NIMHANS Nursing Offic…: A nurse caring for a patient who is receiving TPN in ICU, what is the right intervention of the nurse?

NIMHANS Nursing Officer - 2021

Medical & Surgical Nursing

Easy

Appeared in: NIMHANS Nursing Officer - 2021

Explanation

The primary reason for this intervention is infection control.
Total Parenteral Nutrition (TPN) solutions are rich in glucose and lipids, making them an excellent medium for bacterial and fungal growth.
To prevent central line-associated bloodstream infections (CLABSI), standard nursing practice dictates that both the TPN bag and the administration set (tubing) must be changed every 24 hours.
This rule applies even if there is solution remaining in the bag, as the risk of sepsis outweighs the cost of the discarded fluid.

Option B: This option is vague and does not describe a specific, correct action. 'Continue start TPN' is grammatically unclear and not a recognized nursing intervention.
Option C: Stopping TPN abruptly is a dangerous action. It can lead to rebound hypoglycemia, a rapid and severe drop in blood glucose levels. The patient's body has adapted to the high glucose load by increasing insulin production; suddenly removing the glucose source while insulin levels remain high causes this complication.
Option D: This option is incorrect because options B and C are incorrect and unsafe.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Total Parenteral Nutrition (TPN) Administration and Safety in acute care settings.
Preventing CLABSI is a major nursing responsibility and a key quality indicator in healthcare. Adhering to the 24-hour TPN bag and tubing change rule is a critical, evidence-based practice to ensure patient safety.
Nurses must be vigilant in monitoring for complications of TPN, including hyperglycemia, hypoglycemia, fluid overload, and signs of infection (fever, chills, elevated WBC).
What if? If a new TPN bag is not available from the pharmacy when the 24-hour mark is reached, the nurse must not simply stop the infusion. The correct action is to hang a bag of 10% Dextrose in Water (D10W) at the same infusion rate to prevent rebound hypoglycemia until the new TPN solution arrives.

How to Approach the Question

First, identify the core concept of the question, which is the safe administration of TPN in an ICU setting.
Evaluate each option based on established nursing principles and safety protocols.
Option A relates to infection control, a major concern with TPN. Recall that TPN solutions are a growth medium for microbes.
Option C involves stopping the infusion. Consider the metabolic consequences of abruptly stopping a high-glucose solution. This should trigger thoughts about rebound hypoglycemia.
Option B is poorly worded and doesn't represent a clear action. This makes it a likely distractor.
Based on the analysis, Option A is a critical safety protocol, while Option C is a dangerous action. Therefore, Option A is the only correct intervention.

Concept Tested & Keywords

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

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