 125 mL of solution is infused per
hour.

5. The cyclic method is another type of continuous feeding that is infused over 8 to 16 hours daily
(day or night).Administration during daytime hours is suggested for patients who are restless or for
those who have a greater risk for aspiration. The nighttime schedule allows more freedom during the
day for patients who are ambulatory.
Complications
1. Dehydration can occur if an insufficient amount of water is
given with or between feedings.

2. Aspiration pneumonitis is the major complication of enteral

nutrition and may occur if the patient is fed while lying down or
is unconscious. The head of the bed should be elevated at
least 30 to 45 degrees. The nurse should check for gastric
residual by gently aspirating the stomach contents before
administering the next enteral feeding and every 4 hours
minimum between feedings.

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Complications

3. One of the major problems of enteral feeding is diarrhea.

This could be caused by rapid administration of feeding, high
caloric solutions, malnutrition, GI bacteria (Clostridium
difficile), and drugs

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 The American Society for Parenteral and Enteral Nutrition (ASPEN)

Enteral Safety initiated the Be A.L.E.R.T. campaign to promote safe tube feeding:

Aseptic technique:
Right patient, right formula, right
For preparation and delivery of enteral formula, practice
good hand-washing technique, wear gloves when tube:
handling feeding tube, and avoid touching can tops,
Match the formula and rate to the patient’s feeding order; verify
container openings, spike, and spike port.
enteral tubing set; connect formula container to feeding tube.
Label enteral equipment:
Label with patient name (and location), formula name
and rate, date and time of initiation, and nurse’s Trace all lines and tubing back to
initials. Equipment is changed every 24 hours;
ensure that new equipment is labeled.
patient:
avoid misconnections; trace all lines from origin to patient;

Elevate head of bed at least 30 only enteral to-enteral connections.

degrees:
Elevate when clinically possible, as it may mitigate the risk of reflux and
aspiration of gastric content.
Enteral Medications
Most drugs that can be administered orally can also be given via enteral tube.
• The drug must be in liquid form or dissolved into a liquid.
• Drugs that cannot be dissolved are time-release forms, enteric-coated forms, sublingual
forms, and bulk-forming laxatives.
• Liquid medication should be diluted with water to reduce the osmolality to 500 mOsm/kg
H2O (mildly hypertonic) and thus decrease GI intolerance.
• It is essential to know the importance of temporarily stopping the infusion when certain
types of medications are administered. Some medications require that the feeding be
stopped for as long as 30 minutes to allow for adequate absorption.
 NURSING INTERVENTION
■ Check tube placement by aspirating gastric secretion or injecting air into tube to listen by stethoscope for
1 air movement in the stomach. (However, injecting air to check for placement may be misleading, because
the tube may be in the base of the lung and air flow there produces similar sounds as when the tube is
placed in the stomach.) For placement of the tube for small intestine route, confirmation by x-ray may be
needed.

2 ■ Determine gastric residual before enteral feeding. A residual of more than 50% of previous feeding
indicates delayed gastric emptying. Notify health care provider. Usual residual is 0 to 100 mL.

■ Raise head of bed to a 30- to 45-degree angle at all times during infusion of tube feedings. If elevating
head of bed is contraindicated, then position patient on right side.

3 ■ Flush feeding tube accordingly: intermittent feeding, 30 mL before and after; continuous feeding, every 4
hours; medications, 30 mL before and after. If tube obstruction occurs, flush with warm water or cola.

■ Change feeding bag daily. Do not add new solution to old solution in feeding bag. Nutritional solution
4 should be room temperature.
 PARENTERAL NUTRITION
1.Total Parenteral Nutrition TPN is the primary method for providing complete nutrients by the
parenteral or IV route.

TPN is an infusion of hyperosmolar glucose, amino acids, vitamins, electrolytes, minerals, and trace
elements; it can meet a patient’s total nutritional needs.

The nurse must be familiar with the specific

equipment used in caring for the patient on TPN. A
variety of “setups” are available for administration.

Some tubings have antireflux valves, and others

have clamps. Each has implications for the
administration of medications. Parenteral
preparations must be administered by infusion
pump to ensure accurate flow rate.
 NURSING INTERVENTION
■ Refrigerate TPN solution that is not in use. High glucose concentration is an excellent
1 medium for bacterial growth.
■ Hang dextrose 10% if TPN finishes before the next time it is to be administered.

■ Have patient perform Valsalva maneuver (taking deep breath, holding it, and bearing
2 down) in the absence of clamp to close tubing completely during solution bag/tubing
change to prevent air embolus. Valsalva maneuver may cause dysrhythmias, so
monitor cardiac status.
■ Check for signs and symptoms of overhydration: coughing, dyspnea, neck vein
3 engorgement, or chest rales. Report findings.

Parenteral nutrition is typically discontinued when about

4 75% to 80% of a patient’s nutritional needs are being
met through enteral feeding.
Thank you
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