Nokea
A nurse is preparing to discharge a patient home on parenteral nutrition. What should an effective home care teaching program address? Select all that apply.
- A. Preparing the patient to troubleshoot for problems
- B. Teaching the patient and family strict aseptic technique
- C. Teaching the patient and family how to set up the infusion
- D. Teaching the patient to flush the line with sterile water
- E. Teaching the patient when it is safe to leave the access site open to air
Correct Answer: A,B,C
Rationale: An effective home care teaching program prepares the patient to store solutions, set up the infusion, flush the line with heparin, change the dressings, and troubleshoot for problems. The most common complication is sepsis. Strict aseptic technique is taught for hand hygiene, handling equipment, changing the dressing, and preparing the solution. Sterile water is never used for flushes and the access site must never be left open to air.
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A patients physician has determined that for the next 3 to 4 weeks the patient will require parenteral nutrition (PN). The nurse should anticipate the placement of what type of venous access device?
- A. Peripheral catheter
- B. Nontunneled central catheter
- C. Implantable port
- D. Tunneled central catheter
Correct Answer: B
Rationale: Nontunneled central catheters are used for short-term (less than 6 weeks) IV therapy. A peripheral catheter can be used for the administration of peripheral parenteral nutrition for 5 to 7 days. Implantable ports and tunneled central catheters are for long-term use and may remain in place for many years. Peripherally inserted central catheters (PICCs) are another potential option.
A nurse is caring for a patient with a subclavian central line who is receiving parenteral nutrition (PN). In preparing a care plan for this patient, what nursing diagnosis should the nurse prioritize?
- A. Risk for Activity Intolerance Related to the Presence of a Subclavian Catheter
- B. Risk for Infection Related to the Presence of a Subclavian Catheter
- C. Risk for Functional Urinary Incontinence Related to the Presence of a Subclavian Catheter
- D. Risk for Sleep Deprivation Related to the presence of a Subclavian Catheter
Correct Answer: B
Rationale: The high glucose content of PN solutions makes the solutions an ideal culture media for bacterial and fungal growth, and the central venous access devices provide a port of entry. Prevention of infection is consequently a high priority. The patient will experience some inconveniences with regard to toileting, activity, and sleep, but the infection risk is a priority over each of these.
A nurse is creating a care plan for a patient who is receiving parenteral nutrition. The patients care plan should include nursing actions relevant to what potential complications? Select all that apply.
- A. Dumping syndrome
- B. Clotted or displaced catheter
- C. Pneumothorax
- D. Hyperglycemia
- E. Line sepsis
Correct Answer: B,C,D,E
Rationale: Common complications of PN include a clotted or displaced catheter, pneumothorax, hyperglycemia, and infection from the venous access device (line sepsis). Dumping syndrome applies to enteral nutrition, not PN.
A nurse is preparing to administer a patients scheduled parenteral nutrition (PN). Upon inspecting the bag, the nurse notices that the presence of small amounts of white precipitate are present in the bag. What is the nurses best action?
- A. Recognize this as an expected outcome.
- B. Place the bag in a warm environment for 30 minutes.
- C. Shake the bag vigorously for 10 to 20 seconds.
- D. Contact the pharmacy to obtain a new bag of PN.
Correct Answer: D
Rationale: Before PN infusion is administered, the solution must be inspected for separation, oily appearance (also known as a cracked solution), or any precipitate (which appears as white crystals). If any of these are present, it is not safe to use. Warming or shaking the bag is inappropriate and unsafe.
The nurse is assessing placement of a nasogastric tube that the patient has had in place for 2 days. The tube is draining green aspirate. What is the nurses most appropriate action?
- A. Inform the physician that the tube may be in the patients pleural space.
- B. Withdraw the tube 2 to 4 cm.
- C. Leave the tube in its present position.
- D. Advance the tube up to 8 cm.
Correct Answer: C
Rationale: The patients aspirate is from the gastric area when the nurse observes that the color of the aspirate is green. Further confirmation of placement is necessary, but there is likely no need for repositioning. Pleural secretions are pale yellow.