SG #37 Total Parenteral Nutrition

Nurse Russell is preparing to give a total parenteral nutrition using a central line. Place the following steps for administration in the correct order? 1. Connect the tubing to the central line. 2. Regulate the electric infusion pump at the ordered rate. 3. Maintain aseptic technique when handling the injection cap. 4. Check the solution for cloudiness, particles, or a change in color. 5. Prime the IV tubing through an infusion pump. 6. Select and flush the correct tubing and filter.

4, 6, 5, 3, 1, and 2

A nurse observes the client receiving fat emulsions is having hives. A nurse reviews the client's history and note in which of the following may cause about by the complaint of the client? A. Allergy to an egg. B. Allergy to peanut. C. Allergy to shellfish. D. Allergy to corn.

A. allergy to egg Rationale: fam emulsions (lipids) contain egg yolk phospholipids and should not be given to clients with egg allergies.

A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat globules at the top of the solution. The nurse ensure to do which of the following actions? A. Take another bottle of solution. B. Runs the bottle solution under a warm water. C. Rolls the bottle solution gently. D. Shake the bottle solution vigorously.

A. take another bottle of solution Rationale: The nurse should examine the bottle of fat emulsion for separation of emulsion into layers or fat globules or the accumulation of froth. The nurse should not hang a fat emulsion if any of these observed and should return the solution to the pharmacy.

A nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 2 hours delayed. The nurse should do which of the following actions? a. adjust the infusion rate to catch up over the next hour B. make sure the infusion rate is infusing at the ordered rate C. increase the infusion rate to catch up over the next few hours D. adjust the infusion rate to full blast until the solution is back on time

B rationale: the nurse should maintain the prescribed rate of fat emulsion even if the infusion's time consume is behind. Options A, C, and D could potentially lead to fluid overload.

A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse next assesses the client to identify the presence of which of the following? A. Hypotension. B. Crackles upon auscultation of the lungs. C. Thirst. D. Polyuria.

B Rationale: Normally, the weight gain of a client receiving PN is about 1-2 pound a week. A weight gain of 5 pounds over a week indicates a client is experiencing fluid retention that can result to hypervolemia

A 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 ask the client to take which essential action during the tube change? A. Turn the head to the right. B. Inhale deeply, hold it, and bear down. C. Breathe normally. D. Exhale slowly and evenly.

B Rationale: This helps avoid air embolism during tube changes.

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

B. Hypervolemia Rationale: The client's symptoms presented in the question are consistent with hypervolemia. The increased intravascular volume increases the blood pressure whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The increased volume also causes neck vein distention and shifting of fluid into the alveoli, resulting in lung crackles.

A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse next assesses which of the following items? A. Time of last dressing change. B. Tightness of the tuning connections. C. Client's temperature. D. Expiration date on the bag.

C Rationale: Redness at the catheter insertion site is a possible sign of infection. The nurse would next assess for other signs of infection.

A nurse is caring for a group of clients on a medical-surgical nursing unit. The nurse recognizes that which of the following clients would be the least likely candidate for parenteral nutrition? A. A 55-year-old with persistent nausea and vomiting from chemotherapy. B. A 44-year old client with ulcerative colitis. C. A 59-year old client who had an appendectomy. D. A 25-year old client with a Hirschprung's Disease.

C Rationale: The client with an appendectomy is not a candidate because this client would resume a regular diet within a few days following the surgery.

Nurse Spencer is caring for an anorexic client who is having total parenteral nutrition solution for the first time. Which of the following assessments requires the most immediate attention? A. Dry sticky mouth. B. Temperature of 100° Fahrenheit. C. Blood glucose of 210 mg/dl. D. Fasting blood sugar of 98 mg/dl.

C Rationale: TPN formula contains dextrose. A blood glucose level of 210mg/dL is considered high

What are some indications for TPN? (7 )

- inability to ingest adequate calories or nutrients d/t: severe trauma GI obstruction Crohn's disease severe pancreatitis excessive requirements neoplastic disease w/GI toxicity d/t chemo post-op bariatric surgery

9 things we should monitor while pt is on TPN therapy

1. check vital signs q6hrs 2. check blood sugar q6hrs 3. blood glucose daily 4. i&o to monitor fluid balance 5. daily weight 6. check line q1hr 7. daily chemistries (LFT, BMP, BUN, CR) 8. excellent oral hygiene (especially NPO patients) 9. monitor for complications

A nurse is making initial rounds at the beginning of the shift and notice that the parenteral nutrition (PN) bag of an assigned client is empty. Which of the following solutions readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit? A. 10% dextrose in water. B. 5% dextrose in water. C. 5% dextrose in normal saline. D. 5% dextrose in lactated Ringer solution.

A Rationale: The client is at risk of hypoglycemia. Hence the nurse will hang a solution that has the highest amount of glucose until the new parenteral nutrition solution becomes readily available.

