A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse identify as an adverse effect of TPN

When caring for a client receiving heparin by continuous IV infusion for the treatment of venous thrombosis, the nurse should monitor the client's aPTT (Activated Partial Thromboplastin Time) to titrate the heparin dose.

Heparin is an anticoagulant medication used to prevent and treat blood clots. The aPTT is a coagulation test that measures the time it takes for the blood to clot when a specific activator is added. Monitoring the aPTT is a standard method for assessing the anticoagulant effect of heparin and ensuring that the client's blood remains within the desired therapeutic range.

The therapeutic range for aPTT while on heparin therapy varies depending on the indication and the client's condition but is generally maintained at a level that prolongs the clotting time enough to prevent and treat thrombosis while avoiding excessive bleeding risk.

Let's go through the other options:

A. Platelet function assay: While monitoring platelet function is essential for assessing overall hemostasis and platelet function, it is not specifically used for titrating heparin doses. Platelet function assays are more commonly used to assess the function of platelets in the context of platelet disorders or antiplatelet medication therapy.

C. INR (International Normalized Ratio): The INR is used to monitor the effect of vitamin K antagonist anticoagulants, such as warfarin, and is not the appropriate test for monitoring heparin therapy.

D. Amylase: Amylase is an enzyme produced by the pancreas and salivary glands and is not relevant for monitoring heparin therapy. Elevated amylase levels are typically associated with pancreatitis and not related to heparin treatment.

To calculate the rate at which the IV pump should deliver dopamine, we can follow these steps:

Step 1: Convert the weight of the client from pounds to kilograms.

220 lb ÷ 2.2 = 100 kg (rounded to the nearest whole number)

Step 2: Calculate the total dose of dopamine per minute.

5 mcg/kg/min × 100 kg = 500 mcg/min

Step 3: Convert the dose from micrograms (mcg) to milligrams (mg).

500 mcg/min ÷ 1000 = 0.5 mg/min

Step 4: Determine the infusion rate in milliliters per hour (mL/hr).

The total volume of the solution is 250 mL.

The total dose of dopamine is 400 mg.

So, the infusion rate is (0.5 mg/min ÷ 400 mg) × 250 mL = 0.3125 mL/min.

Step 5: Convert the infusion rate from mL/min to mL/hr.

0.3125 mL/min × 60 min/hr = 18.75 mL/hr (rounded to the nearest tenth).

Therefore, the nurse should set the IV pump to deliver 18.8 mL/hr (rounded to the nearest tenth).