A nurse caring a patient which receiving TPN in ICU, what is the right intervention of the nurse? & x20; - AIIMS Rishikesh & Jodhpur NO - 2017

AIIMS Rishikesh & Jodhpur NO - 2017

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

Total Parenteral Nutrition (TPN) solutions have a high concentration of glucose and lipids, which creates an ideal medium for the growth of bacteria and fungi.
To prevent Central Line-Associated Bloodstream Infections (CLABSI), it is a standard and critical nursing practice to change the TPN bag and the entire infusion set every 24 hours.
This rule applies regardless of whether there is still solution left in the bag.
Adhering to this 24-hour rule is a primary intervention to ensure patient safety during TPN therapy.

Option B: This option is too vague and grammatically awkward. While continuing TPN is the overall goal of therapy, it is not a specific, actionable intervention related to the critical 24-hour cycle of bag and tubing changes.
Option C: This is a dangerous and incorrect action. Abruptly stopping a TPN infusion can lead to severe rebound hypoglycemia. The patient's pancreas is producing high levels of insulin to manage the high glucose load from the TPN; suddenly stopping the glucose source will cause blood sugar to drop rapidly.
Option D: This option is incorrect because option B is vague and option C describes a dangerous action that should never be performed.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Safe Administration of Total Parenteral Nutrition (TPN) in acute care settings.
A nurse's primary role in TPN therapy is to prevent complications, with infection (CLABSI) and metabolic instability (hyper/hypoglycemia) being the most critical.
Strict adherence to the 24-hour bag and tubing change protocol is a non-negotiable standard of care that directly prevents life-threatening bloodstream infections.
What if? If a new TPN bag is not available from the pharmacy when the 24-hour change is due, the nurse's immediate action is to discontinue the old TPN and hang a bag of 10% Dextrose in Water (D10W) at the same infusion rate. This prevents rebound hypoglycemia until the new TPN solution arrives.

How to Approach the Question

First, identify the core subject of the question, which is the nursing care for a patient receiving TPN in the ICU.
Recognize that the question asks for the 'right intervention', indicating a need to apply knowledge of standard safety protocols.
Evaluate each option based on established principles of TPN administration.
Option A describes the 24-hour rule for changing TPN bags, a key infection control measure. Recall that TPN is a high-risk solution for microbial growth.
Option C suggests stopping the TPN. Recall the significant risk of rebound hypoglycemia from abrupt cessation. This makes it a dangerous and incorrect choice.
Based on the critical importance of infection control and the danger of stopping the infusion, identify Option A as the correct and safest intervention.

Concept Tested & Keywords

Concept Tested: Safe Administration of Total Parenteral Nutrition (TPN)
Stem keywords: TPN, ICU, nurse, intervention
Lead-in keywords: right intervention
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Negative lead-in flag: false

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