Podcast
Questions and Answers
A client receiving parenteral nutrition (PN) via a central line develops a fever, chills, and elevated heart rate. What is the priority nursing intervention?
A client receiving parenteral nutrition (PN) via a central line develops a fever, chills, and elevated heart rate. What is the priority nursing intervention?
- Increase the infusion rate of the PN solution to meet the client's metabolic demands.
- Encourage the client to increase oral fluid intake to prevent dehydration.
- Administer antipyretics and monitor the client's temperature every 4 hours.
- Assess the central line insertion site for signs of infection and notify the provider. (correct)
Which of the following actions is crucial when preparing to administer parenteral nutrition (PN) solution that does not contain lipids?
Which of the following actions is crucial when preparing to administer parenteral nutrition (PN) solution that does not contain lipids?
- Ensuring the PN solution is exposed to direct sunlight to activate the vitamins.
- Adding a multivitamin preparation directly to the PN solution immediately before administration.
- Warming the PN solution in a microwave oven to body temperature.
- Keeping the PN solution covered with a protective dark cover. (correct)
When administering parenteral nutrition (PN) through a central venous catheter, what is the primary reason for confirming catheter patency by aspirating for blood return before flushing?
When administering parenteral nutrition (PN) through a central venous catheter, what is the primary reason for confirming catheter patency by aspirating for blood return before flushing?
- To reduce the risk of introducing air into the circulatory system.
- To verify that the catheter tip is correctly placed within the vein. (correct)
- To ensure the client does not have a bleeding disorder.
- To maintain the sterility of the catheter hub.
A nurse is preparing to administer parenteral nutrition (PN) to a client. Prior to initiating the infusion, what assessment finding would necessitate withholding the PN and contacting the provider?
A nurse is preparing to administer parenteral nutrition (PN) to a client. Prior to initiating the infusion, what assessment finding would necessitate withholding the PN and contacting the provider?
What is the most important reason for using an electronic infusion pump when administering parenteral nutrition (PN)?
What is the most important reason for using an electronic infusion pump when administering parenteral nutrition (PN)?
A client receiving parenteral nutrition (PN) suddenly experiences shortness of breath and a rapid weight gain. Upon auscultation, the nurse notes crackles in the lung bases. Which intervention should the nurse perform first?
A client receiving parenteral nutrition (PN) suddenly experiences shortness of breath and a rapid weight gain. Upon auscultation, the nurse notes crackles in the lung bases. Which intervention should the nurse perform first?
When should the nurse document client education regarding parenteral nutrition (PN) administration?
When should the nurse document client education regarding parenteral nutrition (PN) administration?
A client receiving parenteral nutrition (PN) complains of pain at the insertion site. Upon assessment, the nurse notes redness and swelling. What should the nurse do first?
A client receiving parenteral nutrition (PN) complains of pain at the insertion site. Upon assessment, the nurse notes redness and swelling. What should the nurse do first?
A nurse is preparing to administer parenteral nutrition (PN) with lipids. Which filter size is most appropriate for this type of solution?
A nurse is preparing to administer parenteral nutrition (PN) with lipids. Which filter size is most appropriate for this type of solution?
What is the rationale for allowing parenteral nutrition (PN) solution to warm to room temperature for 30 to 60 minutes prior to administration?
What is the rationale for allowing parenteral nutrition (PN) solution to warm to room temperature for 30 to 60 minutes prior to administration?
A nurse is administering parenteral nutrition (PN) to a client with a history of heart failure. What assessment finding would warrant immediate intervention?
A nurse is administering parenteral nutrition (PN) to a client with a history of heart failure. What assessment finding would warrant immediate intervention?
What is the most appropriate method for verifying the correct administration rate of parenteral nutrition (PN)?
What is the most appropriate method for verifying the correct administration rate of parenteral nutrition (PN)?
Which of the following is the priority nursing action if a client's parenteral nutrition (PN) solution runs out and a new bag is not immediately available?
Which of the following is the priority nursing action if a client's parenteral nutrition (PN) solution runs out and a new bag is not immediately available?
A client on parenteral nutrition (PN) develops hyperglycemia. Besides administering insulin as prescribed, what other intervention should the nurse implement?
A client on parenteral nutrition (PN) develops hyperglycemia. Besides administering insulin as prescribed, what other intervention should the nurse implement?
What is the primary reason for changing parenteral nutrition (PN) administration sets every 24 hours?
What is the primary reason for changing parenteral nutrition (PN) administration sets every 24 hours?
Which of the following actions will minimize the risk of an air embolism during central line parenteral nutrition (PN) administration?
Which of the following actions will minimize the risk of an air embolism during central line parenteral nutrition (PN) administration?
What is the most reliable method for confirming correct placement of a newly inserted central venous catheter before initiating parenteral nutrition (PN)?
What is the most reliable method for confirming correct placement of a newly inserted central venous catheter before initiating parenteral nutrition (PN)?
A client receiving parenteral nutrition (PN) reports feeling anxious and overwhelmed by the complexity of their nutritional regimen. What is the most appropriate nursing intervention?
A client receiving parenteral nutrition (PN) reports feeling anxious and overwhelmed by the complexity of their nutritional regimen. What is the most appropriate nursing intervention?
Which of the following laboratory values is most important to monitor regularly in a client receiving parenteral nutrition (PN)?
Which of the following laboratory values is most important to monitor regularly in a client receiving parenteral nutrition (PN)?
Which of the following strategies is most effective in preventing catheter-related bloodstream infections (CRBSIs) in clients receiving parenteral nutrition (PN) through a central line?
Which of the following strategies is most effective in preventing catheter-related bloodstream infections (CRBSIs) in clients receiving parenteral nutrition (PN) through a central line?
What component of parenteral nutrition (PN) requires the nurse to be especially vigilant for signs and symptoms of an allergic reaction?
What component of parenteral nutrition (PN) requires the nurse to be especially vigilant for signs and symptoms of an allergic reaction?
A client receiving parenteral nutrition (PN) has a complex medical history, including diabetes mellitus and renal insufficiency. Which of the following adjustments to the standard PN formula is most likely necessary?
A client receiving parenteral nutrition (PN) has a complex medical history, including diabetes mellitus and renal insufficiency. Which of the following adjustments to the standard PN formula is most likely necessary?
Which of the following actions is most important for the nurse to perform immediately after discontinuing a central venous catheter used for parenteral nutrition (PN)?
Which of the following actions is most important for the nurse to perform immediately after discontinuing a central venous catheter used for parenteral nutrition (PN)?
A client receiving parenteral nutrition (PN) at home reports persistent diarrhea. What is the most appropriate initial nursing intervention?
A client receiving parenteral nutrition (PN) at home reports persistent diarrhea. What is the most appropriate initial nursing intervention?
Which of the following actions demonstrates appropriate technique when scrubbing the hub of a central venous catheter prior to administering parenteral nutrition (PN)?
Which of the following actions demonstrates appropriate technique when scrubbing the hub of a central venous catheter prior to administering parenteral nutrition (PN)?
During parenteral nutrition (PN) administration, a client exhibits signs of fluid overload, including increased blood pressure, bounding pulse, and jugular vein distention. In what order should the following nursing interventions be implemented?
During parenteral nutrition (PN) administration, a client exhibits signs of fluid overload, including increased blood pressure, bounding pulse, and jugular vein distention. In what order should the following nursing interventions be implemented?
A client receiving parenteral nutrition (PN) develops refeeding syndrome. Which of the following electrolyte imbalances is the nurse most likely to observe?
A client receiving parenteral nutrition (PN) develops refeeding syndrome. Which of the following electrolyte imbalances is the nurse most likely to observe?
A client on long-term parenteral nutrition (PN) is being discharged home. What is the most important teaching point to emphasize regarding the prevention of complications?
A client on long-term parenteral nutrition (PN) is being discharged home. What is the most important teaching point to emphasize regarding the prevention of complications?
Which of the following strategies should the nurse implement to prevent precipitation of calcium and phosphate in a parenteral nutrition (PN) solution?
Which of the following strategies should the nurse implement to prevent precipitation of calcium and phosphate in a parenteral nutrition (PN) solution?
What is the primary purpose of using a filter during the administration of parenteral nutrition (PN)?
What is the primary purpose of using a filter during the administration of parenteral nutrition (PN)?
What is the recommended method for verifying the client's understanding of parenteral nutrition (PN) self-administration at home?
What is the recommended method for verifying the client's understanding of parenteral nutrition (PN) self-administration at home?
A client receiving parenteral nutrition (PN) develops a suspected air embolism. What is the priority nursing intervention?
A client receiving parenteral nutrition (PN) develops a suspected air embolism. What is the priority nursing intervention?
A client is receiving parenteral nutrition (PN) through a peripheral IV line. Which of the following findings would indicate the need to discontinue the peripheral PN and consider a central line?
