NCM 107 | Nutrition and Diet Therapy (LAB)---- 1

Therapeutic Nutrition (TN) C. Light Diet

 TN- It’s rapport that is being used to identify anything  transitional (intermediate) diet between the soft and
that will be use in the treatment of the patients the regular diet, contains easily digested foods
 Diet Therapy is concerned with the nutrition of all D. Liquid Diet
clients receiving normal diets as well as those whose  consist of foods that will pour or are liquid at room
modified diet has been prescribed. temperature
 Therapeutic Nutrition is the study wherein food is Indications: Patients in the febrile state, post-operative, or
utilized as an agent in affecting recovery or bringing when the patient is unable to tolerate solid foods
good health through the use of therapeutic diets. - TYPES OF LIQUID DIET
1. Clear liquid diet – made up of clear liquid foods which
Purpose of diet therapy leave no residue in the GIT
1. Maintain good nutrition status Indications:
2. Current deficiencies that may have occurred a) A clear liquid diet serves a primary function of
3. Afford rest to the whole body or to certain organs that providing fluids and electrolytes to prevent
may have been affected. dehydration.
4. Adjust the food intake to the body’s ability to b) The diet is used as an initial feeding after complete
metabolize to nutrients bowel rest.
Considerations in the modification of the normal c) The diet is used initially to feed a malnourished
diet person or a person who has not had any oral intake
1. Normal requirement and allowance for the patient for some time
based on the RDA for Filipinos guide to good nutrition d) The diet also is used for bowel preparation for
and food exchange list surgery or tests.
2. Pathophysiology of the disease process e) The diet is a postoperative diet.
3. Duration of the disease f) A clear liquid diet is used in cases of diarrhea.
4. Previous nutritive of the patient Nursing considerations
5. Socioeconomic, religious factors & others a) Clear liquid is deficient in energy and most nutrients.
6. Tolerance to food b) The body digests and absorbs clear liquids easily.
7. Dietary factors to be altered c) Clear liquid contributes to little or no residue in the
gastrointenstinal tract.
Standard hospital diet d) Clear liquid can be unappetizing and boring.
A. Regular diet e) Client should not stay on a clear liquid diet for more
 nearly normal diet based on the basic food groups than a day or two.
Indications: ambulatory or bed patients whose f) Clear liquid consists of foods that are relatively
conditions do not necessitate a modified diet transparent to light and are clear and liquid at room
B. Soft Diet and body temperature.
 very similar to the regular diet except that the g) Foods include items such as water, bouillon, clear
texture of the foods has been modified broth, carbonated beverages, gelatin, hard candy,
1. Indications lemonade, popcicles, and regular or decaffeinated
a) A soft diet is used for clients with dental problems, coffee or tea.
clients with poor-fitting dentures, and clients who have h) The nurse should limit the amount of caffeine
difficulty chewing or swallowing. consumed by the client because caffeine can cause an
b) The diet is used for clients who have ulcerations of the upset stomach and sleeplessness.
mouth or gums, oral surgery, a broken jaw, plastic i) The client may have salt or sugar.
surgery of the head or neck, dysphagia, or for the j) Dairy products are not allowed.
client who had a stroke.
c) The diet is therapeutic for clients with impaired 2. Full liquid diet – contains all foods in the clear liquid diet
digestion or absorption as a result of conditions such with the addition of more nutritious foods
as ulcerative colitis and Crohn’s disease Indication:
a) full liquid diet may be used as a second diet after
clear liquids following surgery or for a client who is
unable to chew or swallow solid foods.
 b) Acutely ill Nursing considerations
c) Lesions in the mouth a) Bland foods are less likely to form gas than regular
d) Fever and infection diets.
Nursing considerations b) Eliminate foods that stimulate gastric acid secretions.
a. A full liquid diet is nutritionally deficient in energy c) Eliminate foods that are irritating to the gastric
and most nutrients. mucosa.
b. The diet includes clear and opaque liquid foods and d) Foods to be avoided include alcohol; caffeine and
those that liquefy at body temperature. caffeine-containing beverages such as cola, cocoa,
c. Foods include all clear liquids and items such as plain coffee, and tea; fried foods; pepper and spicy foods.
ice cream, sherbet, breakfast drinks, milk, pudding
and custard, soups that are strained, and strained F. Residue Restricted Diet –
vegetable juices. Includes foods which are
easily digestible and almost
3. Cold Liquid Diet – all foods are served cold and iced completely absorbed, leaving
Indications: a minimum amount of residue in the GIT
a) post tonsillectomy Types:
b) Dental extraction 1. Minimum residue diet – restricted in allowance of fruits
c) Other minor operations of the mouth and throat and vegetables that are very low in fiber
Foods avoided – sharp and sour fruit juices and hot soups Indications: diarrhea, post-hemorroidectomy, ulcerative
Nursing considerations colitis
a) Clients with mouth sores should be served foods at 2. Low-residue/low-fiber diet – more liberal than the
cooler temperatures. minimum residue diet. It allows low-fibered vegetables &
b) Clients who have difficulty chewing and swallowing fruits up to 2 cups of whole or skimmed milk
because of a reduced flow of saliva can increase 1. Indications
salivary flow by sucking on sour candy. a. The diet supplies foods that are least likely to form
c) Encourage the client to eat a variety of foods. an obstruction when the intestinal tract is narrowed
d) THERAPEUTIC DIETS by inflammation or scarring or when gastrointestinal
e) Provide plenty of fluids with meals to ease chewing motility is slowed.
and swallowing of foods.  The diet is used for inflammatory bowel disease,
f) Sucking fluids through a straw may be easier than partial obstruction of the intestinal tract, enteritis,
drinking them from a cup or glass. diarrhea, or other gastrointestinal disorders.
g) All foods and seasonings are permitted; however,  THERAPEUTIC DIETS
liquid, chopped, or pureed foods or regular foods 2. Nursing considerations
with a soft consistency are best tolerated. a. Foods high in carbohydrate are usually low in
h) THERAPEUTIC DIETS residue and include white bread, cereals, and pasta.
i) Avoid foods than contain nuts or seeds, which easily b. Foods to be avoided are raw fruits (except bananas),
can become trapped in the mouth and cause vegetables, seeds, plant fiber, and whole grains.
discomfort. c. Dairy products are limited to two servings a day.
j) Avoid raw fruits and  THERAPEUTIC DIETS
a. vegetables, fried foods, and 3. High-residue/high-fiber diet
b. whole grains. 1. Indications
a. The diet is used for clients who have constipation.
E. Bland diet b. The diet is used for irritable bowel syndrome when
 a progression of diets made up of foods which do the primary symptom is alternating constipation and
not unduly increase gastric acid production & are diarrhea and for asymptomatic diverticular disease.
non-irritating to the GIT. c. The diet helps regulate blood glucose in clients with
Indication: A bland diet may be prescribed for the client diabetes mellitus.
with gastritis, ulcers, reflux, esophagitis, or other d. The diet helps control blood cholesterol in
gastrointestinal disorders, congestive heart failure, or clients with heart disease
myocardial infarction.  THERAPEUTIC DIETS
2. Nursing considerations
 a. The diet provides 20 to 25 g of dietary fiber daily. cirrhosis of the liver require a sodium-restriction
b. The diet adds volume and weight to the stool and diet.
speeds the movement of undigested material 2. Nursing considerations
through the intestine. a. This type of diet includes 2000 to 4000 mg of sodium
c. The diet consists of fruits and vegetables and whole daily (mild restriction), 1000 mg of sodium daily
grain products. (moderate restriction), or 500 mg of sodium daily
 THERAPEUTIC DIETS (strict and seldom prescribed).
G. Fat-controlled diet b. Cereals allowed on a sodium-restricted diet include
1. Indications dried or instant cereals, puffed wheat, puffed rice,
a. The fat-controlled diet is indicated for and shredded wheat.
