safety measures
What is the primary risk of abruptly stopping TPN, and what should be kept at the bedside to prevent this risk?
Hypoglycemia; keep dextrose 10% in water at the bedside.
What is the primary concern when administering lipid infusions, and what precautions should be taken?
Risk of fat overload syndrome; monitor triglyceride levels and assess for fever, jaundice, or hepatomegaly.
What are two major blood glucose-related metabolic complications of TPN?
Hyperglycemia and hypoglycemia.
What causes an air embolism when using TPN?
A pressure change during tubing changes, allowing air to enter the bloodstream.
Why does TPN increase the risk for fluid volume excess?
TPN is a hyperosmotic solution, causing fluid shifts and potential overload.
Why is it contraindicated to speed up or slow down the rate of TPN infusion?
It can cause significant blood glucose fluctuations, leading to hyperglycemia or hypoglycemia.
What are common metabolic complications associated with TPN?
Hyperglycemia, hypoglycemia, and vitamin deficiencies.
Why do older adult clients receiving TPN have an increased risk of glucose intolerance?
Due to decreased insulin sensitivity and pancreatic function.
What are the symptoms of an air embolism?
Sudden onset of dyspnea, chest pain, anxiety, and hypoxia.
What are common signs of fluid volume excess in a patient receiving TPN?
Crackles in lungs, edema, weight gain, and respiratory distress.
What should be done if a new bag of TPN is unavailable and the previous bag has finished?
Administer dextrose 10% in water to prevent hypoglycemia until the new bag is available.
What should nurses review daily to ensure TPN is meeting the client’s needs?
Daily laboratory results to match prescribed TPN components with patient requirements.
What are the signs of hyperglycemia in a patient receiving TPN?
Polyuria, polydipsia, confusion, and fatigue.
What immediate actions should the nurse take if an air embolism is suspected?
Clamp the catheter, place the patient on their left side in Trendelenburg position, administer oxygen, and notify the provider.
Why are older adults more vulnerable to fluid and electrolyte imbalances when receiving TPN?
Due to decreased kidney function and reduced physiological reserves.
Why should the TPN line not be used for other IV bolus fluids and medications?
To reduce the risk of infection, as repeated access increases contamination risk.
What are common manifestations of systemic infection due to TPN administration?
Fever, chills, increased WBC count, and malaise.
How are fluid needs typically replaced in a patient on TPN to prevent fluid volume excess?
With a separate IV bolus instead of increasing TPN volume.
What position should the patient be placed in if an air embolism is suspected?
Left side in Trendelenburg position to trap the air in the right atrium.
What should be assessed daily to monitor for fluid imbalances in a patient receiving TPN?
Daily weights, intake and output, and lung sounds.
How often should capillary glucose be checked during the first 24 hours of TPN administration?
Every 4 to 6 hours.
How often should IV tubing be changed for TPN administration?
Every 24 hours.
What nursing interventions should be implemented to prevent vitamin deficiencies in patients receiving TPN?
Monitor vitamin levels and ensure prescribed multivitamins and trace elements are included in TPN.
Why does clamping the catheter help in the case of an air embolism?
It prevents further air from entering the bloodstream.
Why is a controlled infusion pump essential for TPN administration?
It ensures a precise rate to avoid fluid and glucose imbalances.