A client is being weaned off from parenteral nutrition (PN) and is approved to take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding the PN solution will accompany the diet order? A. Decrease the PN rate to 60ml/hr. B. Start 0.9% normal saline at 30 ml/hr. C. Maintain the present infusion rate. D. Discontinue the PN.

A Rationale: When a client begins eating a regular diet after a period of receiving PN, the PN is decreased slowly. PN that is terminated abruptly will cause hypoglycemia. Gradually decreasing the infusion rate allows the client to remain sufficiently nourished during the transition to a normal diet and prevents an episode of hypoglycemia.

A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies the physician and the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the following with the discontinued materials? A. Send them to the laboratory for culture. B. Save them for a return to the manufacturer. C. Return them to the hospital pharmacy. D. Discard them in the unit trash.

A Rationale: When the client who is receiving PN has a high temperature, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for an infectious organism.

A nurse is caring for a combative client who is ordered to have a nutritional therapy using parenteral nutrition (PN). The nurse should plan which of the following measures to prevent the client from injury? A. Monitor blood glucose twice a day. B. Instruct the relative to stay with the nurse. C. Measure 24-hour intake and output. D. Secure all connections in the parenteral system.

D Rationale: the nurse should plan to secure all connections in the tubing. this will prevent the client from pulling the connections apart.

A nurse is caring a client who disconnected the tubing of the parenteral nutrition from the central line catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate position for the client in this kind of situation? A. On the right side, with head higher than the feet. B. On the right side, with head lower than the feet. C. On the left side, with the head higher than the feet. D. On the left side, with head lower than the feet.

D Rationale: Air embolism happens when air enters the catheter system when the IV tubing disconnects. If it is suspected, the client should be placed in a left-side-lying position. The head should be lower than the feet. This position will lessen the effect of the air traveling as a bolus to the lungs by trapping it on the right side of the heart.

A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client for complications of the therapy and assesses the client for which of the following signs of hyperglycemia? A. High-grade fever, chills, and decreased urination. B. Fatigue, increased sweating, and heat intolerance. C. Coarse dry hair, weakness, and fatigue. D. Thirst, blurred vision, and diuresis.

D rationale: Signs of hyperglycemia include excessive thirst, fatigue, restlessness, blurred vision, confusion, weakness, Kussmaul's respirations, diuresis, and coma when hyperglycemia is severe. Option A are signs of infection. Option B are signs of hyperthyroidism. Option C are signs of hypothyroidism.

A nurse is conducting a follow-up home visit to a client who has been discharged with a parenteral nutrition(PN). Which of the following should the nurse most closely monitor in this kind of therapy? A. Blood pressure and temperature. B. Blood pressure and pulse rate. C. Height and weight. D. Temperature and weight.

D temp and weight Rationale: temp is monitored to identify signs of infection while the weight is monitored to detect hypervolemia

A patient receiving parenteral nutrition is administerd via the following routes except: A. subclavian line B. central venous catheter C. PICC line D. PEG tube

D. PEG tube Rationale: PEG tube is inserted into a person's stomach through the abdominal wall that is used to provide a means of feeding when oral intake is inadequate.

A client receiving parenteral nutrition (PN) complains of shortness of breath and shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse determines that the client is experiencing which complication of PN therapy? A. Air embolism. B. Hypervolemia. C. Hyperglycemia. D. Pneumothorax.

D. Pneumothorax Rationale: Pneumothorax might happen during a parenteral therapy due to inexact catheter placement. In order to prevent this, the nurse obtains a chest x-ray after insertion of the catheter to ensure proper catheter placement.

A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via the central line of a malnourished client. The nurse ensure the availability of which medical equipment before hanging the solution? A. Glucometer. B. Dressing tray. C. Nebulizer D. infusion pump

D. infusion pump Rationale: the nurse should prepare an infusion pump prior to hanging a parenteral solution. the use of an infusion pump is important to make sure that the solution does not infuse too quickly or delayed.

A bag of TPN should hang for no longer than how many hours?

No longer than 24 hours

Which approach to TPN is only for a short period of time? (14 days)

Peripheral venous TPN

What is the only kind of insulin that can be added to TPN?

Regular insulin

What two members of the care team are responsible for determining a patient's TPN prescription?

The HCP and the pharmacist

In central venous TPN, the dextrose concentration can be as high as ___%

as high as 50%

What type of TPN delivery is the best option for independent patients?

cycling TPN therapy

Why is it important to monitor pt blood sugar levels while on TPN?

d/t high dextrose concentrations in TPN

What is the main reason for a patient requiring TPN?

patient is suffering from some kind of nutritional deficit

Possible complications of TPN therapy (5)

sepsis (d/t lack of aseptic technique) thrombosis (clot) air embolism (IV lines) displacement hyper/hypoglycemia (d/t increased levels of dextrose)

True or False Peripheral venous TPN can be stopped quickly without tapering

true