atherosclerosis, diabetes mellitus, hyperlipidemia,  THERAPEUTIC DIETS
hypertension, myocardinal infraction, nephrotic Sodium-Free Spices and Flavorings
syndrome, and renal failure. Allspice
b. The diet reduces the risk of heart disease. Almond extract
 THERAPEUTIC DIETS Bay leaves
2. Nursing considerations: Limit the total amount of Caraway seeds
fats and amounts of polyunsaturated, Cinnamon
monounsaturated, and saturated fats and Curry powder
cholesterol. Garlic powder or garlic
G. Low Calorie Diet – has an energy value below the required Ginger
for the maintenance in order to bring about weight Lemon extract
reduction. Maple extract
 Indications : weight reduction in obesity, overweight, Marjoram
cardiac disease, cardiovascular diseases, Mustard powder
hypertensive, arthritic or diabetic individuals Nutmeg
 THERAPEUTIC DIETS  THERAPEUTIC DIETS
H. High-calorie diet – allows foods and drinks which J. Protein-restriction diet
energy value of 50-100% above requirement 1. Indications: Persons with acute renal failure, chronic
1. Indications: Persons with severe stress, burns, renal disease, cirrhosis of the liver, and hepatic coma
cancer, human immunodeficiency virus infections, require a
acquired immunodeficiency syndrome, chronic protein-restriction diet.
obstructive pulmonary disease, respiratory failure,  THERAPEUTIC DIETS
or any other type of debilitating disease 2. Nursing considerations
require a high-calorie diet. a. Provide enough protein to maintain nutritional
 THERAPEUTIC DIETS status but not an amount that will allow the buildup
2. Nursing considerations of waste products from protein metabolism (40-60 g
a. The high-calorie diet also should be high in protein of protein daily).
because the purpose of the diet is to build or b. The smaller the amount of protein allowed, the
maintain lean body mass. more important it becomes that all protein included
b. Add fats to foods whenever possible. in the diet be of high quality.
c. Add nuts and dried fruits such as raisins to desserts  THERAPEUTIC DIETS
or cereals if the client can tolerate and eat these c. An adequate total energy intake from foods is critical
foods. for clients on protein-restricted diets (protein will be
 THERAPEUTIC DIETS used for energy, rather than for protein synthesis).
d. Add sugar to food, and provide high-calorie desserts. d. Special low-protein products, such as pastas, bread,
e. Encourage snacks between meals, such as milk- cookies, wafers, and gelatin made with wheat starch,
shakes and instant breakfasts. can improve energy intake and add variety to the
 THERAPEUTIC DIETS diet.
I. Sodium-restriction diet e. Carbohydrates in powdered or liquid forms also can
1. Indications: Persons with hypertension, congestive provide additional energy.
heart failure, kidney diseases, cardiac diseases, and  THERAPEUTIC DIETS
f. Vegetables and fruits contain some protein, and for b. The diet includes organ meats, meat, egg yolks,
very low-protein diets, these foods must be whole wheat products, leafy vegetables, dried fruit,
calculated into the diet. legumes.
g. Foods are limited from the milk, meat, bread, and  THERAPEUTIC DIETS
starch exchange. P. Diet for diverticular disease
 THERAPEUTIC DIETS 1. Symptomatic diverticulitis: The client avoids fiber
K. High-protein diet because a high-fiber diet is irritating to the bowel.
1. Indications: High-protein diets are for tissue building, 2. Asymptomatic diverticular disease: the client
burns, liver disease, and older clients. consumes a high-fiber diet to prevent constipation.
2. Nursing considerations 3. The client should maintain a liberal fluid intake of
a. High-protein diets correct protein loss or assist with 2500 to 3000 mL/day, unless contraindicated.
tissue repair.  THERAPEUTIC DIETS
b. Increase foods such as meat, fish, fowl, and dairy 4. The client should avoid seeds and nuts because they
products. become trapped in the diverticula and cause
c. The client may need protein supplements. irritation.
 THERAPEUTIC DIETS 5. The client should avoid gas-forming foods
L. Low-calcium diet  THERAPEUTIC DIETS
1. Indication: A low-calcium diet may be prescribed to Gas-Forming Foods
prevent renal calculi in the client at risk for forming Apples Figs
calculi composed of calcium. Artichokes Honey
2. Nursing considerations: Decrease the total intake of Barley Melons
calcium to prevent further stone formation; avoid Beans Milk
whole grains, milk and dairy products, and green, Bran Molasses
leafy vegetables. Broccoli Nuts
 THERAPEUTIC DIETS Brussels sprouts Onions
M. High-calcium diet Cabbage Radishes
1. Indications: Calcium is needed during bone growth Celery Soybeans
and in adulthood to prevent osteoporosis. Cherries Wheat
2. Nursing considerations Coconuts Yeast
a. Primary dietary sources of calcium are dairy Eggplant
products  THERAPEUTIC DIETS
b. Clients experiencing lactose intolerance need to Q. Fluid restriction
incorporate sources of calcium other than dairy 1. Indications: Acute renal failure-oliguric phase,
products into their dietary patterns regularly. chronic renal disease, cirrhosis of the liver,
