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A patient is admitted with severe malnutrition. A central venous catheter is placed in the right subclavian vein and total parenteral nutrition (TPN) is started. What medical interventions may be initiated with the onset of hyperglycemia?

A.

Adding insulin to the TPN

B.

Discontinuing the infusion

C.

Weaning from the TPN over a 6-hour period

D.

Starting an infusion of 0.9% normal saline

Answer and Explanation

The Correct Answer is A

A. Insulin can be added to the TPN to control blood sugar levels. TPN often leads to hyperglycemia, and insulin is commonly added to the solution to regulate glucose levels.  
B. Discontinuing the infusion would not address the hyperglycemia and would risk nutrient deficiencies.  
C. Weaning from TPN may be indicated when discontinuing the nutrition support, but it is not a direct intervention for hyperglycemia.  
D. Starting an infusion of 0.9% normal saline would not address the hyperglycemia directly and may not be effective in managing the glucose levels.


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Explanation

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Correct Answer is D

Explanation

A. Administering an enema every third day may be too infrequent to effectively manage constipation. Enemas are generally not a first-line solution for constipation prevention in patients on long-term opioid therapy.
B. Constipation is nothing to worry about; take your medicine is incorrect because constipation is a common and preventable side effect of opioid use. It should be addressed proactively.
C. Only taking morphine when experiencing the most severe pain could lead to uncontrolled pain. It is important for cancer pain to be managed consistently, and adjusting the timing of medication is not recommended.
D. Increasing fluids and high-fiber foods, and using a mild laxative is the most appropriate recommendation. It helps prevent constipation, which is a common side effect of opioid use. Mild laxatives can also be helpful, but regular bowel care is essential.

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