You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a poor historian. The patient appears malnourished and TPN has been started
Why would you know to start the TPN slowly?
A) Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
B) Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.
C) Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
D) Patients receiving TPN are at risk for hypochloremia if fluids are introduced too rapidly.
Ans: B
Feedback: The nurse identifies patients who are at risk for hypophosphatemia and monitors them. Because malnourished patients receiving parenteral nutrition are at risk when calories are introduced too aggressively, preventive measures involve gradually introducing the solution to avoid rapid shifts of phosphorus into the cells. Options A, C, and D are incorrect; patients receiving TPN are not at risk for hypercalcemia, hypernatremia, or hypochloremia if calories or fluids are started to rapidly.
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