The nurse knows that which of the following routes is the SAFEST to infuse total parenteral nutrition (TPN)? (SELECT ALL THAT APPLY)

Choice A rationale

Tenesmus is a frequent urge to defecate, common in ulcerative colitis but not indicative of toxic megacolon. It results from inflammation and irritation of the rectal and colonic mucosa, causing discomfort and straining during bowel movements.

Choice B rationale

Hyperactive bowel sounds are associated with increased gastrointestinal activity, often seen in diarrheal states and early mechanical bowel obstruction but not typically linked to toxic megacolon. Toxic megacolon often presents with reduced or absent bowel sounds due to colonic paralysis.

Choice C rationale

An enlarging abdominal girth indicates distension, a significant sign of toxic megacolon. This condition involves extreme dilation of the colon, which can lead to severe abdominal distension due to trapped gas and stool. This can be life-threatening if not treated promptly.

Choice D rationale

Anal fissures are tears in the anal canal, common in chronic constipation or Crohn’s disease, not typically a sign of toxic megacolon. They cause pain and bleeding during bowel movements but do not indicate toxic megacolon.

Choice A rationale

Flush with 15-30 mL sterile water after each medication. Flushing the gastrostomy tube with sterile water ensures that the medication is fully delivered and prevents clogging of the tube, which is crucial for maintaining its patency.

Choice B rationale

Crush each immediate-release tablet and mix it in 15-30 mL sterile water. Crushing immediate-release tablets and mixing them with sterile water makes it easier to administer through the tube, ensuring that the medication can be properly absorbed by the body.

Choice C rationale

Add medications directly to the tube feeding formula. Adding medications directly to the feeding formula can cause drug-nutrient interactions and may affect the medication's efficacy and absorption, making this practice generally not recommended.

Choice D rationale

Use liquid medications when available. Liquid medications are preferred for tube feedings as they are less likely to cause blockages and are easier to administer and absorb compared to crushed tablets.

Choice E rationale

Mix all medications, dilute with water and give them together. Mixing all medications together can lead to interactions between the drugs, potentially altering their effectiveness and increasing the risk of adverse reactions, making this practice inappropriate.