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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is managing the care of a client who is receiving continuous total parenteral nutrition (TPN) via a peripherally inserted central catheter (PICC). Which of the following nursing actions are appropriate to include in the client's plan of care? (Select all that apply.)

  1. Obtain capillary blood glucose measurements every 4 to 6 hours.Answer
  2. Replace the TPN infusion bag and intravenous tubing every 24 hours.Answer
  3. Hang a 10% dextrose in water (D10W) infusion if the current TPN bag is empty and the new one is not yet available.Answer
  4. D
    Administer intermittent intravenous piggyback medications through the dedicated TPN lumen.
  5. E
    Increase the infusion pump rate to catch up if the volume delivered falls behind schedule.
  6. F
    Disconnect the TPN tubing temporarily when the client ambulates to the bathroom.

Answer

The correct actions are obtaining capillary blood glucose measurements every 4 to 6 hours, replacing the TPN bag and tubing every 24 hours, and hanging a 10% dextrose in water (D10W) infusion if the TPN is abruptly stopped.
Safe administration of Total Parenteral Nutrition requires strict infection control (changing bags and tubing every 24 hours), vigilant glycemic monitoring (checking blood glucose every 4-6 hours), and prevention of sudden hypoglycemia (keeping D10W available if the TPN runs out).

Step-by-Step Solution

1
Evaluate the risk of hyperglycemia and hypoglycemia associated with high-dextrose TPN solutions.
Identified the need for routine blood glucose monitoring and the use of D10W if the infusion is interrupted.
TPN creates continuous high glucose loads, requiring endogenous insulin adaptation. Stopping it suddenly causes hypoglycemia; running it continuously requires monitoring.
2
Assess infection control protocols for central lines and highly concentrated nutritional fluids.
Identified the need to change the tubing/bag every 24 hours and avoid disconnecting the line during ambulation.
TPN solutions are ideal environments for bacterial and fungal growth.
3
Analyze the safety guidelines regarding TPN line access.
Determined that the TPN lumen must be dedicated exclusively to TPN.
Mixing other medications in the TPN line carries a severe risk of chemical incompatibility and precipitation.

Key Concept

Total Parenteral Nutrition (TPN) Safety and Administration
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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