 THERAPEUTIC DIETS congestive heart failure and other cardiac disorders,
N. Low-purine diet and hepatic coma require fluid restriction.
1. Indication: the diet is used to treat gout. 2. Nursing considerations: Usually this diet restricts
2. Nursing considerations those foods that are composed largely of water,
a. Purine is a precursor for uric acid that forms stones such as carbonated beverages, coffee, juices, milk,
and crystals. tea, water, frozen yogurt, gelatin, ice cream, ice milk,
b. The client needs to avoid consuming fish such as Popsicles, sherbet, soup, cream, and liquid
anchovies, herring, mackerel, sardines, and scallops. medications.
c. The client needs to avoid consuming glandular  THERAPEUTIC DIETS
meats, gravies, meat extracts, will game, goose, and Measures to Relieve Thirst
sweetbreads. Chew gum or suck hard candy.
 THERAPEUTIC DIETS Freeze fluids so they take longer to consume.
O. High-iron diet Add lemon juice to water to make it more refreshing.
1. Indication: the diet is used for clients with anemia. Gargle with refrigerated mouthwash.
2. Nursing considerations  THERAPEUTIC DIETS
a. The high-iron diet replaces iron deficit from R. Carbohydrate-controlled diet
inadequate intake or loss. 1. Indications
 a. The diet helps maintain normal glucose levels in 1. Enteral nutrition is necessary when the
clients with disorders that cause blood glucose levels gastrointestinal tract is functional but oral intake is
to rise or fall abnormally. not feasible.
b. The diet is used for client with diabetes mellitus, 2. Enteral nutrition is used for clients with swallowing
hypoglycemia, lactose intolerance, galactosemia, problems, burns, major trauma, liver failure, or
dumping syndrome, and obesity. severe malnutrition.
 THERAPEUTIC DIETS  It is required if sufficient oral intake of food and
2. Nursing considerations: Exchange System for Meal supplemental formula is not possible but the
Planning gastrointestinal tract is functioning.
a. The Exchange System for Meal Planning, developed Preparations :
by the American Dietetic Association and the A. 1. Standard tube feeding – based largely on milk, sugar
American Diabetes Association, is a food guide used and soft-cooked eggs
to control diabetes mellitus and manage weight. 2. blenderized tube feeding – includes foods normally
b. The Exchange System groups foods according to the included in soft diet which can be blenderized easily.
amounts of the carbohydrates, fats, and proteins 3. Gastrostomy – if NGT and esphagostomy is not allowed.
they contain. Tube is placed towards stomach.
 THERAPEUTIC DIETS Indication :
c. Major food groups include carbohydrate group, - patient is not at risk of aspiration
meat and meat substitute group, and fat group. - Cardiac sphincter is functioning normally
S. Miscellaneous diets 4. Jejunostomy – opening is made on the duodenum. Tube
 VEGETARIAN DIETS extends from duodenum to jejunum.
A. Types Indication :
LACTO-OVO VEGETARIANS - Patient is at risk of aspiration
Diet consists of plant foods with dairy products and  Parenteral Nutrition
eggs. Persons may consume fish and occasionally poultry.  It refers to the special feeding method of infusing
VEGANS predigested nutrients directly into the blood
Persons follow a strict vegetarian diet and use no circulation through certain veins when the
animal foods. gastrointestinal tract cannot be used.
Food patter consists entirely of plant foods.  Partial Parenteral Nutrition (PPN)/Peripheral Vein
 VEGETARIAN DIETS Feeding
B. Nursing considerations - The use of a smaller peripheral vein, usually in the arm, to
1. Ensure that the client eats a sufficient amount of deliver less concentrated solutions for brief periods (not less
varied foods to meet normal nutrient and energy more than 10 days)
needs.  Indications
2. Protein intake can be increased by consumption of a - Patients with normal renal function who need only
variety of vegetable protein sources based on whole short term nutritional support
grains, legumes, seeds, nuts, and vegetables - Supplement to oral feeding
combined to provide all the essential amino acids. - When inserting IV catheter into a central vein is
3. Adequate energy intakes are important to ensure difficult
that dietary protein is used for protein synthesis.  Total Parenteral Nutrition (TPN)/Intravenous
 VEGETARIAN DIETS Hyperalimentation (IVN)
C. Nursing considerations  The use of a large central vein, usually the subclavian
1. Clients with lactose intolerance need to be placed on vein leading directly into the rapid blood flow of the
lactose-free formulas. superior vena cava to the heart, to deliver
Nutritional Support concentrated solutions that supply full nutritional
 ENTERAL NUTRITION support for longer periods (more than 5-7 days)
A. Description: Enteral nutrition/ Tube feeding  TOTAL PARENTERAL NUTRITION/INTRAVENOUS
provides liquefied foods into gastrointestinal tract HYPERALIMENTATION
via a tube.
