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Lecture 11

NURS 342 Lecture Notes - Lecture 11: Sepsis, Pacifier, External Jugular Vein

Course Code
NURS 342

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Nurs 342: Week 1
Mat and Child: pg. 1091-1092
Total Parenteral Nutrition
Important therapy for children who have gastrointestinal illnesses that prevent proper absorption of basic caloric or fluid
requirements or respiratory illnesses that make infants too exhausted to suck
Nursing Diagnoses and Related Interventions
Imbalanced nutrition, less than body requirements r/t malabsorption of nutritients
oAssess signs of dehydration, weight, intestinal cramps, distension
oHypertonic solution of IV therapy containing glucose, vitamins, electrolytes, trace minerals, and proteins
oAnd intralipid solution (emulsified fat able to be administered IV) given once or twice per week supplies needed
fatty acids
oChildren with chronic diarrhea or vomiting, IBD, bowel obstruction, anorexia, or extreme immaturity are examples
of children who greatly benefit from TPN
oTPN solutions administered via central intravenous access site or via PICC
oIf a central site is chosen, a catheter is inserted through the right external jugular vein into the superior vena cava or
directly into the subclavian vein under strict aseptic conditions.
oCatheter is secured at the site of insertion with sutures and covered with a sterile dressing to help reduce bacterial
oA major vein of this type is chosen to avoid inflammation reactions and resulting venous thrombosis from the high-
caloric and high osmotic fluid that will be infused
oTPN solution prepared at the pharmacy under sterile conditions
oMillipore filter which removes small particles in the solution that might cause an embolus to form, is inserted into
the tubing
oSolution given by continuous infusion pump so rate can be monitored
If rate should fall behind, do not increase it unil the next hour to make up the amount of fluid, or serious
cardiovascular overload could result b/c of the concentrated fluid being administered
Infection major danger of TPN b/c solution is perfect medium for growth of bacteria or candida organisms
oDressing over insertion site and the Iv tubing changed every 1-2 days to avoid infection
oTubing should not be used for obtaining blood or adding medications unless double barreled tube is used to avoid
further infection risk
oSterile technique required when changing bottles of solution so that tubing is not contaminated
oDepending on facility- you may have to wear mask and gloves while changing bottles of solution- to avoid airborne
and direct contamination
oInspect insertion site at the time of the dressing change for indications of local infection- redness, tenderness,
discharge- can lead to serious sepsis or thrombosis
Second mjr problem with TPN- dehydration
oTPN contains approx.. 2x amount of glucose normally administered in IV solution to ensure that the amino acids in
a solution will be used for protein synthesis, not energy
oDehydration may occur as the kidneys recognize the amount of glucose in the bloodstream as excessive and start to
reduce it by excreting it (think diabetes)
oWhen TPN has begun, test urine for glucose and specific gravity with each voiding, if 2 or more consecutive
samples indicate 3+ or 4+ glucose level, either the rate of infusion or the amount of glucose in he solution may need
to be decreased or insulin may need to be added to the solution to counteract excess glucose
oDecreasing the concentration of glucose and then gradually increasing I again allows the child’s body to adjust to the
glucose overload
oAfter the first few days of TPN- a rebound effect (the childs body produces increased insulin) may cause
oA urine sample that suddenly is negative for glucose after several serial specimens have been necessarily positive
and therefore not necessarily an encouraging sign- warning that childs glucose level has become dangerously low
oTPN solution should never be d/c abruptly but gradually tapered or a glucose rebound effect could also occur
oIf a TPN catheter should be accidentally pulled out, child should be immediately assessed for a hemorrhage from the
insertion site and closely observed in the next few hours for signs of hypoglycemia such as lethargy, incoordination,
fidgeting or seizures.
oChildren should be able to voice and understand the reason they are receiving TPN
oWhen others are eating, encourage social interaction but have something for the child to do.
oAsk whether a child can be allowed chewing gum or occasional hard candy for chewing and taste sensations
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