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Difficulty: HardPharmacological and Parenteral Therapies

A client with a severe exacerbation of Crohn's disease is receiving continuous total parenteral nutrition (TPN) via a single-lumen peripherally inserted central catheter (PICC). The healthcare provider prescribes an intravenous (IV) push dose of famotidine every 12 hours. Which of the following nursing actions are appropriate? (Select all that apply.)

  1. Establish a separate peripheral intravenous catheter for the administration of the famotidine.Answer
  2. B
    Pause the continuous TPN, flush the PICC with normal saline, administer the famotidine, and flush again.
  3. C
    Administer the famotidine directly into the Y-site port of the continuous TPN infusion tubing.
  4. Administer the intravenous famotidine slowly over at least 2 minutes to prevent sudden cardiovascular adverse effects.Answer
  5. E
    Increase the TPN infusion rate temporarily to catch up on volume if the infusion is interrupted for any reason.
  6. Monitor the client's capillary blood glucose levels every 4 to 6 hours during the continuous TPN therapy.Answer

Answer

The appropriate actions are establishing a separate peripheral IV for the famotidine, administering the famotidine slowly over at least 2 minutes, and monitoring capillary blood glucose every 4 to 6 hours.
Total parenteral nutrition (TPN) contains complex mixtures of amino acids, dextrose, and electrolytes that are highly incompatible with many medications. Standard safe practice requires TPN to have a strictly dedicated intravenous line. Because the client has a single-lumen PICC, the nurse must establish a separate peripheral IV access to safely administer the famotidine. When administering famotidine via IV push, it must be given slowly over a minimum of 2 minutes to avoid adverse cardiovascular effects such as hypotension or dysrhythmias. Additionally, due to the high dextrose content infused continuously during TPN therapy, the nurse must monitor the client's capillary blood glucose levels every 4 to 6 hours to detect and manage hyperglycemia.

Step-by-Step Solution

1
Analyze the access device and the current continuous therapy.
The client has a single-lumen PICC that is dedicated to a continuous total parenteral nutrition (TPN) infusion.
Identifying the specific type of venous access and current infusions determines how new intravenous medications can be safely administered without causing incompatibilities.
2
Evaluate the standard safety principles for TPN administration.
TPN requires a strictly dedicated line and cannot be paused, flushed, or mixed with other medications in a single lumen.
This strict protocol prevents severe chemical precipitation in the line and minimizes the high risk of central line-associated bloodstream infections.
3
Determine the correct administration route and technique for the new medication.
A new peripheral IV must be established for the famotidine, and the medication must be pushed slowly over at least 2 minutes.
A separate peripheral line maintains the integrity of the TPN infusion. Slow administration of famotidine prevents adverse cardiovascular responses, such as severe hypotension.
4
Identify the ongoing monitoring requirements for a client on TPN therapy.
Capillary blood glucose must be monitored every 4 to 6 hours.
The continuous infusion of highly concentrated dextrose in TPN places the client at constant risk for hyperglycemia, requiring routine monitoring.

Key Concept

Safe administration of Total Parenteral Nutrition (TPN) and IV push medications.
Estimated Time:2m 0s
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Topics

Pharmacological and Parenteral Therapies

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