The 21-year-old patient with a body mass index of 10.1 undergoes placement of a peripherally inserted central catheter (PICC) at 1000 and total parenteral nutrition (TPN) is initiated at 1200. At 1600, 160 mL have infused and the patient is noted to be breathing shallowly, there is blood oozing from the PICC insertion site, and the patient is exhibiting confusion. Which action does the nurse perform first?

Institute seizure precautions. The severely malnourished patient who abruptly exhibits confusion, oozing, and shallow breathing is likely experiencing refeeding syndrome due to the total parenteral nutrition (TPN). This patient is at risk for seizures, so the nurse’s first action is to protect the patient by instituting seizure precautions. Then, the nurse can contact the provider to obtain an order to draw an electrolyte panel. The patient might require oxygen, but the question does not indicate the patient is hypoxic. Oozing blood from the insertion site needs to be addressed, but oozing indicates a slow bleed; the patient is more at risk for injury due to seizure activity.

The 21-year-old patient with a body mass index of 10.1 under...

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Pharmacological and Parenteral Therapies
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Category: Pharmacological and Parenteral Therapies
Difficulty: 8

Topics: Communication & Documentation Crisis Management Delegation, Prioritization and Leadership Disease Prevention Fluid and Electrolytes Neurology Acid-Base Cardiovascular Endocrine Gastrointestinal Health Promotion Nursing Interventions

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