A nurse is planning care for a client who has a new prescription to receive a continuous infusion of total parenteral nutrition (TPN) Which of the following interventions should the nurse implement?
A.
Change the TPN infusion tubing once every 3 days
B.
Check the client’s blood glucose level regularly
C.
Insert the peripheral IV catheter for administration
D.
Monitor the client’s weight every 3 days
The correct answer and Explanation is :
The correct answer is B. Check the client’s blood glucose level regularly.
Explanation:
Total Parenteral Nutrition (TPN) is a method of providing all the nutritional needs of a patient through intravenous infusion. It bypasses the digestive system, delivering nutrients directly into the bloodstream. Given this, managing and monitoring a patient on TPN involves several critical interventions:
- Blood Glucose Monitoring:
- Rationale: TPN solutions are high in carbohydrates, which can lead to hyperglycemia (high blood sugar levels). Patients receiving TPN are at risk for developing insulin resistance or hyperglycemia, especially if they have preexisting diabetes or impaired glucose tolerance. Therefore, regular blood glucose monitoring is essential to adjust insulin requirements and ensure glucose levels are maintained within a normal range. This helps prevent complications like hyperglycemic crises or infections.
- Infusion Tubing Changes:
- Rationale: TPN infusion tubing should be changed every 24 hours to prevent infection and ensure the sterility of the solution. The option of changing the tubing once every 3 days is inadequate, as it could increase the risk of infection.
- Peripheral IV Catheter:
- Rationale: TPN is typically administered through a central venous catheter (CVC) rather than a peripheral IV catheter. Central access is preferred due to the high osmolarity of TPN solutions, which can cause irritation and damage to peripheral veins.
- Weight Monitoring:
- Rationale: Regular weight monitoring is important to assess the patient’s response to TPN and to adjust the nutrient composition as needed. However, monitoring every 3 days might be less frequent than optimal. More frequent monitoring might be necessary, especially in the initial stages of TPN therapy.
In summary, checking blood glucose levels regularly is crucial for managing patients on TPN due to the high carbohydrate content of the solution and the risk of hyperglycemia. Other interventions, such as changing infusion tubing and using appropriate catheter types, are also important but do not directly address the glucose-related concerns.