A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following nursing actions are appropriate? (Select all that apply.)

A. Verify the solution with another RN prior to infusion: To ensure patient safety, the TPN solution should be verified by two licensed healthcare providers before infusion. This helps prevent errors in administering the incorrect solution.

B. Monitor serum blood glucose during infusion: TPN contains high concentrations of glucose, which can lead to hyperglycemia. Monitoring blood glucose levels is essential to prevent complications such as hyperglycemia or hypoglycemia.

C. Increase the rate of infusion if the solution is delayed: The rate of infusion should not be increased to make up for a delayed start, as rapid infusion can lead to fluid overload or metabolic disturbances. The infusion rate should be adjusted based on medical guidelines and the provider's orders.

D. Infuse 0.9% sodium chloride if the solution is not available: If TPN is unavailable, the client should not receive just sodium chloride, as TPN is a complete nutrition solution. Alternative methods should be discussed with the healthcare provider, and the client should not be left without the required nutritional support.

E. Obtain the client's weight daily: Daily weight measurements are crucial to monitor fluid status and nutritional intake, especially when the client is receiving TPN, to ensure that the client is maintaining proper nutritional balance and avoiding complications like fluid retention.

Rationale for Correct Choices:

• Oxygen saturation: The client's oxygen saturation is 94% on room air. While not critically low, given their reported shortness of breath and fatigue, this warrants follow-up. It could be indicative of the severity of their anemia impacting oxygen delivery.
• Blood pressure: The client shows signs of orthostatic hypotension, with a significant drop from 132/60 mm Hg (supine) to 102/50 mm Hg (standing). This change can cause dizziness, falls, and worsened fatigue, and it may be related to anemia or volume depletion that needs evaluation.
• Hematocrit: A hematocrit of 24% is critically low, indicating significant anemia. This aligns with the client’s symptoms of fatigue and dyspnea and requires prompt intervention to determine the underlying cause, such as iron or B12 deficiency.
• Activity level: The client reports shortness of breath with minimal exertion and difficulty keeping up with grandchildren. This functional decline reflects impaired oxygen delivery due to anemia and must be addressed as it affects quality of life and safety.

Rationale for Incorrect Choices:

• Pain level: The client reports no pain or discomfort at this time. While pain is common in rheumatoid arthritis, the current lack of pain does not require further assessment or intervention.
• Temperature: The client's temperature is 37°C (98.6°F), which is normal. There are no signs of infection or inflammation requiring follow-up based solely on this vital sign.
• Breath sounds: Bilateral clear breath sounds indicate that the lungs are not congested and there is no evidence of pulmonary pathology at this time. Therefore, this finding does not require follow-up.