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Zorluk: OrtaPharmacological and Parenteral Therapies

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

  1. Change the TPN infusion tubing and filter every 24 hours.Cevap
  2. Assess the client's capillary blood glucose every 4 to 6 hours.Cevap
  3. Keep a bag of 10% dextrose in water (D10W) available in case the TPN solution bag becomes empty.Cevap
  4. D
    Administer prescribed intravenous push (IVP) medications through the same lumen as the TPN infusion.
  5. E
    Increase the infusion rate to catch up if the volume delivered falls behind the prescribed schedule.
  6. F
    Delegate the routine assessment of the central line insertion site to the unlicensed assistive personnel (UAP).

Cevap

The appropriate actions are changing the tubing/filter every 24 hours, monitoring blood glucose every 4 to 6 hours, and keeping a bag of D10W available.
The correct actions reflect safe total parenteral nutrition (TPN) administration principles. Because TPN is rich in glucose and nutrients, the infusion tubing and filter must be replaced every 24 hours to prevent bacterial growth. The continuous high dextrose concentration requires capillary blood glucose monitoring every 4 to 6 hours to detect and manage hyperglycemia. Additionally, if the TPN bag becomes empty before a replacement is available, immediately infusing 10% dextrose in water (D10W) at the exact same rate prevents life-threatening rebound hypoglycemia.

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1
Identify the therapy being administered and its associated physiological risks.
The client is receiving total parenteral nutrition (TPN), which is hypertonic, rich in glucose and nutrients, and must be administered via a central line.
Understanding the composition of TPN helps anticipate potential complications such as systemic infection, severe hyperglycemia, and rebound hypoglycemia.
2
Evaluate each nursing action against TPN safety protocols and central venous catheter care standards.
Changing the tubing every 24 hours limits bacterial colonization. Monitoring blood glucose every 4 to 6 hours detects hyperglycemia early. Hanging D10W if TPN runs out prevents sudden hypoglycemia.
These interventions directly mitigate the known risks associated with continuous high-dextrose parenteral infusions.
3
Identify contraindicated actions that violate pharmacological safety and delegation principles.
Giving medications through a dedicated TPN line, speeding up the IV rate, and delegating site assessments to a UAP are unsafe clinical practices.
TPN requires a dedicated line to avoid drug crystallization. Rate alterations cause dangerous glycemic shifts, and UAPs lack the scope of practice to perform physiological assessments.

Anahtar Kavram

Total Parenteral Nutrition (TPN) Administration and Safety
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Konular

Pharmacological and Parenteral Therapies

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