A nurse caring for a patient who is receiving TPN in ICU, what is the right intervention of the nurse?

AIIMS Rishikesh & Jodhpur NO - 2017

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

Discarding the TPN bag and tubing every 24 hours is a critical infection control measure, which is a standard of care.
TPN solutions have high concentrations of glucose and lipids, making them an ideal medium for bacterial and fungal growth.
This practice is essential to prevent potentially fatal central line-associated bloodstream infections (CLABSIs).

Option B: Continuing the same TPN infusion bag beyond 24 hours significantly increases the risk of sepsis because the nutrient-rich solution promotes microbial growth.
Option C: Abruptly stopping TPN is dangerous and can lead to rebound hypoglycemia, characterized by symptoms like dizziness, sweating, and tachycardia.
Option D: This is incorrect because continuing an old bag and stopping TPN abruptly are both incorrect and unsafe nursing interventions.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Safety protocols and nursing interventions for Total Parenteral Nutrition (TPN) administration in acute care settings.
Strict adherence to the 24-hour rule for TPN bags and tubing is a nurse's primary defense against life-threatening Central Line-Associated Bloodstream Infections (CLABSIs).
Nurses must meticulously monitor blood glucose levels during TPN therapy to manage the dual risks of hyperglycemia (from the infusion) and hypoglycemia (if the infusion is interrupted).
What if? If a new TPN bag is not available from the pharmacy when the 24-hour infusion is complete, the nurse's priority is to hang a bag of 10% Dextrose in Water (D10W) at the same infusion rate to prevent rebound hypoglycemia until the new TPN bag arrives.

How to Approach the Question

First, identify the question as a clinical safety and procedure question concerning a high-risk therapy (TPN).
Focus on the keywords: 'TPN' and 'right intervention'. This signals that you need to select the most critical, evidence-based action.
Recall the primary risks associated with TPN: 1) Infection (due to the nutrient-rich solution and central line) and 2) Metabolic instability (hyperglycemia and hypoglycemia).
Evaluate each option against these two primary risks.
Option A directly addresses the risk of infection, which is a major and constant threat with TPN.
Options B and C, if misinterpreted or performed incorrectly, violate principles of infection control and metabolic safety.

Concept Tested & Keywords

Concept Tested: Safety protocols and nursing interventions for Total Parenteral Nutrition (TPN) administration.
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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