B. Indications A. Description
1. Total parenteral nutrition supplies necessary 9. Heparin may be added to reduce the buildup of a
nutrients via the veins. fibrinous clot at the catheter tip.
2. Total parenteral nutrition supplies carbohydrates in  INTRAVENOUS SITES
the form of dextrose, fats in special emulsified form, A. Central parenteral nutrition (CPN)
proteins in the form of amino acids, vitamins, 1. For central parenteral nutrition, TPN is administered
minerals, and water. through a central venous access when the client
3. Total parenteral nutrition prevents subcutaneous requires a larger concentration of carbohydrates
fat and muscle protein from being catabolized by the (greater than 10% glucose)
body for energy. 2. The subclavian or internal jugular veins are used
 TOTAL PARENTERAL NUTRITION when TPN is a short-term intervention (less than 4
B. Indications weeks).
1. Clients whose gastrointestinal tracts are severely 3. When TPN is anticipated for an extended period
dysfunctional and are unable to process nutrients (greater than 4 weeks), a more permanent catheter,
normally require TPN. such as a peripherally inserted central catheter line,
2. Clients who can take some oral nutrition, but not a tunneled catheter, or an implanted vascular access
enough to meet the needs of the body require TPN. device, is used.
 TOTAL PARENTERAL NUTRITION  INTRAVENOUS SITES
3. Clients with multiple gastrointestinal surgeries, B. Peripheral parenteral nutrition (PPN)
gastrointestinal trauma, severe intolerance to 1. Peripheral parenteral nutrition is administered
enteral feedings, or intestinal obstructions or who through a peripheral vein.
need to rest the bowel for healing require TPN. 2. Peripheral parenteral nutrition is used for short
4. Clients with acquire immunodeficiency syndrome, periods (5 to 7 days) and when the client needs only
cancer, or malnutrition or clients receiving small concentrations of carbohydrates, fats, and
chemotherapy require TPN. proteins.
 TOTAL PARENTERAL NUTRITION 3. Peripheral parenteral nutrition is used to deliver
C. Components isotonic or mildly hypertonic solutions; the delivery
1. Carbohydrates of highly hypertonic solutions into peripheral veins
a. Carbohydrates are mainly in the form of glucose, can cause sclerosis, phlebitis, or swelling.
with ranges from a 5% glucose solution for  LIPIDS (FAT EMULSION)
peripheral parenteral nutrition to a 50% to 70% A. Lipids are given an isotonic solution that can be
glucose (hypertonic) solution for central parenteral administered through a peripheral vein.
nutrition. B. Lipids are administered to prevent or correct fatty
b. The strength of the glucose solution prescribed acid deficiency.
depends on the client’s nutritional needs and on C. Most fat emulsions are prepared from soybean oil;
agency protocols. the primary components are linoleic, oleic, palmitic,
c. Carbohydrates provide 60% to 70% of caloric linolenic, and stearic acids.
(energy) needs.  LIPIDS (FAT EMULSION)
 TOTAL PARENTERAL NUTRITION D. Examine bottle for separation of emulsion into layers
2. Amino acid provides 3% to 15% of the total calories. or fat globules or for the accumulation of froth; if
3. Lipids (fat emulsion) observed, do not use and return the solution to the
a. Lipids provide up to 30% of caloric (energy) needs. pharmacy.
b. Lipids provide nonprotein calories and prevent or E. Do not put additives into the fat emulsion solution.
correct fatty acid deficiency. F. Do not use an intravenous (IV filter because particles
 TOTAL PARENTERAL NUTRITION in the fat emulsion are too large to pass through
4. Vitamins filters.
5. Minerals and trace elements  LIPIDS (FAT EMULSION)
6. Water G. If the fat emulsion has been added to the parenteral
7. Electrolytes nutrition solution, a 1.2-µm filter or a larger filter
8. Insulin may be added to control the blood glucose should be used to be used to allow the fat emulsion
level because of the high concentration of glucose to pass through.
solution in the TPN.
