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Zorluk: OrtaPharmacological and Parenteral Therapies

A nurse is assuming care for a client with severe Crohn's disease who is receiving continuous total parenteral nutrition (TPN) via a double-lumen central venous catheter. The client is currently resting comfortably. Which of the following nursing interventions are appropriate for managing this client's parenteral therapy? Select all that apply.

  1. Keep a bag of 10% dextrose in water (D10W) readily available on the nursing unit.Cevap
  2. Monitor the client's capillary blood glucose levels every 4 to 6 hours.Cevap
  3. Change the TPN solution bag and intravenous administration tubing every 24 hours.Cevap
  4. D
    Increase the TPN infusion rate by 10 mL/hr to catch up if the volume infused falls behind the prescribed schedule.
  5. E
    Administer prescribed intravenous piggyback antibiotics through the dedicated TPN lumen.
  6. F
    Utilize clean technique and clean gloves when performing the central venous catheter dressing change.

Cevap

The correct interventions are keeping 10% dextrose in water (D10W) available, monitoring blood glucose levels every 4 to 6 hours, and changing the TPN bag and tubing every 24 hours.
Safe management of continuous Total Parenteral Nutrition (TPN) involves proactive measures to prevent both metabolic and infectious complications. Because TPN contains a high concentration of dextrose, routine blood glucose checks (every 4 to 6 hours) are necessary to monitor for hyperglycemia. Conversely, if the TPN infusion is suddenly interrupted, the client is at high risk for rebound hypoglycemia; therefore, keeping 10% dextrose in water (D10W) readily available on the unit ensures the glucose infusion can be safely maintained. Finally, the nutrient-dense composition of TPN creates an ideal environment for microbial growth, making it a critical standard of practice to change the TPN bag and the entire administration tubing set strictly every 24 hours.

Adım Adım Çözüm

1
Evaluate the risk of hypoglycemia associated with abrupt TPN cessation.
Identify that a backup supply of D10W must be available to maintain blood glucose levels if the primary TPN bag runs out.
Sudden discontinuation of high-dextrose TPN can trigger severe rebound hypoglycemia.
2
Assess the metabolic complications of continuous high-dextrose infusions.
Determine that frequent blood glucose monitoring (every 4 to 6 hours) is required to detect hyperglycemia.
The high carbohydrate load in TPN can overwhelm the pancreas, leading to elevated blood glucose regardless of diabetic history.
3
Analyze the infection control requirements for hyperalimentation and central venous catheters.
Confirm that TPN bags and tubing must be replaced every 24 hours, and that sterile technique is strictly required for central line dressing changes.
TPN solutions are ideal media for bacterial and fungal growth; strict asepsis and timely equipment changes prevent CLABSI.
4
Review safe administration principles for continuous parenteral therapy.
Determine that TPN rates should never be sped up to catch up, and that the TPN lumen must remain dedicated exclusively for nutrition.
Speeding up the rate causes hyperosmolar diuresis. Mixing medications in the TPN lumen causes dangerous incompatibilities.

Anahtar Kavram

Safe administration of Total Parenteral Nutrition (TPN) requires strict infection control, frequent metabolic monitoring, and adherence to dedicated intravenous line protocols.
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Pharmacological and Parenteral Therapies

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