Fundamentals of Nursing Q 245
A nurse is monitoring the status of a client’s fat emulsion (lipid) infusion and notes that the infusion is 2 hours delay. The nurse should do which of the following actions?
A. Adjust the infusion rate to catch up over the next hour.
B. Make sure the infusion rate is infusing at the ordered rate.
C. Increase the infusion rate to catch up over the next few hours.
D. Adjust the infusion rate to full blast until the solution is back on time.
Correct Answer: B. Make sure the infusion rate is infusing at the ordered rate.
The nurse should maintain the prescribed rate of a fat emulsion even if the infusion’s time consumed is behind. The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates, and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ?7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids.
Option A: This intervention may cause hyperglycemia. Low-fat PN with a high glucose intake increases the risk of hyperglycemia. In parenterally fed patients with a tendency to hyperglycemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake.
Option C: C is incorrect since increasing the rate will potentially cause a fluid overload. The risk of PN complications (e.g. refeeding syndrome, hyperglycemia, bone demineralization, catheter infections) can be minimized by carefully monitoring patients and the use of nutrition support teams particularly during long-term PN.
Option D: If the infusion rate is adjusted to full blast, the patient might undergo fluid overload and other complications. Occurring complications are e.g. the refeeding syndrome in patients suffering from severe malnutrition with the initiation of refeeding or metabolic, hypertriglyceridemia, hyperglycemia, osteomalacia and osteoporosis, and hepatic complications including fatty liver, non-alcoholic fatty liver disease, cholestasis, cholecystitis, and cholelithiasis.