Page 2405 - Saunders Comprehensive Review For NCLEX-RN

4. Prepare the client for obtaining blood cultures.
5. Prepare for antibiotic administration.
6. Document the occurrence, the actions taken, and the client’s
response.

Reference

Ignatavicius, Workman, Rebar (2018), p. 221.

D. Additional nursing considerations

1. Check the PN solution with the PHCP’s prescription
to ensure that the prescribed components are
contained in the solution; some health care agencies
require validation of the prescription by 2 registered
nurses.
2. To prevent infection and solution incompatibility, IV
medications and blood are not given through the PN
line.
3. Blood for testing may be drawn from the central
venous access site; a port other than the port used to
infuse the PN is used for blood draws after the PN
has been stopped for several minutes (per agency
procedure), because the PN solution can alter the
results of the sample. The client with a central venous
access site receiving PN should still have a
venipuncture site.
4. Monitor partial thromboplastin time and prothrombin
time for clients receiving anticoagulants.
5. Monitor electrolyte and albumin levels and liver and
renal function studies, as well as any other prescribed
laboratory studies. Blood studies for blood
chemistries are normally done every other day or 3
times per week (per agency procedures) when the
client is receiving PN; the results are the basis for the
PHCP continuing or changing the PN solution or rate.
6. Monitor blood glucose levels as prescribed (usually
every 4 hours) because of the risk for hyperglycemia
from the PN solution components.
7. In severely dehydrated clients, the albumin level may
drop initially after initiating PN because the treatment
restores hydration.
8. With severely malnourished clients, monitor for
“refeeding syndrome” (a rapid drop in potassium,
magnesium, and phosphate serum levels).
9. The electrolyte shift that occurs in “refeeding
syndrome” can cause cardiovascular, respiratory, and
neurological problems; monitor for shallow
respirations, confusion, weakness, bleeding

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