A nurse sees an AP perform the following interventions for a patient receiving continuous enteral feedings. Which action would require immediate attention by the nurse?

Point-of-care blood glucose monitoring must combine infection control, correct technique, and device accuracy. Steps done in the right order reduce false readings and prevent transmission of infection.

Rationale for correct answer:

1. (3) Instruct patient to perform hand hygiene with soap and water.
   Prevents contamination from sugar or other residues on the fingers, which could give falsely high readings.
2. (6) Check code on test strip vial.
   Ensures the test strips are calibrated correctly for the glucometer.
3. (1) Press button on meter to confirm match codes.
   Confirms that the meter’s internal code matches the strip code for accuracy.
4. (8) Perform hand hygiene and put on clean gloves.
   Protects both nurse and patient from bloodborne pathogens and infection transmission.
5. (4) Clean patient finger with antiseptic swab.
   Disinfects the puncture site. Important: allow to dry to avoid dilution of blood with alcohol.
6. (7) Holding lancet to finger, press release button on machine.
   Obtains capillary blood sample safely and effectively.
7. (2) Bringing meter to test strip, allow blood drop to wick onto test strip.
   Ensures an adequate sample is absorbed by the strip for analysis.
8. (5) Interpret results and document.
   Completes the procedure and ensures accurate communication of results for clinical decision-making.

Take home points:

• Correct sequence matters: code verification comes before gloves and antiseptic.
• Always finish with interpretation and documentation- this closes the loop on safe patient care.

Total parenteral nutrition (TPN) requires central venous access and strict aseptic technique because the central line is a major route for bloodstream infections.

Rationale for correct answer:

1. Change the dressing using sterile technique: Sterile dressing changes reduce microbial colonization at the insertion site and lower risk of central line-associated bloodstream infection (CLABSI).

3. Change the TPN tubing every 24 hours: Frequent tubing changes (usually every 24 hours for lipid-containing or TPN administration sets) help prevent microbial contamination and reduce CLABSI risk.

Rationale for incorrect answers:

2. Change TPN containers every 48 hours: TPN containers and lipid admixtures are typically changed every 24 hours to limit bacterial growth; leaving containers longer (e.g., 48 hrs) increases infection risk.

4. Monitor glucose levels to watch and assess for glucose intolerance. — Important for metabolic monitoring of TPN (hyper/hypoglycemia) but not a primary intervention to prevent central line infection.

5. Elevate head of the bed 45 degrees to prevent aspiration: Good for aspiration prevention, but unrelated to preventing central line infections.

Take home points:

Preventing central line infections centers on aseptic technique:

• sterile dressing changes
• proper skin antisepsis
• hub/port disinfection before access
• routine tubing/container changes per policy (commonly every 24 hours for TPN).