IV therapy & TPN

[Armymom2x]

Hello all! I am a nursing student and I have a question regarding IV therapy (this is for our case study-but I cannot find the answer I am looking for in my books). Our 'patient' has an NGT (this is many what the case study is about). She is 3 days post NGT suctioning. Her Na is 130; K 2.5; Cl 97; C03 31; BUN 38; Creatinine 2.2; glucose 65; Albumin 2.1; protein 4.9. She is NPO (small bowel obstruction). Our question is regarding IV therapy and what measures would be taken to correct the imbalances. First I would think we would administer isotonic fluids, but my question is really about TPN-would TPN take care of all lyte imbalances? I know TPN contains lytes, glucose, and minerals... but would it help in her case? Does anyone have a web link that might help me understand IV therapy?

[AgentBeast, MSN, RN]

Probably going to want to do something about that potassium at 2.5 first . . .

[turnforthenurse, MSN, NP]

TPN can contains lytes, but that alone isn't going to help that K of 2.5. You will probably want to get an order for some KCl IVPB...

[tarheelsu]

Unfortunately there is no quick and simple answer.

Look up TPN and fluid and electrolyte imbalances in your textbook.

TPN is not going to fix all the electrolyte imbalances and it can cause significant side effects. I can't tell from your post if the patient is already on TPN. If not, I don't know if they would be put on it at only 3 days of not eating. I think you can go longer on fluids that that.

The potassium is a big deal. The MD needs to be notified right away of that and will order KCL IV.

The sodium is low (the low chlorine goes along with the sodium). I'd guess she would get NS fluids. You want to raise the sodium level relatively slowly. You probably want to put the patient on seizure precautions.

The albumin does seem really low. You can give concentrate albumin IV I think. I'd also guess that their calcium is low if albumin is really low since so much of calcium is bound to albumin.

I'd also look up patho and interventions for bowel obstructions.

I think TPN needs its own dedicated central line.

I've heard great things about the nursing made incredibly easy fluid and electrolyte book.

[Mentalageis16]

Na is 130; K 2.5; Cl 97; C03 31; BUN 38; Creatinine 2.2; glucose 65; Albumin 2.1; protein 4.9.

D5W with Potassium chloride.

which electrolyte is lower then give that thing, you replace whatever is missing from her body, the key is hemostasis and keep pt. well balanced. I'm 3 months into the program, if I'm incorrect, please let me know

[Armymom2x]

Thank you everyone. I did end up finding my answers I needed with a little research. I get so stressed out with this nursing program! I really appreciate all the replys!