AIIMS Delhi NO- 2019
Medical & Surgical Nursing
Easy
Identify the following procedure which nurse is doing in following image:
Appeared in: AIIMS Delhi NO- 2019
Explanation
- The procedure involves preparing a Total Parenteral Nutrition (TPN) bag.
- The distinct yellow color of the fluid is a hallmark of TPN solutions containing multivitamins, particularly B-complex vitamins.
- TPN is a hypertonic solution containing dextrose, amino acids, lipids, electrolytes, and vitamins, administered intravenously when the GI tract is non-functional.
- The large bag with a detailed pharmacy label is characteristic of a compounded TPN solution tailored to a specific patient's needs.
Why Other Options Were Wrong
- Option B: Dialysis solutions (dialysate) are clear and colorless. Hemodialysis involves a machine and external blood circulation, which is not depicted.
- Option C: Standard intravenous hydration fluids, like Normal Saline or Lactated Ringer's, are clear and colorless, not yellow.
- Option D: Lavage solutions, used for irrigation of body cavities (e.g., gastric lavage), consist of sterile water or saline and are clear.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Identification of Total Parenteral Nutrition (TPN) solution based on visual characteristics to guide bedside assessment, documentation, and the next nursing action.
- Administering TPN is a high-risk nursing activity. Nurses must use strict aseptic technique to prevent Central Line-Associated Bloodstream Infections (CLABSI), as the high glucose content of TPN is a medium for bacterial growth.
- Frequent blood glucose monitoring (typically every 4-6 hours) is critical because the high concentration of dextrose in TPN can lead to severe hyperglycemia.
- What if? If the TPN bag appeared milky white instead of yellow, it would likely be a 3-in-1 solution where lipids are mixed directly with the dextrose and amino acids. If it were clear, it might be a 2-in-1 solution (dextrose and amino acids) before the vitamins and lipids are added.
How to Approach the Question
- First, carefully analyze the image for key visual clues. Note the color of the fluid, the type of container, and any labels or equipment visible.
- In this image, the most prominent feature is the yellow fluid in a large IV bag. This is a strong and specific indicator.
- Next, evaluate each option against your visual analysis.
- Consider 'TPN'. Recall or look up the typical appearance of TPN. TPN with multivitamins is characteristically yellow.
- Consider 'Dialysis', 'Hydration', and 'Lavage solution'. Recall that these solutions are typically clear and colorless.
- Based on the unique yellow color, conclude that the bag contains TPN, making it the correct identification.
Concept Tested & Keywords
- Concept Tested: Identification of Total Parenteral Nutrition (TPN) solution based on visual characteristics.
- Stem keywords: procedure, nurse, image
- Lead-in keywords: Identify
- Clinical cues: The yellow color of the fluid in the IV bag is a key clinical cue, indicating the presence of multivitamins.
Question ID
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Reference Book
E6 Nursing Fundamentals Taylor p. 518-520
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 67-69
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 107-109
Practise the full AIIMS Delhi NO- 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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