Patient Care Plans for TPN

Instructor: Laura Lewicki
This lesson is designed to develop a plan of care for the client receiving total parenteral nutrition (TPN). We will discuss the purpose of TPN, the types of patients requiring TPN, and nursing actions to prevent complications.

Using TPN

Total parenteral nutrition (TPN) is nutrition that is provided to the client through the bloodstream using an intravenous line. TPN is used to provide necessary nutrients to the client when there is a medical reason that the gastrointestinal (GI) tract is avoided. TPN contains proteins (amino acids), glucose, electrolytes, and minerals. The client will also receive lipids through an intravenous line. Let's take a look at one example of a client and how the nurse will manage nutrition, fluid volume, infection, and alterations in blood glucose.

Plan of Care

You are providing care for Katie Robinson, a 47-year-old female who recently had surgery for a small bowel obstruction. Katie is TPN via a peripherally inserted central catheter (PICC) line.

Nutrition Assessment

In performing assessment, you should begin by focusing on Katie's nutritional status. Katie should be weighed daily and this weight should be compared to prior readings. Her skin should be assessed for signs of dehydration such as dry mucous membranes or skin tenting. Likewise, Katie should be assessed for a low albumin level.

The nursing diagnosis for Katie would be 'Alteration in Nutrition: Less than Body Requirements' related to the inability to absorb nutrients due to surgical intervention. This nursing diagnosis is appropriate for any client that has trouble absorbing nutrients from the gastro-intestinal (GI) tract for areas such as anorexia nervosa, malabsorption syndrome, or a surgical or mechanical obstruction in the GI tract.

The goal as you care for Katie over several days or weeks would be to return her to an optimal nutritional status. The nursing interventions you will implement to promote optimal nutrition include:

  • Double check the TPN solution to the orders prior to administering to ensure accurate, individualized formula.
  • Administer at prescribed rate.
  • Monitor the client's weight at the same time each day.
  • Monitor the client's electrolytes, glucose level, and albumin levels daily.

Alterations in Fluid Volume

As you provide nursing care for Katie, it is important to assess for alterations in fluid volume. These assessments include intake and output, daily weight, vital sign measurements, and skin assessments for either dehydration or the presence of edema.

Katie is at 'Risk for Deficient Fluid Volume' related to the hypertonicity of the composition of the TPN. When planning care for Katie, the goal will be to prevent deficient fluid volume which would be evidenced by normal urine output and no clinical manifestations of dehydration.

The nursing interventions you should implement in providing care for Katie include:

  • Administer TPN at prescribed rate via filtered tubing on an infusion pump.
  • Assess for manifestations of fluid volume deficit: tachycardia, low blood pressure, dry mucous membranes.
  • Assess for manifestations of fluid volume excess: crackles, shortness of breath, edema.
  • Accurate intake and output each shift.


All clients that receive TPN are at risk for infection due to the high tonicity of the solution. The presence of a central venous access device increases that risk. Katie should be assessed for the clinical manifestations of infection including elevated temperature and elevated heart rate. The complete blood count should be monitored for an increase in the white blood cell count.

The nursing diagnosis for Katie would be 'Risk for Infection' related to receiving TPN. The plan will be to keep Katie free from infection while receiving TPN. You should implement the following nursing interventions when providing care to Katie:

  • Ensure proper handling of the central venous access device per hospital protocols.
  • Change the IV tubing and filter every 24 hours.
  • Assess for signs of infection at the insertion site: redness, inflammation, drainage.
  • Monitor for changes in vital signs, including elevated temperature and tachycardia.
  • Monitor complete blood count for elevated white blood cells.

Blood Glucose Management

The high concentration of dextrose in the TPN makes the client receiving TPN at risk for either hypoglycemic or hyperglycemic events. You should assess Katie's blood sugar at least every 6 hours while she is receiving TPN. Katie should be monitored for the clinical manifestations of a hypoglycemic event or a hyperglycemic event.

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