ch 12 Parenteral Nutrition

total nutrient admixture (TNA)

a 3-in-1 PN solution: amino acids, fat, dextrose

A patient who is receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What would the nurse do first? a. Have the patient perform a Valsalva procedure b. Clamp the intravenous (IV) tubing to prevent more air from entering the line c. Have the patient take a deep breath and hold it d. Notify the health care provider immediately

a. Have the patient perform a Valsalva procedure Fundamentals

A nurse is planning care for a pt who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply) a. obtain a capillary blood glucose 4 x daily b. administer prescribed medications through a secondary port on the TPN IV tubing c. monitor vital signs 3 x during the 12-hr shift d. change the TPN IV tubing every 24 hrs e. ensure a daily aPTT is obtained

a. obtain a capillary blood glucose 4 x daily c. monitor vital signs 3 x during the 12-hr shift d. change the TPN IV tubing every 24 hrs ATI

A nurse is caring for a pt who is receiving TPN solution. The current bag of solution was hung 24 hr ago, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take? a. remove the current bag and hang a new bag b. infuse the remaining solution at the current rate and then hang a new bag c. increase the infusion rate so the remaining solution is administered within the hour and hang a new bag d. remove the current bag and hang a bag of lactated Ringer's

a. remove the current bag and hang a new bag (bag should not hang for more than 24 hr) ATI

parenteral nutrition

administration of nutrients directly into the bloodstream, used when GI tract can't be used for ingestion, digestion, or absorption

A pt is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse gives: a. 20% intralipids b. 5% dextrose solution c. 0.45% normal saline d. 5% lactated Ringer's solution

b. 5% dextrose solution MS

A patient is receiving both parenteral (PN) and enteral nutrition (EN). When would the nurse collaborate with the health care provider and request discontinuing parenteral nutrition? a. When 25% of the patient's nutritional needs are met by the tube feedings b. When bowel sounds return c. When central line has been in for 10 days d. When 75% of the patient's nutritional needs are met by the tube feedings

d. When 75% of the patient's nutritional needs are met by the tube feedings Fundamentals

cyclic parenteral nutrition

delivery of parenteral nutrition over a reduced time frame - over 8-18 hrs, rather than a 24-hr continuous infusion

how often to change PN solution bag

every 24 hrs (even if bag isn't empty)

how often to check blood glucose for parenteral feedings

every 4-6 hr

parenteral nutrition: how to prevent hypoglycemia

if formula bag empties before new solution is available, administer dextrose solution to prevent hypoglycemia -5% for peripheral PN -10-20% for central PN

what is the purpose of adding heparin to a TPN solution?

to reduce the buildup of a fibrinous clot at the catheter tip / reduce the risk of thrombotic problems with IV catheter

how often to change PN tubing

-PN with lipids (TNA): every 24 hrs -PN without lipids: every 96 hrs -intermittent infusions: changed with each new container or every 24 hrs

what are the benefits of cyclic TPN? (2)

-allows pts requiring TPN on a long-term basis to participate in ADLs without the inconvenience of an IV bag and pump set -prevents or treats hepatotoxicity induced by continuous PN

when to choose CVAD vs peripheral line for TPN (3)

-high osmolarity of solution can cause phlebitis in peripheral line (>600 mOsm/L) -solutions with >10% dextrose must be infused via CVAD -CVAD for long-term use

indications for cyclic TPN (5)

-pts who have been stable on continuous PN -pts who require long-term PN -pts receiving home PN -pts who can handle total infusion volume in a shortened time period -pts who require PN for only a portion of their nutritional needs

A client receiving total parenteral nutrition experiences sudden development of chest pain, dyspnea, tachycardia, cyanosis, and a decreased level of consciousness. What should the nurse suspect as a complication of the total parenteral nutrition? 1. Air embolism 2. Hyperglycemia 3. Catheter-related sepsis 4. Allergic reaction to the catheter

1. Air embolism NCLEX

A client receiving parenteral nutrition through a central intravenous (IV) line is scheduled to receive an antibiotic by the IV route. Which action by the nurse is appropriate before hanging the antibiotic solution? 1. Ensure a separate IV access for the antibiotic. 2. Turn off the solution for 30 minutes before administering the antibiotic. 3. Flush the central IV line with 60 mL of normal saline before giving the antibiotic. 4. Check with the pharmacy to be sure the antibiotic can be given through the parenteral nutrition solution line.

1. Ensure a separate IV access for the antibiotic.

The nurse is educating the patient and his family about the parenteral nutrition. Which aspect related to this form of nutrition would be appropriate to include? (Select all that apply.) 1. The purpose of the fat emulsion in parenteral nutrition is to prevent a deficiency in essential fatty acids. 2. We can give you parenteral nutrition through your peripheral intravenous line to prevent further infection. 3. The fat emulsion will help control hyperglycemia during periods of stress. 4. The parenteral nutrition will help your wounds heal. 5. Since we just started the parenteral nutrition, we will only infuse it at 50% of your daily needs for the next 6 hours.

