A nurse is caring for a client who has skeletal traction for a fracture of the lower extremity. Which of the following actions should the nurse take?

Choice A reason: Verifying TPN with another RN is a safety protocol for this high-risk, complex solution containing dextrose, amino acids, and lipids. Errors in formulation or additives can cause severe metabolic imbalances or infections. This double-check reduces risks, ensuring the prescribed nutrients match the bag’s contents. It’s a standard of care in TPN administration, protecting the client from potential harm due to preparation mistakes, especially given its central line delivery.

Choice B reason: TPN’s high dextrose content elevates blood glucose, risking hyperglycemia, especially in stressed or diabetic clients. Monitoring serum glucose during infusion allows timely insulin adjustments, preventing complications like osmotic diuresis or ketoacidosis. This action aligns with metabolic management, as TPN bypasses digestion, delivering glucose directly into the bloodstream. Regular checks ensure glycemic control, a critical aspect of safe parenteral nutrition therapy.

Choice C reason: Increasing the TPN infusion rate to catch up if delayed is dangerous, risking fluid overload, electrolyte shifts, and refeeding syndrome. TPN rates are calculated precisely based on caloric and fluid needs, administered via infusion pumps for consistency. Speeding it up disrupts this balance, potentially causing cardiac strain or metabolic chaos. This action violates administration guidelines, making it inappropriate and unsafe.

Choice D reason: Infusing 0.9% sodium chloride instead of TPN lacks calories, amino acids, and lipids, interrupting nutritional support and risking hypoglycemia from prior high-glucose TPN. Protocol recommends 10% dextrose if TPN is unavailable, maintaining some glucose input. Sodium chloride only provides hydration, not sustenance, undermining TPN’s purpose. This substitution fails to meet the client’s metabolic needs, rendering it an incorrect action.

Choice E reason: Daily weights assess fluid balance and nutritional efficacy in TPN clients, detecting overhydration (weight gain) or malnutrition (loss). TPN delivers precise fluid and calories, and weight changes signal adjustments needed in therapy. This non-invasive measure tracks trends, complementing lab data, and is a cornerstone of monitoring. It ensures the treatment meets goals without causing volume-related complications, making it essential.

Choice A reason: Removing weights during repositioning disrupts skeletal traction’s constant pull, risking fracture misalignment or delayed healing. Traction maintains bone stability via weights and pulleys, essential for immobilization. Lifting the client without weights negates this, potentially shifting the fracture site. This action contradicts traction principles, compromising treatment efficacy and patient outcomes, making it unsafe and incorrect.

Choice B reason: Cleansing pin sites with hydrogen peroxide damages healthy tissue and delays healing by disrupting granulation, despite its antiseptic properties. Sterile saline or chlorhexidine is preferred, preserving skin integrity around traction pins. This outdated practice increases infection risk ironically, as tissue breakdown invites pathogens. It’s not aligned with current evidence-based care, rendering it inappropriate.

Choice C reason: Inspecting pin sites daily for redness, swelling, or pus detects infection early, a common traction complication like osteomyelitis. Chemotherapy or immobility heightens this risk, and prompt identification allows intervention, protecting bone health. This action aligns with standards, ensuring the fracture heals without secondary issues. It’s a proactive, essential step in traction management.

Choice D reason: Checking ropes every 8 hours ensures traction equipment integrity, preventing sudden weight drops that could misalign the fracture. While important, it’s secondary to infection monitoring, as fraying is less immediate than sepsis risk. Daily pin checks address a more urgent threat to healing. This action, though useful, isn’t the top priority here.