Yuni Sufyanti A, S.Kp,M.

Kes

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PRE TEST
Perbedaan TPN dan PPN
Komplikasi Parenteral nutrition
Intervensi Keperawatan pada parenteral nutrition

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DEFINISI
Suatu bentuk pemberian nutrisi yang diberikan
langsung melalui pembuluh darah tanpa melalui
saluran pencernaan

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KLASIFIKASI
1.

CPN/Central Parenteral Nutrition

When feeding is infused in to a large
diameter vein such as the SVC and
subclavian veins TPN

2. PPN (Peripheral Parenteral Nutrition)

when smaller perifer is used such as the
vein in forearm hyperalimentasi, central
venous nutrition, periferal venous nutrition

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KOMPONEN PN
PN admixture are proteins, carbohydrates, fats,
electrolytes, vitamins, trace minerals, and
sterile water

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TUJUAN
Menyediakan nutrisi bagi tubuh melalui
intravena,karena tidak memungkinkannya
saluran cerna untuk melakukan proses
pencernaan makanan.
TPN digunakan pada pasien dengan luka bakar
yang berat,pancreatitis,inflammatory bowel
syndrome,inflammatory bowel
disease,ulcerative colitis,acute renal
failure,hepatic failure,cardiac
disease,pembedahan dan cancer.
Mencegah lemak subcutan dan otot digunakan
oleh tubuh untuk melakukan katabolisme
energy
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DASAR FISIOLOGI
Kebutuhan nutrisi tidak tercukupi Kekurangan kalori dan
nitrogen
Apabila terjadi defisiensi nutrisi proses glukoneogenesis
akan berlangsung dalam tubuh untuk mengubah protein
menjadi karbohidrat.
Kebutuhan kalori Kurang lebih 1500 kalori/hari,diperlukan
oleh rata-rata dewasa untuk mencegah protein dalam tubuh
untuk digunakan.

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DASAR FISIOLOGI
Kebutuhan kalori menigkat terjadi pada pasien dengan
penyakit hipermetabolisme,fever,injury,membutuhkan kalori
sampai dengan 10.000 kalori/hari.
Proses ini menyediakan kalori yang dibutuhkan dalam
konsentrasi yang langsung ke dalam system intravena yang
secara cepat terdilusi menjadi nutrisi yang tepat sesuai
toleransi tubuh.

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PN is indicated in the following

situations:
The patients intake is insufficient to maintain an
anabolic state (eg, severe burns, malnutrition, short
bowel syndrome, AIDS, sepsis, cancer).
The patients ability to ingest food orally or by tube is
impaired (eg, paralytic ileus, Crohns disease with
obstruction, postradiation enteritis, severe
hyperemesis gravidarum in pregnancy).
The patient is not interested in or is unwilling to
ingest adequate nutrients (eg, anorexia nervosa,
postoperative elderly patients).
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PN is indicated in the following situations:

The underlying medical condition precludes being fed

orally or by tube (eg, acute pancreatitis, high
enterocutaneous fistula).
Preoperative and postoperative nutritional needs are
prolonged (eg, extensive bowel surgery).

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KOMPLIKASI
Technical complication
- malposisi kateter
- subclavian arteri puncture
- carotid arteri puncture
- air embolisme
- trombosis
Septic complication
- cateter related sepsis
- sepsis trombosis
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KOMPLIKASI
Metabolic complication
- hyperglikemi
- hypokalsemi
- hyperkalemi
- hyperfospatemia

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Monitoring TPN
Monitor intake output
Urynari glukose elektrolit
BUN Ca, P, Mg
Alkaline phospate
Albumin
Trygilserid
Prealbumin
3-7 hari pertama tergantung stabilitas pasien
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ASUHAN KEPERAWATAN
PADA PASIEN DENGAN
PARENTERAL NUTRITION
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PENGKAJIAN
Identifying patients who may be
candidates for PN Kehilangan BB yang
signifikan (10% or more of usual weight),
a decrease in oral food intake for more
than 1 week
any significant sign of protein loss (serum
albuminlevels less than 3.2 g/dL [32 g/L]

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PENGKAJIAN
muscle wasting
decreased tissue healing
abnormal urea nitrogen excretion
Persistent vomiting and diarrhea
Mengkaji status hidrasi pasien, intake kalori,
dan nilai elektrolit

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NURSING DIAGNOSIS
Based on the assessment data, the major nursing
diagnoses may include the following:
Imbalanced nutrition, less than body requirements,
related to inadequate oral intake of nutrients
Risk for infection related to contamination of the
central catheter site or infusion line
Risk for excess or deficient fluid volume related to
altered infusion rate
Risk for immobility related to fear that the catheter
will become dislodged or occluded
Risk for ineffective therapeutic regimen
management related to knowledge deficit about
home PN therapy
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COLLABORATIVE PROBLEMS/
POTENTIAL COMPLICATIONS

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Complications of Parenteral Nutrition

complication

cause

nursing actions and collaborative

interventions

Pneumotorak

Improper catheterplacement
and inadvertent puncture of
the pleura

Place patient in Fowlers position.

