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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is planning care for a client who is receiving continuous total parenteral nutrition (TPN) via a peripherally inserted central catheter (PICC). Which of the following interventions should the nurse include in the client's plan of care? (Select all that apply.)

  1. Monitor capillary blood glucose levels every 4 to 6 hours.Answer
  2. Keep a liter of 10% dextrose in water (D10W) readily available on the unit.Answer
  3. C
    Administer scheduled intravenous antibiotics through the same PICC lumen used for the TPN.
  4. Change the TPN administration set and filter every 24 hours.Answer
  5. E
    Instruct the unlicensed assistive personnel (UAP) to adjust the infusion pump rate if an occlusion alarm sounds.

Answer

The appropriate interventions include monitoring blood glucose every 4 to 6 hours, keeping 10% dextrose in water available, and changing the TPN tubing and filter every 24 hours.
Total parenteral nutrition (TPN) safely requires strict metabolic and infection control monitoring. Because of the high dextrose load, blood glucose must be monitored every 4 to 6 hours to detect hyperglycemia. If the TPN bag empties before the next one is available, a 10% dextrose in water (D10W) solution must be infused at the prescribed TPN rate to prevent dangerous rebound hypoglycemia. Furthermore, the nutrient-rich solution is highly susceptible to bacterial growth, requiring the tubing and filter to be replaced every 24 hours.

Step-by-Step Solution

1
Analyze the metabolic requirements and risks associated with total parenteral nutrition (TPN).
Identify that TPN has a high dextrose concentration, posing risks for hyperglycemia during infusion and hypoglycemia if stopped abruptly.
Understanding the composition of TPN dictates the need for frequent blood glucose checks and having D10W on standby.
2
Evaluate infection control standards for parenteral nutrition.
Determine that the high nutrient content necessitates changing the administration set and filter every 24 hours.
Strict asepsis is required to prevent central line-associated bloodstream infections (CLABSI).
3
Assess intravenous line compatibility and delegation principles.
Recognize that TPN requires a dedicated line and that managing IV pumps is strictly a nursing responsibility.
Co-administering medications risks precipitation or occlusion, and UAPs lack the scope of practice to manage IV infusions.

Key Concept

Safe administration and monitoring of Total Parenteral Nutrition (TPN)
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Topics

Pharmacological and Parenteral Therapies

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