A client is receiving parenteral nutrition (PN) through a peripheral IV line. Which of the following findings would indicate the need to discontinue the peripheral PN and consider a central line?
Prior to administering parenteral nutrition (PN), the nurse notes that the solution has a slightly oily appearance. What is the most appropriate action?
Prior to administering parenteral nutrition (PN), the nurse notes that the solution has a slightly oily appearance. What is the most appropriate action?
When administering parenteral nutrition (PN), what is the primary reason for avoiding the addition of medications directly to the PN solution?
When administering parenteral nutrition (PN), what is the primary reason for avoiding the addition of medications directly to the PN solution?
A client on parenteral nutrition (PN) is also receiving warfarin. Which laboratory value requires close monitoring to adjust the warfarin dosage?
A client on parenteral nutrition (PN) is also receiving warfarin. Which laboratory value requires close monitoring to adjust the warfarin dosage?
A client receiving parenteral nutrition (PN) at home reports difficulty sleeping and feeling anxious. Beyond medication, what is the most appropriate nursing recommendation?
A client receiving parenteral nutrition (PN) at home reports difficulty sleeping and feeling anxious. Beyond medication, what is the most appropriate nursing recommendation?
During the administration of parenteral nutrition (PN), a nurse observes phlebitis at the IV site. What is the most appropriate initial action?
During the administration of parenteral nutrition (PN), a nurse observes phlebitis at the IV site. What is the most appropriate initial action?
A nurse is preparing to administer parenteral nutrition (PN) to a client via a central line. Despite meticulous technique, after connecting the PN solution, the nurse notices a small air bubble in the tubing close to the insertion site. What is the most appropriate immediate action?
A nurse is preparing to administer parenteral nutrition (PN) to a client via a central line. Despite meticulous technique, after connecting the PN solution, the nurse notices a small air bubble in the tubing close to the insertion site. What is the most appropriate immediate action?
A client receiving parenteral nutrition (PN) at home reports persistent nausea and a new, localized pain at the central line insertion site, but no signs of infection are present. The client's weight has remained stable, and vital signs are within normal limits. What is the most appropriate nursing recommendation?
A client receiving parenteral nutrition (PN) at home reports persistent nausea and a new, localized pain at the central line insertion site, but no signs of infection are present. The client's weight has remained stable, and vital signs are within normal limits. What is the most appropriate nursing recommendation?
A nurse is teaching a client and family about home parenteral nutrition (PN) administration. The client has a history of frequent central line-associated bloodstream infections (CLABSIs). Which of the following statements made by the client indicates a need for further teaching?
A nurse is teaching a client and family about home parenteral nutrition (PN) administration. The client has a history of frequent central line-associated bloodstream infections (CLABSIs). Which of the following statements made by the client indicates a need for further teaching?
A client receiving parenteral nutrition (PN) suddenly develops significant edema in the lower extremities, accompanied by a distended neck vein and a 2 kg weight gain in 24 hours. Auscultation reveals bilateral crackles in the lung bases. After notifying the healthcare provider, which order should the nurse anticipate first?
A client receiving parenteral nutrition (PN) suddenly develops significant edema in the lower extremities, accompanied by a distended neck vein and a 2 kg weight gain in 24 hours. Auscultation reveals bilateral crackles in the lung bases. After notifying the healthcare provider, which order should the nurse anticipate first?
A client receiving long-term parenteral nutrition (PN) develops a new, persistent cough and reports increasing fatigue. The client's temperature is normal, and there are no signs of infection at the central line insertion site. Which of the following complications of PN therapy should the nurse suspect first?
A client receiving long-term parenteral nutrition (PN) develops a new, persistent cough and reports increasing fatigue. The client's temperature is normal, and there are no signs of infection at the central line insertion site. Which of the following complications of PN therapy should the nurse suspect first?
Flashcards
What is Parenteral Nutrition (PN)?
What is Parenteral Nutrition (PN)?
Intravenous administration of nutrients for clients with insufficient oral or enteral intake.
Key safety considerations for PN administration?
Key safety considerations for PN administration?
Assess for allergies, verify client ID, use standard precautions, follow medication rights.
Equipment needed for PN administration?
Equipment needed for PN administration?
Nonsterile gloves, PN solution, antiseptic, protective cover (if no lipids), syringes, IV set, filters, infusion pump, glucose meter.
General steps before PN administration?
General steps before PN administration?
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Why warm PN solution and use a protective cover?
Why warm PN solution and use a protective cover?
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What to look for when checking a PN bag?
What to look for when checking a PN bag?
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Why use inline filters for PN administration?
Why use inline filters for PN administration?
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Why scrub the catheter hub?
Why scrub the catheter hub?
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Why use an infusion pump for PN?
Why use an infusion pump for PN?
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How often should PN administration sets be changed?
How often should PN administration sets be changed?
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Why consider age when administering PN?
Why consider age when administering PN?
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A sudden increase in weight could indicate?
A sudden increase in weight could indicate?
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What do chills/fever or elevated heart rate indicate?
What do chills/fever or elevated heart rate indicate?
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What to document after PN administration?
What to document after PN administration?
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Study Notes
- Parenteral nutrition (PN) is the intravenous administration of nutrients for clients with insufficient oral or enteral intake.
- PN can be used short-term to meet caloric and metabolic needs.
- RNs can delegate PN administration to LPNs when the client is stable, but not to assistive personnel due to the skill's complexity.
- The nursing process is continuous and dynamic, so skill steps may move back and forth between phases.
Safety Considerations
- Check for allergies, especially to eggs, to prevent allergic reactions.
- Verify client identification to ensure the correct procedure on the correct client.
- Use standard and infection control precautions to prevent transmission of infectious organisms.
- Follow the rights of medication administration to reduce medication errors: right client, medication, dose, route, time, documentation, assessment, evaluation, refusal, and education.
Equipment
- Nonsterile gloves and PPE are needed, if indicated.
- Client's medication administration record (MAR) is needed.
- Parenteral nutrition (PN) solution, antiseptic solution and gauze.
- Protective cover for PN solution without lipids and syringes with appropriate flush solution, if the infusion is not continuous
- IV administration set and secondary set, if lipids are not included in the PN solution, labels for administration set and secondary IV set.
- Filters and infusion pump.
- Glucose meter.
General Steps Prior to Medication Administration
- Review the client’s medical record to identify contraindications, allergies, medical history, medications, previous vital signs, lab values, and the provider’s prescription.
- Obtain necessary supplies to ensure preparedness.
- Provide privacy to maintain client confidentiality.
- Introduce yourself to the client to promote a therapeutic relationship.
- Perform hand hygiene and don appropriate PPE as an infection control measure.
- Identify the client using two unique identifiers.
- Confirm the client’s allergy status.
- Educate the client about the medication, potential adverse effects, and administration procedure, and verify their understanding and right to refuse.
- Check the MAR against the prescription. Check the client’s need for the medication, interactions, contraindications, adverse effects, safe dosing, and any age/condition considerations, and remove the prescribed PN solution from the refrigerator. Allow to warm to room temperature for 30 to 60 minutes before initiating the infusion.
Step-by-Step at the Bedside
- Remove PN bag from refrigerator and allow the solution to warm to room temperature for 30 to 60 minutes before administration.
- Check the PN bag for sediment, discoloration, or cloudiness and ensure there is no leakage.
- Check the client’s overall health status.
- Implementation
- Prepare the medication administration set using aseptic technique by clamping the tubing and attaching the inline filter: -0.22-micron filter for PN without lipids or fat emulsion -1.2-micron filter for solutions with albumin or lipids
- Prime the set and spike the infusion port of the solution bag.
- Apply additional PPE per facility protocol.
- Vigorously scrub the hub of the catheter or infusion port.
- Confirm patency of central line catheter by aspiration of blood and flushing of the line.
- Scrub the hub of the catheter.
- Connect the medication administration set and filter to the catheter hub port.
- Adjust the rate of administration on the pump and start the infusion.
- Place a label on the tubing with the date and time and the nurse’s initials.
- Remove PPE and dispose of used materials.
- Discuss findings with the client.
- Ensure client safety before leaving the room (call light, bed position, needed items within reach).
Evaluation
- Evaluate the outcome of the medication at the appropriate time frame.
Client Considerations
- Consider the age of the client when administering PN because the PN solution is unique to each client based on their age, weight, and height.
- Review the client’s medical history when administering PN.
Interventions for Unexpected Outcomes
- For sudden weight increase and shortness of breath: auscultate lung fields, check oxygenation, elevate head of bed, apply supplemental oxygen, and notify the provider.
- For chills/fever or elevated heart rate elevation: check the catheter insertion site for signs of redness, pain, or drainage, and notify the provider.
Documentation
- Document on the client’s MAR and in medical record: date, time, nurse’s initials, medication, dose, route, pertinent findings, client education, client’s response, and any unexpected outcomes with provider notification.
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