Central Parenteral Nutrition Essay

Central Parenteral Nutrition Essay

Central Parenteral Nutrition Essay

The promotion of adequate nutrition in critically ill patients is important. Central parenteral nutrition is one of the recommended ways of ensuring adequate nutrition in critically ill patients that cannot feed orally. Parenteral nutrition entails the administration of highly concentrated nutrients in a small volume through a central vein. The hypothetical case is a critically ill patient with bowel obstruction who has been placed on central parenteral nutrition. Therefore, this essay explores the essentials of central parenteral nutrition. It explores its background, risks and benefits, interdisciplinary team’s roles and responsibilities, the nursing scope of practice, and patient education.

Explanation and Background

Central parenteral nutrition refers to nutrition that is administered via a central venous catheter. The catheter is inserted in the main vein for nutritional delivery. The main veins that are largely utilized in the modality include the internal jugular, subclavian, and femoral vein among others (Lappas et al., 2018). Central parenteral nutrition is recommended for patients who are likely to receive parenteral nutrition for more than 10 days. Central parenteral nutrition benefits the patient by ensuring the protection of gastrointestinal system integrity in critically ill patients. It also ensures the maintenance of optimum nutrition in critically ill patients who cannot feed orally. As noted above, central parenteral nutrition works by delivering highly concentrated nutrients directly to the bloodstream via a centrally placed catheter (Hamdan & Puckett, 2022). The nutrition comprises amino acids, carbohydrates, lipids, and glucose.

Central parenteral nutrition is indicated for use in different patients. They include those experiencing inadequate absorption via the gastrointestinal tract due to bowel syndrome, gastrointestinal fistula, bowel obstruction, prolonged bowel rest, and severe malnutrition. The modality is also indicated for patients suffering from hypercatabolic states due to polytrauma, fractures, and sepsis, as well as those with post-operative bowel anastomosis leakage (Lappas et al., 2018; Martincich et al., 2020). Central parenteral nutrition is a relatively safe therapeutic modality. Its safety is achieved by ensuring close monitoring of input-output, urine sugar estimates, serum electrolytes, protein, and creatinine levels, and liver function tests.

Risks and Benefits

Central parenteral nutrition benefits patients who cannot feed orally in many ways. First, it prevents malnutrition in patients that cannot obtain their needed nutrients through enteral or oral routes. Patients are assured of continuous nutritional support irrespective of their health status. Central parenteral nutrition also promotes the integrity of the gastrointestinal system in patients requiring rest of the GI tract (Pierik et al., 2021). By bypassing the GI system, central parenteral nutrition facilitates recovery from conditions that include irritable bowel syndrome and bowel obstruction.

Several strategies can be explored to promote positive outcomes in central parenteral nutrition. One of them is close patient monitoring. Patients should be monitored closely for any risks of complications associated with the modality. For example, intake and output should be monitored on 12-hour charts; urine sugar estimates eight hourly, serum protein levels twice daily, and serum creatinine daily. The other strategy entails using aseptic techniques in handling central venous catheters to minimize the risk of infections (Hamdan & Puckett, 2022). Unstable, critically ill patients should also be monitored closely until they regain their stability for positive outcomes.

Central parenteral nutrition predisposes patients to several complications. They include those associated with venous access, catheter site, and metabolic complications. The complications associated with venous insertion include air embolism, pneumothorax, bleeding, vascular injury, and venous thrombosis. Those associated with catheter site infections include local skin infection at the site of insertion or exit and sepsis. Metabolic complications include refeeding syndrome, hyperglycemia, hypoglycemia in case of abrupt discontinuation, serum electrolyte imbalances, Wernicke’s encephalopathy, and cholestasis (Lappas et al., 2018; Martincich et al., 2020; Mateo-Lobo et al., 2019; Trivic et al., 2020).

ORDER A PLAGIARISM FREE-PAPER HERE

Complications associated with central parenteral nutrition are preventable. Strategies that include the use of aseptic technics, monitoring of serum electrolytes, blood glucose levels, liver function tests, and creatinine levels can be explored to prevent them. Patient education on the care of the catheter insertion and exit sites also reduces the risk of complications. Gradual discontinuation of parenteral nutrition also prevents the risk of metabolic complications such as hypoglycemia (Pierik et al., 2021). Therefore, the above interventions should be explored to promote optimum outcomes in central parenteral nutrition.

