Case Study Total Parenteral Nutrition (video case study)

A nurse is preparing to hang a new bag of total parenteral nutrition (TPN) for a client and discovers that is has not arrived from the pharmacy. Which of the following available solutions should the nurse infuse until the clients TPN arrives?

Dextrose 10% in water Rationale: the nurse should infuse dextrose 10% or 20% in water if the clients TPN solution is temporarily unavailable. Dextrose 10% in water is a hypertonic solution and contains 340 calories per liter. Abruptly stopping TPN can cause hypoglycemia therefore infusing dextrose 10% in water temporarily at the same rate as the TPN can prevent this adverse effect.

A nurse is reviewing the serum levels of a client who is receiving total parenteral nutrition (TPN). The nurse should identify which of the following laboratory findings as an adverse effect of the TPN?

Glucose 129 mg/dL Rationale: a serum glucose level of 129 mg/dL is above the expected reference range of 70 to 100 mg/dL; therefore, this value indicates hyperglycemia which is a potential adverse effect of TPN due to the hyperosmolarity of the plasma and may result is osmotic diuresis. The hyperosmolarity is caused by amino acid and dextrose concentrations in the PTN. The increased dextrose in turn causes increased blood glucose (hyperglycemia).

The nurse is providing discharge teaching to the caregiver of a client who is malnourished and will be receiving partial parenteral nutrition (PPN) at home via a peripherally inserted central catheter (PICC). Which of the following instructions should the nurse include?

Place the feeding equipment out of the client's view when it is not in use. Rationale: The nurse should advise the caregiver to always consider the psychosocial characteristics of this type of nutrition a therapy; therefore, the caregiver should place the feeding equipment out of the client's view when it is not in use.

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following actions should the nurse take?

Remove the TPN solution from the refrigerator 1 hr prior to infusion. Rationale: the nurse should remove the TPN solution from the refrigerator 1 hour prior to administration because the TPN should reach room temperature before it is infused.

A nurse is planning to administer total parenteral nutrition (TPN) with 10% dextrose to a newly-admitted client. Which of the following actions should the nurse plan to take?

Change the client's IV catheter tubing every 24 hours. Rationale: The nurse should change the client's IV tubing every 24 hours to protect the client from bacterial and fungal growth, which can cause infections.