Offer reassurance.
Monitor vital signs.
Prepare for thoracentesis or chest tube
insertion.

Air embolism

1.
2.

Disconnected tubing
Cap missing from
port
3.
Blocked segment of
vascular
system

1. Tape all tubing connection sites securely.

Replace tubing immediately and notify
physician.
2. Replace cap and notify physician.
3. Turn patient on left side and place in the
head-low position.
Notify physician.

Clotted catheter line

Inadequate/infrequent
heparin flushes
Disruption of infusion

Administer heparin flush in unused lines

twice a day.
Monitor infusion rate hourly and inspect the
integrity of the line.

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Complications of Parenteral Nutrition

komplikasi

penyebab

nursing actions and collaborative

interventions

Catheter displacement and

contamination

Excessive movement, possibly

with a nonsecured catheter
Separation of tubing and
contamination

Stop the infusion and notify the physician.

Tape all tubing connection sites.
Avoid interrupting the main line or
piggybacking other
lines.

Sepsis

Separation of dressings
Contaminated solution
Infection at insertion site of
catheter

Reinforce or change dressing quickly

using aseptic technique.
Discard. Notify pharmacist.
Notify physician. Monitor vital signs every
4 hours.
Catheter site is changed every 4 weeks

Hyperglycemia

Glucose intolerance

Monitor glucose levels (blood and urine).

Monitor urine output.
Observe for stupor, confusion, lethargy.
Notify physician; the addition of insulin to
the PN solution
may be prescribed.
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Complications of Parenteral Nutrition

komplikasi

penyebab

nursing actions and

collaborative interventions

Fluid overload

Fluid infusing rapidly

Decrease infusion rate, use

infusion pump. Monitor vital
signs. Notify physician. Treat
respiratory distress by sitting
patient upright and
administering oxygen as
needed, if prescribed.

Rebound hypoglycemia

Feedings stopped too abruptly

Monitor for symptoms

(weakness, tremors,
diaphoresis,
headache, hunger, and
apprehension); notify physician.
Gradually wean patient from
PN.

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Planning and Goals

The major goals for the patient may include
optimal level of nutrition,
absence of infection, adequate fluid volume,
optimal level of activity (within individual
limitations), knowledge of and skill in selfcare, and prevention of complications.

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Nursing Interventions
MAINTAINING OPTIMAL NUTRITION
PREVENTING INFECTION
MAINTAINING FLUID BALANCE
ENCOURAGING ACTIVITY

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MEMPERTAHANKAN NUTRISI YANG OPTIMAL

Monitor BB
Monitor intake dan output dan keseimbangan
cairan
Catat PN solution yang diberikan oleh tim medis,
dan catat toleransi dari pasien

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Mencegah Infeksi

Kandungan glukosa yang tinggi sumber

media pertumbuhan bakteri & jamur
Sumber utama mikroorganisme cateter
Tutup tempat penusukan dengan kasa steril,
dan observasi adanya kebocoran, katerer
yang kusut, dan reaksi kulit

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Mempertahankan keseimbangan cairn

Pemberian PN dengan infuse pump
Mempertahankan kecepatan yang akurat dari
pemberian
Jika terlalu cepat Hyperosmolar diuresis (excess
gula >>) Kejang, koma, meninggal
Jika terlalu lambat Pasien tidak mendapatkan
keuntungan yang maksimal untuk mendapatkan
kalori dan nitrogen
Monitor intake output setiap 8 jam
Kaji adanya dehidrasi
Monitir Blood Glukose hyperglikemi menyebbakan
diuresis dan kehilangan cairan yang berlebih
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Encouraging activity

Jika secara fisik pasien mampu anjurkan

untuk beraktivitas dan ambulasi
Pada pemasingan cateter subclavian vein
pasien bebas untuk bergerak dan
mempertahankan tonus otot yang baik
Anjurkan untuk terapi okupasi

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PROMOTING HOME AND

COMMUNITY-BASED CARE

Teaching Patients Self-Care

Continuing Care

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EVALUASI
Expected patient outcomes may include the
following:
1. Attains or maintains nutritional balance
2. Free of infection at the catheter site
a. Is afebrile
b. Has no purulent drainage from the catheter
insertion site
c. Has intact IV line
3. Is hydrated, as evidenced by good skin turgor
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EVALUASI
4. Achieves an optimal level of activity, within
limitations
5. Demonstrates skill in managing PN regimen
6. Prevents complications
a. Maintains proper catheter and equipment
function
b. Has no symptoms of sepsis
c. Maintains metabolic balance within
normal limits
d. Shows improved and stabilized nutritional
status
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Be a Good Nurse.

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POST TEST
Perbedaan TPN dan PPN
Komplikasi Parenteral nutrition
Intervensi Keperawatan pada parenteral nutrition

32

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