Fundamentals of Nursing Q 337
A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that there is redness and drainage at the insertion site. The nurse next assesses which of the following?
A. Time of last dressing change.
B. Allergy.
C. Client's temperature.
D. Expiration date.
Correct Answer: C. Client’s temperature.
Redness at the catheter insertion site is a possible sign of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess. TPN requires a chronic IV access for the solution to run through, and the most common complication is an infection of this catheter. Infection is a common cause of death in these patients, with a mortality rate of approximately 15% per infection, and death usually results from septic shock.
Option A: Assess skin integrity and wound healing. Skin integrity changes and wound healing are used as parameters in monitoring the effectiveness of TPN feeding.
Option B: TPN composition is based on the calculated nutritional needs of the client. Before the therapy is started, a thorough baseline assessment will be completed by health care members which include physicians, nurses, dieticians, and pharmacists. Changes in fluid balance, weight, and caloric intake are used to assess TPN effectiveness.
Option D: Administer TPN at the ordered rate; if the infusion is interrupted, infuse 10% dextrose in water until the TPN infusion is restarted. This substitute infusion provides needed fluid in addition to protecting the client from sudden hypoglycemia; hypoglycemia can result when the high glucose concentration to which the client has metabolically adjusted is suddenly withdrawn.