McKenna's Pharmacology for Nursing, 2e

Appendix B PN is also associated with mechanical problems related to insertion of the line, such as pneumothorax, infections or air emboli; emboli related to protein or lipid aggre- gation; infections related to nutrient-rich solution and invasive administration; metabolic imbalances related to the composition of the solution; gallstone development (especially in children); and nausea (especially related to the administration of lipids). Clinically important drug–drug interactions Some IV drugs can be diluted only with particular IV solutions to avoid precipitation or inactivation of the drug. A drug guide should be checked before diluting any IV drug in solution. ■ ■ Obtain a nutritional assessment. Screen for any medical conditions and drugs being taken. ■ ■ Evaluate the insertion site; skin hydration; orientation and affect; height and weight; pulse, blood pressure and respirations; and blood chemistries, full blood count with differential and glucose levels. Implementation ■ ■ Assess the person’s general physical condition before beginning test to decrease the potential for adverse effects. ■ ■ Monitor the IV insertion site or central line and regularly consult with the prescriber to discontinue the site of infusion and treat any infection or extravasation as soon as it occurs. ■ ■ Follow these administration guidelines to provide the most therapeutic use of PN with the fewest adverse effects: –– Refrigerate PN solutions until ready to use. –– Check contents before hanging to ensure that no precipitates are present. –– Do not hang bag for longer than 24 hours. –– Suggest the use of in-line filters to decrease bacterial invasion and infusion of aggregate. ■ ■ Discontinue PN only after an alternative source of nutrition has been established to ensure continued Care considerations Assessment: History and examination

Parenteral agents

P arenteral preparations are fluids that are given either intravenously (IV) or through a central line. Therapeutic actions and indications Parenteral agents are used for the following purposes: to provide replace- ment fluids, sugars, electrolytes and nutrients to people who are unable to take them in orally; to provide ready access for administration of drugs in an emergency situation; to provide rehydration; and to restore electro- lyte balance. The composition of the IV fluids needed for an individ- ual depends on the person’s fluid and electrolyte status.

Parenteral nutrition (PN) is the administration of essential proteins, amino acids, carbohydrates, vitamins, minerals, trace elements, lipids and fluids. PN is used to improve or stabilise the nutritional status of cachectic or debilitated people who cannot take in or absorb oral nutrition to the extent required to maintain their nutri- tional status. The exact composition of the PN solution is determined after a nutritional assessment and must take into account the person’s current health status, age and metabolic needs. Contraindications and cautions PN is contraindicated in anyone with known allergies to any component of the solution. (Multiple combina- tion products are available, so a suitable solution may be found.) PN should be used with caution in indi- viduals with unstable cardiovascular status because of the change in fluid volume that might occur and the resultant increased workload on the heart. These preparations also should be used with caution in indi- viduals with unstable fluid and electrolyte status, who could react adversely to sudden changes in fluids and electrolytes. Adverse effects Adverse effects associated with the use of PN include IV irritation, extravasation of the fluid into the tissues, infection of the insertion site, fluid volume overload, vascular problems related to fluid shifts and potential electrolyte imbalance related to dilution of the blood.