Uttarakhand CHO - 2021
Medical & Surgical Nursing
Medium
A patient on TPN has been discharged home, so on each home visit, which of the following parameters will the home care nurse primarily assess?
Appeared in: Uttarakhand CHO - 2021
Explanation
- The correct answer focuses on the two most critical and specific assessments for TPN complications: infection and fluid balance.
- Temperature is the most direct indicator of a catheter-related bloodstream infection (CRBSI), a major life-threatening risk of TPN therapy.
- Daily weight is the most sensitive and practical measure of fluid status in a home setting, allowing for early detection of fluid overload or dehydration.
- Monitoring these two parameters allows the home care nurse to promptly identify the most common and severe complications associated with TPN.
Why Other Options Were Wrong
- Option B: While temperature is a correct and primary assessment, blood pressure (BP) is a less specific indicator for initial TPN complications. Changes in BP can be a later sign of sepsis (hypotension) or fluid overload (hypertension), whereas weight changes are more immediate and sensitive for fluid status.
- Option C: While weight is a correct and primary assessment, pulse is less specific than temperature for detecting infection. Tachycardia can be caused by fever, but also by anxiety, pain, or dehydration, making it a non-specific sign.
- Option D: Both pulse and blood pressure are general vital signs. They are not the primary targeted assessments for the most common and unique complications of TPN, which are specifically catheter-related infection and fluid/metabolic imbalances.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Primary nursing assessment for a patient on home Total Parenteral Nutrition (TPN) to guide bedside assessment, documentation, and the next nursing action.
- The home care nurse's primary role in TPN management is the early detection of complications to prevent re-hospitalization and life-threatening events like sepsis.
- Patient and family education is a critical nursing intervention. The nurse must teach the family how to accurately measure temperature and weight, the signs and symptoms to report, and the importance of daily monitoring.
- What if? If the patient also has congestive heart failure (CHF), the assessment priority slightly shifts. While temperature and weight remain crucial, monitoring for signs of fluid overload like shortness of breath, crackles in the lungs, and increased blood pressure becomes equally important, as these patients are highly sensitive to fluid shifts.
How to Approach the Question
- First, identify the core clinical situation: a patient receiving TPN at home.
- Next, recall the most significant and life-threatening complications associated with TPN. The two main categories are infectious (sepsis from the central line) and metabolic (fluid/electrolyte imbalance, hyperglycemia).
- For each major complication, determine the most direct and sensitive assessment parameter a nurse would use for monitoring.
- Infection (sepsis) is most directly indicated by an elevated temperature (fever).
- Fluid imbalance (overload or dehydration) is most practically and sensitively monitored by tracking daily weight.
- Compare this ideal pair of assessments (Temperature & Weight) against the given options.
Concept Tested & Keywords
- Concept Tested: Primary nursing assessment for a patient on home Total Parenteral Nutrition (TPN).
- Stem keywords: TPN, Total Parenteral Nutrition, home care nurse, primarily assess, discharged home
- Lead-in keywords: primarily
- Clinical cues: Patient is on TPN at home, which increases the risk of specific complications like line sepsis and fluid imbalance.
- Negative lead-in flag: false
Question ID
Qmk4zHa4xfhsOnJ6x6ElDI
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 108-110
E6 Pharmacology Nursing Lilley 11e Part 3 p. 234-236
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 207-209
Practise the full Uttarakhand CHO - 2021
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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