Fundamentals of Nursing Q 322
A nurse is caring for a group of clients in a medical-surgical nursing unit. The nurse recognizes that which of the following clients would be the least likely candidate for parenteral nutrition?
A. A 55-year-old with persistent nausea and vomiting from chemotherapy.
B. A 44-year old client with ulcerative colitis.
C. A 59-year old client who had an appendectomy.
D. A 25-year old client with Hirschsprung's Disease.
Correct Answer: C. A 59-year old client who had an appendectomy.
The client with an appendectomy is not a candidate because this client would resume a regular diet within a few days following the surgery. The principal indication for TPN is a seriously ill patient where enteral feeding is not possible. It may also be used to supplement inadequate oral intake. The successful use of TPN requires proper selection of patients, adequate experience with the technique, and awareness of its complications.
Option A: An indication of TPN are patients with malignancies in whom malnutrition may jeopardize successful delivery of a therapeutic option (surgery, chemo- or radiotherapy). While the indication for TPN may be self-evident in the majority of the patients, it is recommended to have some form of assessment of the nutritional status of the patient prior to institution of TPN in order to plan the treatment and to formulate clear-cut therapeutic goals
Option B: Malabsorption secondary to sprue, enzyme & pancreatic deficiencies, regional enteritis, ulcerative colitis, granulomatous colitis, and tuberculous enteritis are indications for parenteral nutrition. The indications of TPN are now fairly well defined, as is the knowledge about its limitations, side effects, and complications. Advances in technology have now made it possible for TPN to be delivered at the patient’s own residence, thus reducing hospital costs.
Option D: Option D is incorrect because parenteral nutrition is indicated in this client since their gastrointestinal tracts are not functional or cannot take in a diet enterally for extended periods. Newborns with gastrointestinal anomalies such as tracheoesophageal fistula, massive intestinal atresia, complicated meconium ileus, massive diaphragmatic hernia, gastroschisis, omphalocele or cloacal exstrophy, and neglected pyloric stenosis.