 H. Use vented IV tubing because the solution is A. Description
supplied in a glass container for administration. 1. Pneumothorax and air embolism are associated with
I. Infuse solution initially at 1mL/min, monitor vital central line placement; air embolism is also
signs every 10 minutes, and observed for adverse associated with tubing changes.
reactions for the first 30 minutes of the infusion; if 2. Other complications include infection (catheter
signs of an adverse reaction occur, stop the infusion related), fluid overload, and metabolic alterations
and notify the physician. such as hyperglycemia and hypoglycemia; these
 LIPIDS (FAT EMULSION) complications are usually due to the parenteral
Signs of an Adverse Reaction to Lipids nutrition solution itself.
Chest and back pain  COMPLICATIONS
Chills B. Pneumothorax
Cyanosis Signs of a Pneumothorax
Diaphoresis Absence of breath sounds on affected side
Dyspnea Chest or shoulder pain
Fever Sudden shortness of breath
Flushing Tachycardia
Headache  COMPLICATIONS
Nausea and vomiting 1. Monitor for signs of pneumothorax
Pressure over the eyes 2. After insertion of the catheter, obtain a portable
Thrombophlebitis chest x-ray film to confirm correct catheter
Vertigo placement and to detect the presence of a
 LIPIDS (FAT EMULSION) pneumothorax; parenteral nutrition is not initiated
J. If no adverse reaction occurs, adjust flow to until verification of correct catheter placement and
prescribed rate. the absence of pneumothorax.
K. Monitor serum lipids 4 hours after discontinuing 3. After confirmation of catheter placement and the
infusion. absence of pneumothorax, parenteral nutrition is
L. Monitor liver function tests for evidence of impaired intiated.
liver function indicating the inability of the liver to  COMPLICATIONS
metabolize the lipids. C. Air embolism
 FILTERS Signs of an Air Embolism
A. Total parenteral nutrition and peripheral parenteral Apprehension
nutrition must be administered through tubing with Chest pain
an in-line filter to remove crystals from the solution. Dyspnea
B. A 0.22-µm filter is sufficient for administering Hypotension
solutions without lipid additives. Loud churning sound heard over the pericardium
 FILTERS Rapid and weak pulse
C. Lipids are administered through separate tubing Respiratory distress
attached below the filter of the main IV  COMPLICATIONS
administration because particles in the fat emulsion 1. Instruct the client in Valsalva’s maneuver for tubing
are too large to pass through filters. and cap changes.
D. If the parenteral nutrition solution has lipids added 2. For tubing and cap changes, place the client in a
to it, a 1.2-µm filter or a larger filter should be used. head down position (if not contraindicated) with the
 COMPLICATIONS head turned in the opposite direction of insertion
Complications to Total Parenteral Nutrition site (increases intrathoracic venous pressure).
Air embolism 3. Check all catheter connections and secure (use tape
Fluid overload per agency protocol) tubing connections.
Hyperglycemia  COMPLICATIONS
Hypoglycemia 4. If an air embolism is suspected, do the following:
Infection a. Clamp the intravenous catheter.
Pneumothorax
 COMPLICATIONS
 b. Place the client in a left side-lying position with the 4. Monitor intake and output.
head lower than the feet (to trap air in right side of 5. Weigh the client daily (ideal weight gain is 1 to 2 lb
the heart). per week)
c. Notify the physician.  COMPLICATIONS
d. Administer oxygen as prescribed. F. Hyperglycemia
 COMPLICATIONS Signs of Hyperglycemia
D. Infection Coma, when severe
Signs of an infection Confusion
Chills Diuresis
Elevated white blood cell count Elevated blood glucose level
Erythema or drainage at the insertion site Excessive thirst
Fever Fatigue
 COMPLICATIONS Kussmaul’s respirations
1. Use strict aseptic technique; because the TPN Restlessness
solution has a high concentration of glucose, it is a Weakness
medium for bacterial growth.  COMPLICATIONS
2. Monitor temperature; in the event of fever, suspect 1. Assess the client for a history of glucose intolerance.
sepsis. 2. Assess the client’s medication history
3. Assess the IV site for redness, swelling, tenderness, (corticosteroids may increase the blood glucose
or drainage. level).
