The nurse is caring for a client receiving total parenteral nutrition (TPN). Which of the following complications should the nurse assess for during the therapy? Select all that apply.
The nurse is caring for a client receiving total parenteral nutrition (TPN). Which of the following complications should the nurse assess for during the therapy? Select all that apply.
Statistics
Subject/Lesson
Subject
Adult Health
Lesson
Gastrointestinal
Client Need
Test Plan
Reduction of Risk Potential
Related Topic
Potential for Complications of Diagnostic Tests/Treatments/Procedures
Item Type
Item Type
Analysis
Explanation
Choices A, B, C, and E are correct. The base solution of TPN is dextrose 50%, and this concentrate will increase blood glucose levels. Hyperglycemia (blood glucose > 250 mg/dL, (13.89 mmol/L) [70-110 mg/dL, 4.0–11.0 mmol/L]) is a complication and should be avoided as it may delay healing. The base solution of TPN being dense in dextrose increases the risk for central line-associated bloodstream infection (CLABSI) because fungus and bacteria would be attracted to the dextrose. Air embolism, although rare, may occur if any IV product is not appropriately primed. Dehydration is a possible complication if hyperglycemia also occurs. If the glucose levels are high, this will trigger osmotic diuresis, leading to polyuria. This polyuria would cause dehydration. If the blood glucose remains well controlled, dehydration will not occur with TPN administration.
Choice D is incorrect. Cardiac tamponade is not a complication of TPN administration. Tamponade occurs when there is bleeding or effusion into the pericardial cavity and a subsequent, abrupt increase in central venous pressure with a decrease in systemic blood pressure.
Learning Objective
Recognize the critical complications of TPN administration.
Related Videos
5 Key Topics
TPN
6.7 GI Drugs
TPN Therapy
10.5 Parenteral Therapies
Additional Info
✓ Monitoring of blood glucose levels is crucial for clients receiving TPN. Frequent blood glucose checks help in detecting and managing hyperglycemia promptly. Nurses should be vigilant in monitoring trends and alert healthcare providers if blood glucose levels exceed the desired range.
✓ Given the increased risk of central line-associated bloodstream infections (CLABSI) due to the dextrose content in TPN, strict adherence to infection prevention protocols is essential. Nurses should ensure proper sterile technique during line insertion, dressing changes, and handling of TPN components to minimize the risk of infections.
✓ Work closely with the healthcare team, including dietitians and endocrinologists, to adjust the TPN formulation as needed to control blood glucose levels effectively. Collaboration ensures a holistic approach to the client's care, addressing both nutritional needs and glycemic control.
