A nurse is preparing to administer intermittent lipid emulsion and notes a layer of fat floating in the IV solution bag. Which action should the nurse take?

Choice A: Fever and chills Fever and chills are not typically associated with the abrupt cessation of TPN. These symptoms are more commonly related to infections or inflammatory processes in the body. While infections can be a complication of TPN due to the invasive nature of the therapy, they are not a direct result of the discontinuation of the infusion. Total Parenteral Nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the nutrients the body needs. The sudden stop in the infusion of TPN can lead to a rapid drop in blood sugar levels, known as hypoglycemia, because the body has become accustomed to the continuous influx of glucose from the TPN solution.

Choice B: Hypertension and crackles Hypertension (high blood pressure) and crackles (sounds heard on lung auscultation indicative of fluid in the air spaces) are not expected clinical manifestations due to the stopping of TPN. These symptoms are more commonly associated with cardiovascular and pulmonary conditions, respectively.

Choice C: Excessive thirst and urination Excessive thirst and urination could be symptoms of hyperglycemia (high blood sugar), which might occur if TPN is infused too quickly or if the patient has an increased insulin requirement. However, these are not the immediate concerns when TPN is abruptly stopped.

Choice D: Shakiness and diaphoresis Shakiness and diaphoresis (sweating) are common signs of hypoglycemia, which can occur if TPN is stopped suddenly. The body may have been receiving a steady supply of glucose from the TPN, and a sudden halt can cause blood sugar levels to drop quickly. This can lead to symptoms such as weakness, shakiness, sweating, and even confusion or loss of consciousness if not addressed promptly. When TPN is abruptly discontinued, the nurse should monitor the client for signs of hypoglycemia, including shakiness and diaphoresis. It is important to restart the TPN infusion as soon as possible or provide an alternative source of glucose to prevent hypoglycemia and its potential complications.

Choice A reason: A client who works in a child care center is not typically at risk for hepatitis C unless they are exposed to blood or bodily fluids from an infected individual. Hepatitis C is primarily spread through blood-to-blood contact. While working in a child care center may increase the risk of exposure to various infections due to close contact with children, it is not a common route of transmission for hepatitis C.

Choice B reason: Eating raw shellfish is more commonly associated with hepatitis A and E, which are transmitted through the fecal-oral route, often due to contaminated food or water. Hepatitis C, however, is not typically transmitted through food or water. It is a bloodborne virus, and thus, eating raw shellfish would not be considered a high-risk activity for contracting hepatitis C.

Choice C reason: A client who has multiple tattoos is at risk for developing hepatitis C, particularly if the tattoos were done using non-sterile equipment or in an unregulated setting. The hepatitis C virus can be transmitted through the use of contaminated needles, which can occur in tattoo parlors that do not adhere to strict hygiene and sterilization practices. This is why choice C is the correct answer. While all the options presented could potentially involve some risk of infection, it is the client with multiple tattoos who is most at risk for hepatitis C, assuming the tattoos were obtained in a setting where infection control practices were not followed. It’s important for healthcare providers to assess each client’s individual risk factors and educate them on the ways to prevent hepatitis C, such as ensuring the use of sterile needles for tattoos and piercings.

Choice D reason: Traveling to an underdeveloped country may increase the risk of various infectious diseases, but hepatitis C is not commonly spread through casual contact or environmental factors. It requires blood-to-blood contact for transmission. Therefore, unless the client engaged in activities that involved such exposure, like receiving medical or dental procedures with non-sterile equipment, simply traveling to an underdeveloped country does not significantly increase the risk of contracting hepatitis C.