Examkin

Question

Difficulty: HardPharmacological and Parenteral Therapies

A nurse is receiving a handoff report for a client who is receiving total parenteral nutrition (TPN) via a dedicated lumen of a central venous catheter (CVC). Which of the following actions should the nurse include in the client's plan of care? (Select all that apply)

  1. Verify the components of the newly prepared TPN solution against the provider's prescription with another registered nurse.Answer
  2. Assess the client's capillary blood glucose levels every 4 to 6 hours.Answer
  3. Hang an infusion of 10% dextrose in water (D10W) at the prescribed TPN rate if the current bag empties before the next one arrives.Answer
  4. D
    Temporarily pause the TPN to administer an intermittent intravenous (IV) antibiotic through the same central line lumen.
  5. E
    Increase the TPN infusion rate to catch up if the volume infused falls behind the ordered schedule.
  6. F
    Delegate the daily evaluation of the central venous catheter insertion site to the unlicensed assistive personnel (UAP).

Answer

The correct actions include verifying the TPN components with another registered nurse, assessing blood glucose levels every 4 to 6 hours, and hanging D10W if the TPN bag empties prematurely.
Total Parenteral Nutrition (TPN) is a high-alert medication that requires strict adherence to safety protocols. Because it is customized daily, two nurses must verify the prescription to prevent errors. The high dextrose concentration necessitates routine capillary blood glucose monitoring to detect and treat hyperglycemia. Furthermore, if the TPN infusion is interrupted abruptly, the client is at high risk for severe rebound hypoglycemia due to actively circulating insulin; therefore, infusing 10% dextrose in water (D10W) at the prescribed rate is a critical safety measure to maintain glycemic stability.

Step-by-Step Solution

1
Evaluate the requirement for medication verification.
Identify that TPN is a high-alert medication containing customized electrolytes and nutrients.
High-alert medications require independent double-checking by two registered nurses to ensure patient safety and correct formulation.
2
Analyze the metabolic complications associated with TPN.
Determine that the high dextrose concentration causes hyperglycemia, and abrupt cessation causes rebound hypoglycemia.
This establishes the critical need for routine blood glucose monitoring and the use of a D10W bridge if the TPN supply is interrupted.
3
Assess the safety of the proposed intravenous line management and delegation.
Identify that TPN lines must remain completely dedicated, infusion rates must not be artificially increased, and clinical site assessments cannot be delegated.
Adhering to these strict pharmacological and delegation protocols prevents severe complications like medication incompatibility, hyperosmolar states, and undetected central line infections.

Key Concept

Safe administration and monitoring of Total Parenteral Nutrition (TPN)
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic