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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is receiving shift report for a client with severe Crohn's disease who is malnourished and has just been started on continuous total parenteral nutrition (TPN) via a newly placed peripherally inserted central catheter (PICC). Which of the following nursing interventions should the nurse include in the client's daily plan of care? (Select all that apply.)

  1. Monitor the client's capillary blood glucose levels every 4 to 6 hours.Answer
  2. Change the TPN infusion tubing and intravenous filter every 24 hours.Answer
  3. Keep a liter bag of 10% dextrose in water (D10W) readily available on the unit.Answer
  4. D
    Increase the TPN infusion rate by 10 mL/hr to catch up if the volume infused is behind schedule.
  5. E
    Administer prescribed intermittent IV antibiotics through the Y-site of the TPN line.
  6. F
    Delegate the assessment of the PICC insertion site for redness and swelling to the unlicensed assistive personnel (UAP).

Answer

The correct interventions for a client receiving TPN include monitoring capillary blood glucose every 4 to 6 hours, changing the TPN infusion tubing and filter every 24 hours, and keeping 10% dextrose in water (D10W) available at the bedside.
Total parenteral nutrition (TPN) is a hypertonic solution containing a high concentration of dextrose, amino acids, and other nutrients. Because of the high dextrose load, clients are at significant risk for hyperglycemia, requiring routine capillary blood glucose monitoring every 4 to 6 hours. The high nutrient content also makes TPN an ideal medium for bacterial growth, so the infusion tubing and intravenous filter must be changed every 24 hours to prevent central line-associated bloodstream infections (CLABSI). Additionally, if the TPN solution must be abruptly stopped or the next bag is delayed, infusing 10% dextrose in water (D10W) at the same rate is necessary to prevent rebound hypoglycemia.

Step-by-Step Solution

1
Identify the primary therapy and its associated risks.
The client is receiving continuous TPN, which poses specific risks for hyperglycemia, systemic infection, rebound hypoglycemia, and IV incompatibility.
Recognizing the high glucose, hyperosmolar nature, and complex composition of TPN guides necessary safety interventions.
2
Evaluate each intervention for safety and appropriateness.
Monitoring glucose, changing tubing every 24 hours, and having D10W available appropriately mitigate these risks. Conversely, increasing infusion rates, co-infusing medications, and delegating central line assessments compromise patient safety.
Ensures adherence to core pharmacological and parenteral therapy administration standards.

Key Concept

Safe administration, monitoring, and complication prevention for Total Parenteral Nutrition (TPN)
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Topics

Pharmacological and Parenteral Therapies

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