Clinical Reasoning Case Study: Total Parenteral Nutrition Name _____________________________ Chief Complaint CC/History

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Clinical Reasoning Case Study: Total Parenteral
Nutrition Name
_____________________________
Chief Complaint CC/History of Present
Illness:
Mrs. Morris is a 66-year-old woman who has been complaining of
nausea, vomiting, weakness, abdominal pain and abdominal fullness
for the past 3 days. She has had a fever for the last 24 hours and
reports that her mid-abdominal pain is colicky and “crampy”. She
states her “Crohn’s” has been acting up for the past 4 weeks with
diarrhea, anorexia, extreme fatigue and weight loss. She is 65
inches tall and weighs 65 kg with a usual weight of 75 kg. Mrs.
Morris was admitted to the Med/Surg unit with a complete small
bowel obstruction, multiple adhesions, and exacerbation of Crohn's
disease. She is NPO and an exploratory lap is scheduled with lysis
of adhesions and small bowel resection to remove diseased bowel.
Mrs. Morris will be NPO postoperatively and it is expected that her
GI tract will not be accessible for at least 10-14 days.
Social and Past Medical History:
Mrs. Morris currently lives alone in a senior living apartment.
Her husband died of pancreatic cancer 2 months ago and they had no
children. She has had Crohn’s disease since she was 37 years old
and was diagnosed with diabetes type 2, five years ago.
Your Initial Nursing Assessment:
GENERAL APPEARANCE: anxious, appears weak and pale
SKIN/INTEG: skin dry, tenting noted, eyes sunken
RESP: breath sounds clear with equal aeration bilaterally,
non-labored
CARDIAC: skin pale, warm & dry, S1S2, no edema, pulses 2+ in
all extremities
NEURO: alert & oriented x4,
GI/GU: abdomen firm and distended. Absent bowel sounds, has not
voided yet
MISC: complains of crampy, colicky abdominal pain in RLQ, 8/10,
nausea and vomiting
Initial Vital
Signs:
T: 100.8 F
P: 110
R: 22
BP: 100/60
O2 sats: 98%
5. Define central venous catheter therapy
_____________________________________________
6. Is a PICC line a central venous catheter? And if
so, why? _______________________________
7.Related to Mrs. Morris’s TPN and CVC
therapy, what nursing priority (s) will
guide your plan of care? (these nursing priorities may or may not
be written as NANDA diagnostic statements)
Nursing Interventions per Nursing Priority
Rationale:
8. What body systems will you focus on based on Mrs.
Morris’s TPN therapy and your nursing priority
(s)?
9. Mrs. Morris is at risk for complications due to
the administration of TPN.
a. What are the worst possible complications to
anticipate with TPN administration and CVC
management?
b. What signs/symptoms should the nurse anticipate
to identify the development of this complication? What relevant
nursing action will need to be implemented for this
complication?
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