Interdisciplinary Team’s Roles and Responsibilities

Interdisciplinary teams are responsible for providing care to patients on central parenteral nutrition. The interdisciplinary team comprises clinicians, pharmacists, dieticians, and nurse specialists. Clinicians are responsible for determining the needed treatment and form of nutrition for the patient. They also coordinate the care given to the patient with the primary care team. Clinicians also insert the central catheter used for the delivery of parenteral nutrition. The pharmacists are responsible for providing sterile, parenteral nutrition (Hamdan & Puckett, 2022). They also advise on issues related to compound stability and nutritional interactions that may be experienced.

The dietician assesses the nutritional needs and status of the patient. They also calculate the daily nutritional requirements for the patients and develop the feeding regime. Nurses and nurse specialists ensure effective care of the catheters. They advocate the adoption of interventions that enhance the safety, quality, and efficiency of care given to patients. They also train patients and their caretakers about the care of the catheters at home. Nurses and nurse specialists also administer medications and monitor patients for any complications associated with central parenteral nutrition (Hamdan & Puckett, 2022).

Nursing Scope of Practice

A registered nurse should possess extensive knowledge and skills in parenteral nutrition when caring for a patient prescribed this modality. The nurse should be knowledgeable about the administration of parenteral nutrition. They should also be knowledgeable on the care of catheters and potential complications that may befall the patient. Nurses should also know interpersonal relations to enable them to work with interdisciplinary teams and educate patients and caretakers on catheter care. Nurses should also be skilled in several areas related to catheter care. They should possess skills in nutrition administration, catheter care, patient education, management of complications, and effective collaboration with other healthcare providers (Pierik et al., 2021). The registered nurse should also have an attitude characterized by openness to change, patient-centeredness, innovation, and advocacy in the care of a patient on central parenteral nutrition.

Patient Education

Patients should be educated on several aspects related to central parenteral nutrition. The education focuses on issues that include safe administration of the parenteral nutrition at home, signs of complications, and preventing their occurrences. Patient education also focuses on the interventions to prevent infections on the catheter infection site and signs of infection. Patients also require education on the inspection of total parenteral nutrition before administration. Patient education can be achieved using demonstration, instructional videos, active patient participation in the educational sessions, and the use of educational brochures (Pierik et al., 2021). Teaching effectiveness can be evaluated using interventions that include question-answer sessions and observing the patient or caretaker administer parenteral nutrition.

Conclusion

In summary, central parenteral nutrition is a treatment modality used in critically ill patients that cannot feed through the oral or enteral routes. The modality prevents malnutrition in critically ill patients. Central parenteral nutrition is associated with benefits and risks that nurses should aim at minimizing in practice. Interdisciplinary collaboration is important in central parenteral nutrition. Nurses should possess the required knowledge and skills in ensuring effective care given to patients on central parenteral nutrition.

References

Hamdan, M., & Puckett, Y. (2022). Total Parenteral Nutrition. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559036/

Lappas, B. M., Patel, D., Kumpf, V., Adams, D. W., & Seidner, D. L. (2018). Parenteral Nutrition: Indications, Access, and Complications. Gastroenterology Clinics, 47(1), 39–59. https://doi.org/10.1016/j.gtc.2017.10.001

Martincich, I., Cini, K., Lapkin, S., Lord, H., & Fernandez, R. (2020). Central Venous Access Device Complications in Patients Receiving Parenteral Nutrition in General Ward Settings: A Retrospective Analysis. Journal of Parenteral and Enteral Nutrition, 44(6), 1104–1111. https://doi.org/10.1002/jpen.1743

Mateo-Lobo, R., Riveiro, J., Vega-Piñero, B., & Botella-Carretero, J. I. (2019). Infectious Complications in Home Parenteral Nutrition: A Systematic Review and Meta-Analysis Comparing Peripherally-Inserted Central Catheters with Other Central Catheters. Nutrients, 11(9), 2083. https://doi.org/10.3390/nu11092083

Pierik, A., Martins, D. S., Casey, L., & Piper, H. G. (2021). Use of instructional videos to reduce central venous catheter complications in children with intestinal failure receiving home parenteral nutrition. Nutrition in Clinical Practice, 36(4), 872–876. https://doi.org/10.1002/ncp.10638

Trivic, I., Mišak, Z., Kerman, V., Prlic, H., Kolacek, S., & Hojsak, I. (2020). Central Catheter-related Bloodstream Infection Rates in Children on Home Parenteral Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 70(3), e59. https://doi.org/10.1097/MPG.0000000000002559

ORDER A PLAGIARISM FREE-PAPER HERE

Purpose
This purpose of this assignment is for the student to present a complete picture of interdisciplinary care using specific therapeutic modalities in the care of a complex adult health client. The student will demonstrate clinical reasoning skills and will discuss interdisciplinary care that had been incorporated and/or anticipated using a healthcare technology or therapeutic modality for the care of the complex health client.
Course outcomes: This assignment enables the student to meet the following course outcomes:
1. Provide nursing care to patients and their families in critical and emergent care settings based on theories and principles of nursing and related disciplines (PO 1).
2. Initiate the use of appropriate resources in direct care responsibilities within critical-care and emergent care settings (PO 2).
3. Demonstrate effective therapeutic communication and relationship skills in providing care to patients and families in critical-care and emergent care settings (PO 3).
4. Demonstrate effective clinical decision making based on critical thinking skills and legal, ethical, and professional standards and principles when caring for patients and families in critical care and emergent care settings (POs 4, 6).
5. Implement a plan of care for continued personal, professional, and educational development related to nursing practice within critical-care and emergent care settings (PO 5).
7. Use evidence including research findings from nursing and related disciplines to answer clinical questions related to nursing care of patients in critical-care and emergent care settings (PO 8).
Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.
Total points possible: 100 points
Preparing the assignment
Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
1) Adult patient only-Phoenix Addendum
2) Choose a therapeutic modality or healthcare technology.
3) Examples of a therapeutic modality include Extracorporeal Membrane Oxygenation, Automatic rotating pronation beds, right and/or left ventricular assist devices, nontraditional ventilator modes.
4) Examples of healthcare technology can include regional O2 saturation monitoring (NIRS).
5) Refer to your faculty member if your selection requires prior approval.
6) Write a 4-5-page paper (not including the title page or reference page) using APA format.
a. Phoenix Addendum: Expository essay format (page 10 of the 7th ed APA)
7) For APA, formatting, or grammar assistance visit the APA Citation and Writing page in the online library.
8) Include the following sections (detailed criteria listed below and in the Grading Rubric):
a. Introduction – 5 points/5%
• The chosen therapeutic modality or healthcare technology meets one of the following criteria:
o Has been introduced recently at the bedside for care of the complex adult patient.
o Is a non-traditional modality for very ill patients in special circumstances.
o Is being used in a new way to treat a patient with complex needs.
o Requires specific training above and beyond general entry-level nursing education.
• Introduce the therapeutic modality or healthcare technology.
• Name the therapeutic modality or healthcare technology.
• A brief fictional case on a complex adult patient is used to illustrate the therapeutic modality or healthcare technology.
b. Explanation and Background– 15 points/15%
• Include a clear description of the therapeutic modality or healthcare technology.
• Discuss how the therapeutic modality or healthcare technology works.
• Describe the patient population it is used for.
• Include medication, safety, and cost considerations as applicable.
c. Risks and Benefits– 15 points/15%
• Describe how the therapeutic modality or healthcare technology can benefit the patient.
• Discuss ways to promote positive outcomes.
• Explain the complications that may arise.
• Discuss considerations for preventing complications.
d. Interdisciplinary team’s Roles and Responsibilities– 20 points/20%
• Identify all interdisciplinary team members caring for the patient, such as respiratory therapy, assistive personnel, providers, case managers, clinical nurse specialists, and researchers.
• Describe the roles and responsibilities of each member of the healthcare team that is involved in the use of the therapeutic modality or healthcare technology.
• Discuss the roles and responsibilities of the nurse as a member of the interdisciplinary team caring for the patient.
e. Nursing Scope of Practice – 15 points/15%
• Discuss the knowledge needed for the Registered Nurse to provide care for the patient using the therapeutic modality or healthcare technology.
• Describe skills needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology.
• Discuss attitudes needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology.
f. Patient Education – 20 points/20%
• Describe the information to be taught to the patient and/or family.
• Discuss how information will be taught.
• Explain how the effectiveness of the teaching will be evaluated.
g. Conclusion – 5 points/5%
• Provide a summary of the paper.
• No new information is introduced.
• Include additional resources for further learning.
h. APA Style and Organization – 5 points/5%
• References are submitted with paper.
• Uses current APA format and is free of errors.
• Grammar and mechanics are free of errors.
• At least three (3), nursing, scholarly, peer reviewed, primary sources from the last 5 years, excluding the textbook, are provided.

Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned.

