Nursing 105

Essentials of Nursing Study Guide

©2018 Achieve Page 30 of 160 IV dressings (occlusive or transparent) and tubing shall be changed at least every 7 days using sterile technique. The only exceptions are if a 1.2-micron 24-hour filter is used then the tubing, filter, and bag should be changed together every 24 hours. Semipermeable transparent dressings are required for use with central lines. Dressings and tubing shall be dated, timed appropriately. TPN solutions hung, but not infused, shall be discarded after 24 hours. Dumping syndrome occurs when hypertonic food suddenly causes a shift of fluids into the large intestine. Symptoms include sweating, palpitations, tachycardia, pallor, nausea, vomiting, diarrhea and fainting after a feeding. Parenteral Nutrition (PN) Also known as Total Parenteral Nutrition (TPN) or Intravenous Hyperalimentation (IVH), where the nutrients bypass the GI system and enter the blood directly. Solutions of dextrose, water, fat, proteins, electrolytes, vitamins and trace elements are adjusted to each client’s nutritional needs. Hypertonic solutions are injected only into high-flow central veins. Clients with severe malnutrition, severe burns, bowel disease disorders, acute renal failure, hepatic failure, metastatic cancer, and major surgery are NPO for greater than five days. Discontinuation should be done slowly to prevent hyperinsulinemia and hypoglycemia. Nursing interventions for TPN therapy shall include: • comparing admixture to physician’s orders to ensure accuracy • daily weights • I and O every shift • vital signs every shift • glucose monitoring (Accu-check) q6 hours Total Parenteral Nutrition can be done in a variety of ways. • Infusion Lines : TPN solutions are infused into a central or iliac vein via an indwelling central venous catheter, internal jugular or antecubital fossa catheter, femoral venous line, or a peripherally inserted central catheter (PICC). • Intralipids (Fat Emulsion) Infusions: Intralipids (fat emulsions) may be infused with TPN simultaneously, if not already admixed with TPN. The primed lipid tubing shall be attached to the y-connection at the catheter hub. When lipids are infused in this manner, the lipid infusion shall be completed within 12 hours of initiation. • Infusion Pump and Filters: TPN solutions shall be infused via an infusion control device utilizing the appropriate filter. Prepared mixtures of TPN and lipids shall be infused with a 1.2- micron, 24-hour filter, and TPN solutions which are not mixed with lipids shall be infused with a 0.2-micron, 72-hour filter. The TPN solution shall be sent from pharmacy stamped with the type of filter needed to appropriately infuse the solution. • IVDressings and Tubing: