Question

A nurse is caring for a client who has a prescription for parenteral nutrition. Which of the actions should the nurse take?

Answer 1

TPN - SC right line 2200 ml total volume x 24 hours st 2 rows ③ Amino acid: 458 / liter 15 22 ho a = 459x2.24 = 99 grauss & Ak carxgons = 309keals @ Dextrose 1759 / ulex 210 = 125gx2.2 L = 385 9 x 3.4 kcals/g=1309keals ③ lipid 20% 285 mL over 24 hours. at tuos - 285 mis x 2 = 570 kcalss stoloupe Above will provide 2275 Keal, 99g protein, ④ DIR - (3859 dex/ 70 kg / 1440 min in a day & 1000 Job = 3.8 ing/kg/min. ② LR = (285 mis lipid +20%) / 70kg = 0.8 g/kg/day. t vori Woc) ( ( glucose Monitoring a) check daily electrolytes and adjust TPN/PN elec- trolyte additives accordingly, anotooor by cheek accu-cheek glucose as hoon (regulas insulin oso may be added to TPN/ PPN bag. control as needed) to loco ix Non-odiabetics or NIDDHS start with half of the previous day's sliding scale insulin reg. in TPN/PPN bag and increase daily in the same manner untill target glucose is reached. & lüx IDOM: Start with oil units regular insulin gram si dextrose in TPN/PPN, then in- crease daily by half st-the previous days Sliding scale insulin requirement.

nye cy check triglyceride level within 24 hours of starting TPN/ PPN iy If TG7250-400 mg/au, lipid infusion should be signi- ficantly reduced uy consider adding carne fine , grama daily to TPNL ng Carne fine I gram PPN to improve lipid metabolism. ~ 100g tat per week is needed to prevent esse fatty acid deficiency. dy check LET's weekly- iy If LET's significantly elevated significantly elevated as a result - TPN, as then minimize lipids to Lig/Kdy day and cycle TPN/PPN over 12 hours to rest the liver. üx If Bilirubin > 5-10 mg/de due to hepatic dystanc- tion, then discontinue trace elements due to pote- utial for toxicity of manganese and copper. ex check pre-albunan Weekly- adjust amino acid content of TPN/PPN to reach normal pre albumin 18-35 ng/dL uy Adeguate amino acid provided when there is an increase in pre- albumin eta Ing/dl per day fy Acid Base Balance ix adjust- TPN/PPN anion concentration to maintain Proper Acid Base balance uz Increase / decrease chloride content as needed. ny since bicarbonate is unstable in TPN/PPN Preparation, the Pre cansor - acetate is used adjust acetate content as needed.