A nurse is preparing to administer topiramate 25 mg PO capsules BID to a client who has difficulty swallowing. Which of the following actions should the nurse take?

Total parenteral nutrition (TPN) is a hypertonic solutiondelivered intravenously to provide complete nutritional support when the enteral route is non-functional. It contains a balance of amino acids, dextrose, lipids, electrolytes, and vitamins tailored to the patient's metabolic needs. TPN bypasses the gastrointestinal tract, preventing the need for mechanical digestionand nutrient absorption through the intestinal mucosa.

Rationale:

A.TPN is specifically designed to provide all necessary calories and nutrients intravenously, which allows for complete bowel rest. This is essential for patients with severe inflammatory bowel disease, fistulas, or intestinal obstructions where oral intake is impossible. By bypassing the gut, the inflamed or injured tissues have the opportunity to heal without the stress of digestion.

B.TPN does not contain medications that specifically improve the absorption capabilities of the digestive tract itself. Its primary function is to deliver pre-digested nutrients directly into the bloodstream, making intestinal absorption unnecessary. The goal is to provide systemic nutrition while the gut is bypassed, not to pharmacologically alter the intestinal wall's function.

C.TPN does not typically stimulate a client's appetite; in fact, the administration of high-calorie intravenous nutrition often decreases the sensation of hunger. Because the body's nutritional requirements are being met systemically, the physiological triggers for appetite may be suppressed. The purpose of TPN is to replace oral eating, not to encourage increased food consumption.

D.The primary purpose of TPN is nutritional support, not bowel cleansing or preparation for surgical procedures. While the bowels may become relatively empty because the patient is not eating, TPN is not an osmotic laxative or a clearing agent. Bowel clearing for surgery usually requires specific oral preparations or enemas rather than intravenous nutrition.

Preventing medication errorsrequires a multidisciplinary approach involving strict adherence to safety protocolssuch as the "Read Back" method and proper documentation. Verbal prescriptions are inherently risky and should be limited to emergency situations or sterile procedures. Maintaining a clear chain of custodyand verification for every drug order is essential to ensure patient safety.

Rationale:

A.Requiring providers to cosign all verbal prescriptions within a specified timeframe (usually 24 hours) is a standard safety protocol for accountability. This process ensures that the transcribed order accurately reflects the provider’s original intent and provides a legal record of the instruction. It acts as a secondary verification step to catch transcription errors and maintain the integrity of the medication record.

B.The "read back" technique must be used for every verbal or telephone prescription, not just for high-alert medications, according to Joint Commission safety goals. The nurse should write down the order and read it back to the provider to confirm the drug name, dosage, and route. Restricting this practice to specific drugs would leave the client vulnerable to errors involving common medications.

C.Assistive personnel, such as nursing assistants, do not have the legal scope of practice or pharmacological training to witness or transcribe verbal medication prescriptions. Only a licensed nurse or a pharmacist should receive and process verbal orders from a provider to ensure clinical accuracy. Using unqualified personnel as witnesses would increase the risk of errors and violate professional standards of care.

D.The term "safe abbreviations" is a misnomer, as the Institute for Safe Medication Practices recommends avoiding abbreviations altogether to prevent misinterpretation. Regardless of whether it is a provider or a nurse, "Do Not Use" abbreviations like "U" for units or "QD" for daily should never be used. Consistent use of full words is the only way to ensure clear communication.