A nurse on the day shift is preparing to change a client’s total parenteral nutrition (TPN) solution, but the new TPN solution has not arrived from the pharmacy. The client receives additional IV fat emulsion during the night shift.
Which of the following actions should the nurse take?
A.
Hang the IV fat emulsion solution.
B.
Call the provider for new TPN orders.
C.
Hang dextrose 10% in water (D10W) until the TPN solution is delivered.
D.
Saline lock the IV catheter after discontinuing the TPN solution.
The Correct Answer and Explanation is:
Correct Answer: C. Hang dextrose 10% in water (D10W) until the TPN solution is delivered.
Explanation:
Total parenteral nutrition (TPN) is a life-sustaining therapy for clients who cannot obtain adequate nutrition through oral or enteral routes. TPN solutions are hypertonic and provide essential nutrients, including carbohydrates, proteins, fats, vitamins, and minerals, directly into the bloodstream via a central venous catheter. This therapy is particularly vital for clients with severe gastrointestinal disorders, malabsorption syndromes, or those recovering from major surgeries who require complete bowel rest.
One of the critical considerations when administering TPN is maintaining a continuous infusion. Sudden discontinuation or interruption of TPN can lead to severe complications, such as hypoglycemia, because the client’s body becomes dependent on the constant supply of glucose provided by the TPN. Without this continuous glucose supply, blood sugar levels can drop rapidly, leading to symptoms such as confusion, dizziness, diaphoresis, and in severe cases, loss of consciousness or seizures.
If the new TPN solution is not available when it’s time to replace the current one, the appropriate nursing action is to hang dextrose 10% in water (D10W) at the same infusion rate as the TPN. D10W provides a similar glucose concentration to that found in TPN solutions, helping to prevent hypoglycemia until the new TPN solution can be administered. This step is a critical safety measure to ensure the client’s blood glucose levels remain stable.
Option A (Hang the IV fat emulsion solution) is incorrect because IV fat emulsions, while part of nutritional support, do not provide sufficient carbohydrates to prevent hypoglycemia. Option B (Call the provider for new TPN orders) is unnecessary and would delay appropriate care; the provider is not required for this situation since hanging D10W is an appropriate standard practice. Option D (Saline lock the IV catheter after discontinuing the TPN solution) is inappropriate because it would leave the client without a glucose source, risking severe hypoglycemia.
In conclusion, the nurse should hang D10W to maintain the client’s blood glucose levels and prevent complications while awaiting the new TPN solution. This action reflects a critical understanding of the client’s metabolic needs and the importance of continuous nutrient delivery in TPN therapy.