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Difficulty: HardPharmacological and Parenteral Therapies

A nurse assumes care for a client with severe Crohn's disease who is malnourished and receiving Total Parenteral Nutrition (TPN) via a peripherally inserted central catheter (PICC). The client's current vital signs are stable, and the continuous infusion is running on an electronic pump. Which of the following nursing actions must be included in the client's plan of care? Select all that apply.

  1. Monitor the client's capillary blood glucose levels at regular intervals of every 4 to 6 hours.Answer
  2. Replace the parenteral nutrition administration tubing and inline filter every 24 hours.Answer
  3. Verify the specific macronutrient and micronutrient ingredients on the dispensed solution label against the provider's prescription.Answer
  4. D
    Delegate the ongoing inspection of the PICC insertion site for signs of infection to the unlicensed assistive personnel (UAP).
  5. E
    Administer prescribed intermittent intravenous antibiotics through the Y-site of the dedicated parenteral nutrition line.
  6. F
    Recalculate and increase the programmed infusion rate to compensate if the delivered volume falls behind the prescribed schedule.

Answer

The correct actions are to monitor capillary blood glucose every 4 to 6 hours, replace the administration tubing and filter every 24 hours, and verify the specific ingredients on the label against the provider's prescription.
Total Parenteral Nutrition (TPN) is a complex, high-alert therapy requiring meticulous nursing management. Because TPN solutions contain high concentrations of dextrose, clients are at significant risk for therapy-induced blood glucose fluctuations; therefore, routine capillary blood glucose monitoring every 4 to 6 hours is essential. The high glucose and lipid content also creates an ideal medium for bacterial growth, necessitating the strict replacement of the entire administration set and inline filter every 24 hours. Furthermore, due to the highly customized nature of the solution, the nurse must meticulously verify all specific macro- and micronutrients on the bag's label against the original prescription to prevent critical compounding errors.

Step-by-Step Solution

1
Analyze the prescribed therapy and its associated risks.
The client is receiving Total Parenteral Nutrition (TPN) via a central line, which carries significant metabolic, infectious, and compatibility risks.
Recognizing the high-alert nature of TPN guides the prioritization of safety protocols.
2
Evaluate the correct options based on TPN standards of care.
Monitoring blood glucose, verifying exact ingredients, and changing tubing every 24 hours are standard safety protocols.
These specific actions mitigate the inherent risks of hyperglycemia, medication compounding errors, and central line-associated bloodstream infections.
3
Identify and exclude the incorrect nursing actions.
Delegating the site assessment, mixing medications in the line, and increasing the rate to catch up are identified as unsafe.
These actions directly violate delegation guidelines, intravenous compatibility rules, and critical fluid/electrolyte safety limits.

Key Concept

Parenteral Nutrition Administration and Monitoring
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Topics

Pharmacological and Parenteral Therapies

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