Parenteral nutrition

The patient was placed in non per orem or strictly no food and fluid intake. As a result, he was then administered total parenteral nutrition (TPN) to meet his nutritional needs since no ingestion, digestion and absorption of essential nutrients via the gastrointestinal tract is possible during the period of his admission. The dressing to cover the open on the left buttock of the patient has to be changed from time to time. As per doctor’s order, the patient was placed in TPN IV or total parenteral nutrition.

The list of medications carried out were Intraplipids – IV, Baclofen, Clorazapate, Clotrimazole Cream, Ammonium Lactate Cream, Absorbase Cream, Cefepime IV, Prevacid, and Metronidazole Flagyl. Intralipids is needed to provide calories and essential fatty aids to the patient who is getting his nutrition through an injection into the vein. This product helps reverse or prevent the signs of immunodeficiency. Baclofen is used to treat spasm of skeletal muscles that cause muscle Clinical Log – 3 – clonus, rigidity, and pain.

The side effects of Baclofen are drowsiness, weakness, dizziness, headache, seizures, nausea, vomiting, low blood pressure, constipation, confusion, respiratory depression, inability to sleep, and increased urinary frequency or urinary retention. Another drug given to the patient is Clorazepate. It is used to treat anxiety disorders, insomnia. anticonvulsant or muscle relaxant. There are three creams prescribed to the patient namely Clotrimazole cream, Ammonium Lactate ream and Absorbase cream.

Clotrimazole cream is an antifungal agent which kills sensitive fungi by binding to the fungal cell membrane and weakening then death of the fungus. Ammonium Lactate cream is used to treat itching due to dry skin and other minor skin irritations. It decreases itching in the affected area of the patient. The Absorbase cream is used to treat excessively dry skin and dry skin conditions of the patient. The drug Cefepime or cephalosporin antibiotic is given to treat a wide variety of bacterial infections. This medication is known as a cephalosporin antibiotic.

It works by stopping the growth of bacteria. While Prevacid decreases the amount of acid produced in the stomach and to prevent stomach and intestinal ulcers, erosive esophagitis, and other conditions involving excessive stomach acid. Metronidazole Flagyl is an antibacterial drug. It is used to kill any bacteria in the body that are causing infection. Metronidazole is not compatible with TPN thus there is a need to shut off the TPN upon administration of the said drug. The same goes for cephapide. TPN and Intralipids were prescribed to slow down GI motility.

Among the nursing independent actions that I accomplished were turning my patient and other patients from side to side every two hours. The other patients weren’t assigned to me but needs to be turned as well. Clinical Log – 4 – In order to maximize my learning and skills, my preceptor loans me to other nurses in managing their patients when I’m not occupied with my patient. After I had attended to the needs and medications of my patient, I drew blood as a specimen for blood cultures for all patients on the unit. I experienced difficulty in rendering a dressing in the site of infection since the patient kept on defecating.

It was necessary for me to repack the wound two times in a row. I changed the dressing of the wound on his left buttocks twice throughout the whole shift. The constant defecating is related to diarrhea complicates the healing process of the open wound in the perirectal area. We plan on talking to MD about Imodium AD. The patient is exposed to more people outside his home at the age of 4 years old or as a pre-schooler. He is in the stage of initiative versus guilt according to Erikson’s theory of psychosocial development ((Ball, Bindler 531).

I encouraged parental involvement in care to ease the patient’s anxiety due to new faces and environment related to his admission. I encouraged verbalization of feelings of the patient and offered explanations about the procedures and treatments given to him especially about his wound. I also explained to the patient that he is not responsible for causing the illness.

Reference Ball, Jane W. , and Ruth Bindler. Child Health Nursing: partnering with children and families. New Jersey: Carlisle Publishers Service. 2006.

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