ORDER A PLAGIARISM FREE-PAPER HERE

Grading Rubric
Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment.
Assignment Section and
Required Criteria
(Points possible/% of total points available) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper
Introduction
(5 points/5%) 5 points 4 points 3 points 2 points 0 points
Required criteria
1. The chosen therapeutic modality or healthcare technology meets one of the following criteria:
• Has been introduced recently at the bedside for care of the complex adult patient.
• Is a non-traditional modality for very ill patients in special circumstances.
• Is being used in a new way to treat a patient with complex needs.
• Requires specific training above and beyond general entry-level nursing education.
2. Introduce the therapeutic modality or healthcare technology.
3. Name the therapeutic modality or healthcare technology.
4. A brief fictional case is used to illustrate the therapeutic modality or healthcare technology. Includes no fewer than 4 requirements for section. Includes no fewer than 3 requirements for section. Includes no less than 2 requirements for section. Includes no less than 1 requirement for section. No requirements for this section presented.
Explanation and Background
(15 points/15%) 15 points 13 points 11 points 6 points 0 points
Required criteria
1. Include a clear description of the therapeutic modality or healthcare technology.
2. Discuss how the therapeutic modality or healthcare technology works.
3. Describe the patient population it is used for.
4. Include medication, safety, and cost considerations as applicable. Includes no fewer than 4 requirements for section. Includes no fewer than 3 requirements for section. Includes no fewer than 2 requirements for section. Includes no less than 1 requirement for section. No requirements for this section presented.
Or
No citations for this section.
Risks and Benefits
(15 points/15%) 15 points 13 points 11 points 6 points 0 points
Required criteria
1. Describe how the therapeutic modality or healthcare technology can benefit the patient.
2. Discuss ways to promote positive outcomes.
3. Explain the complications that may arise.
4. Discuss considerations for preventing complications. Includes no fewer than 4 requirements for section. Includes no fewer than 3 requirements for section. Includes no less than 2 requirements for section. Includes no less than 1 requirement for section. No requirements for this section presented.
Or
No citations for this section.
Interdisciplinary Team’s
Roles and Responsibilities
(20 points/20%) 20 points 18 points 16 points 8 points 0 points
Required criteria
1. Identify all interdisciplinary team members caring for the patient, such as respiratory therapy, assistive personnel, providers, case managers, clinical nurse specialists, and researchers.
2. Describe the roles and responsibilities of each member of the healthcare team that is involved in the use of the therapeutic modality or healthcare technology.
3. Discuss the roles and responsibilities of the nurse as a member of the interdisciplinary team caring for the patient.
4. Discuss one challenge in working with an interdisciplinary team. Includes no fewer than 4 requirements for section. Includes no fewer than 3 requirements for section. Includes no less than 2 requirements for section. Includes no less than 1 requirement for section. No requirements for this section presented.
Or
No citations for this section.
Nursing Scope of Practice
(15 points/15%) 15 points 13 points 6 points 0 points
Required criteria
1. Discuss the knowledge needed for the Registered Nurse to provide care for the patient using the therapeutic modality or healthcare technology.
2. Describe skills needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology.
3. Discuss attitudes needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology. Includes no fewer than 3 requirements for section.
Includes no fewer than 2 requirements for section. Includes no less than 1 requirement for section. No requirements for this section presented.
Or
No citations for this section.
Patient Education
(20 points/20%) 20 points 18 points 16 points 8 points 0 points
Required criteria
1. Describe the information to be taught to the patient and/or family.
2. Discuss how information will be taught.
3. Discuss potential cultural considerations to teaching
4. Explain how the effectiveness of the teaching will be evaluated. Includes no fewer than 4 requirements for section.
Includes no fewer than 3 requirements for section. Includes no less than 2 requirements for section. Includes no less than 1 requirement for section. No requirements were met for this section.
Or
No citations for this section.
Conclusion
(5 points/5%) 5 points 4 points 3 points 2 points 0 points
Required criteria
1. Provide a summary of the paper.
2. No new information is introduced.
3. Include additional resources for further learning. Includes no fewer than 3 requirements for section.
Includes no fewer than 2 requirements for section. Includes no less than 1 requirement for section. No requirements for this section presented.
No citations for this section.
APA Style and Organization
(5 points/5%) 5 points 4 points 3 points 2 points 0 points
Required criteria
1. References are submitted with paper.
2. Uses current APA format and is free of errors.
3. Grammar and mechanics are free of errors.
4. At least three (3), nursing, scholarly, peer reviewed, primary sources from the last 5 years, excluding the textbook, are provided. Includes no fewer than 4 requirements for section. Includes no fewer than 3 requirements for section. Includes no less than 2 requirements for section. Includes no less than 1 requirement for section. No requirements for this section presented.
Total Points Possible = 100 points