1. The purpose of the fat emulsion in parenteral nutrition is to prevent a deficiency in essential fatty acids. 3. The fat emulsion will help control hyperglycemia during periods of stress. 4. The parenteral nutrition will help your wounds heal. Fundamentals

normal blood glucose levels with parenteral feedings

110-150 mg/dL

The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (PN) bag of an assigned client is empty. Which solution should the nurse hang until another PN solution is mixed and delivered to the nursing unit? 1. 5% dextrose in water 2. 10% dextrose in water 3. 5% dextrose in Ringer's lactate 4. 5% dextrose in 0.9% sodium chloride

2. 10% dextrose in water NCLEX

The nurse is assigned to a client receiving total parenteral nutrition (TPN) who had a blood glucose measurement done at 06:00. The nurse documents on the client's clinical worksheet for the day that the blood glucose level should be checked next at which time? 1. 08:00 2. 12:00 3. 16:00 4. 18:00

2. 12:00 (check blood glucose every 4-6 hrs) NCLEX

A patient is receiving total parenteral nutrition (TPN). What is the primary intervention the nurse should follow to prevent a central line infection? 1. Institute isolation precautions 2. Clean the central line port through which the TPN is infusing with alcohol 3. Change the TPN tubing every 24 hours 4. Monitor glucose levels to watch and assess for glucose intolerance

2. Clean the central line port through which the TPN is infusing with alcohol Fundamentals

Which nursing action is essential prior to initiating a new prescription for 500 mL of fat emulsion (lipids) to infuse at 50 mL/hour? 1. Ensure that the client does not have diabetes. 2. Determine whether the client has an allergy to eggs. 3. Add regular insulin to the fat emulsion, using aseptic technique. 4. Contact the health care provider (HCP) to have a central line inserted for fat emulsion infusion.

2. Determine whether the client has an allergy to eggs. NCLEX

A client has been discharged to home on parenteral nutrition (PN). With each visit, the home care nurse should assess which parameter most closely in monitoring this therapy? 1. Pulse and weight 2. Temperature and weight 3. Pulse and blood pressure 4. Temperature and blood pressure

2. Temperature and weight NCLEX

The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the central line of an assigned client. The nurse should obtain which most essential piece of equipment before hanging the solution? 1. Urine test strips 2. Blood glucose meter 3. Electronic infusion pump 4. Noninvasive blood pressure monitor

3. Electronic infusion pump NCLEX

The nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 1 hour behind. Which action should the nurse take? 1. Adjust the infusion rate to catch up over the next hour. 2. Increase the infusion rate to catch up over the next 2 hours. 3. Ensure that the fat emulsion infusion rate is infusing at the prescribed rate. 4. Adjust the infusion rate to run wide open until the solution is back on time.

3. Ensure that the fat emulsion infusion rate is infusing at the prescribed rate. NCLEX

A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally. The nurse determines that the client is experiencing which complication of PN therapy? 1. Sepsis 2. Air embolism 3. Hypervolemia 4. Hyperglycemia

3. Hypervolemia NCLEX

A client receiving total parenteral nutrition (TPN) has a history of heart failure. The health care provider (HCP) has prescribed furosemide 40 mg by mouth daily to prevent fluid overload. Which laboratory value should the nurse monitor to identify the presence of an adverse effect of this medication? 1. Sodium 2. Glucose 3. Potassium 4. Magnesium

3. Potassium (furosemide is a diuretic - hypokalemia) NCLEX

A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse should next assess the client for the presence of which condition? 1. Thirst 2. Polyuria 3. Decreased blood pressure 4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs (+5 lb/week = fluid retention) NCLEX

A client with pancreatitis is being weaned from total parenteral nutrition (TPN). The client asks the nurse why the TPN cannot just be stopped. The nurse formulates a response knowing that which complication could occur with sudden termination of TPN formula? 1. Dehydration can result 2. Hypokalemia may occur 3. Hypernatremia may occur 4. Rebound hypoglycemia is a risk

4. Rebound hypoglycemia is a risk NCLEX

The nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse asks the client to take which essential action during the tubing change? 1. Breathe normally. 2. Turn the head to the right. 3. Exhale slowly and evenly. 4. Take a deep breath, hold it, and bear down.

4. Take a deep breath, hold it, and bear down. NCLEX

A client is receiving parenteral nutrition (PN). The nurse monitors the client for complications of the therapy and should assess the client for which manifestations of hyperglycemia? 1. Fever, weak pulse, and thirst 2. Nausea, vomiting, and oliguria 3. Sweating, chills, and abdominal pain 4. Weakness, thirst, and increased urine output

4. Weakness, thirst, and increased urine output NCLEX

what is the limit of the osmolarity concentration that can be infused through a peripheral line?

600 mOsm/L