4. Change TPN solution every 12 to 24 hours or 3. Begin infusion at a slow rate (usually 40 to 60 mL/hr)
according to agency protocol. as prescribed.
 COMPLICATIONS 4. Monitor blood glucose levels every 4 to 6 hours or
5. Change IV tubing every 24 hours or according to according to agency protocol.
agency protocol. 5. Administer regular insulin as prescribed.
6. Change dressing at the IV site every 48 hours or  COMPLICATIONS
according to agency protocol. G. Hypoglycemia
 COMPLICATIONS Signs of Hypoglycemia
7. If signs of infection occur at the site, do the Anxiousness
following: Diaphoresis
a. The IV line must be removed and restarted at a Hunger
different site. Low blood glucose level (usually less than 70 mg/dL)
b. Remove the tip of the IV catheter and send it to the Shakiness
laboratory for culture. Weakness
c. Prepare the client for blood cultures.  COMPLICATIONS
 COMPLICATIONS 1. Continue blood glucose monitoring
E. Fluid overload 2. Gradually decrease the infusion when discontinuing
Signs of Fluid Overload TPN.
Bounding pulse 3. When an infusion of hypertonic glucose is stopped,
Crackles on lung auscultation an infusion of 10% dextrose should be instituted and
Headache maintained for 1 to 2 hours to prevent
Increased blood pressure hypoglycemia.
Jugular vein distension 4. Assess blood glucose level 1 hour after discontinuing
Weight gain greater than desired TPN.
 COMPLICATIONS 5. Prepare for the administration of glucose if
1. Fluid overload occurs if the client receives the IV hypoglycemia occurs.
solution too rapidly.  ADDITIONAL NURSING CONSIDERATIONS
2. Total parenteral nutrition is always delivered via an A. Always check the TPN solution with the physician’s
electronic infusion device. order to ensure that the prescribed components are
3. Never increase the infusion rate to “catch up” if the contained in the solution.
IV infusion gets behind.
 B. To prevent infection and solution incompatibility, IV  For symptoms of thrombosis the client should report
medications and blood are not given through the edema of the arm or at the catheter insertion site,
TPN line. neck pain, and jugular vein distention.
C. Monitor partial thromboplastin time and  Leaking of fluid from the insertion site or pain or
prothrombin time for clients receiving discomfort as the fluids are infused may indicate
anticoagulants. displacement of the catheter; this must be reported
 ADDITIONAL NURSING CONSIDERATIONS immediately.
D. Monitor electrolytes, albumin, and liver and renal
function studies.
E. In severely dehydrated clients, the albumin level
may drop initially as the treatment restores
hydration.
F. With severely malnourished clients, monitor for
“refeeding syndrome” (a rapid drop in potassium,
magnesium, and phosphate serum levels).
 ADDITIONAL NURSING CONSIDERATIONS
G. Abnormal liver function values may indicate
intolerance to or an excess of fat emulsions or
problems with metabolism with glucose and protein.
H. Abnormal renal function tests may indicate an
excess of amino acids.
 ADDITIONAL NURSING CONSIDERATIONS
I. Total parenteral nutrition solutions should be stored
under refrigeration and administered within 24
hours from the time that they were prepared
(removed from refrigerator 0.5 to 1 hour before use.
J. Total parenteral nutrition solutions that are cloudy
or darkened should not be used and should be
returned to the pharmacy.
 HOME CARE INSTRUCTIONS
 Teach caregiver how to administer and maintain
total parenteral nutrition fluids.
 Teach caregiver how to change a sterile dressing.
 Obtain a daily weight at the same time of day in the
same clothes.
 Stress that a weight gain of more than 3 lb per week
may indicate excessive fluid intake and should be
reported.
 HOME CARE INSTRUCTIONS
 Monitor the blood glucose level and report
abnormalities immediately.
 Check for signs and symptoms of infection,
thrombosis, air embolism, and catheter
displacement.
 Instruct in the importance of reporting signs and
symptoms of complications.
 Symptoms of an air embolus should be taught to
another person in the client’s home.
 HOME CARE INSTRUCTIONS