Complete the plan for initiating parenteral nutrition in a severely malnourished client.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
An infusate at or above 900 mOsm/L requires central access. Nutrition should advance gradually while glucose and electrolytes are monitored for refeeding complications.
Quick answer Use a central catheter, advance gradually, and monitor glucose plus phosphorus, potassium, and magnesium.
Why this is correct The CLINIMIX E label bases central versus peripheral delivery on final osmolarity and warns about refeeding complications, hyperglycemia, and electrolyte imbalance. High-risk clients need gradual initiation and laboratory surveillance.
Easy analogy or mental picture A concentrated solution needs a larger highway, and a depleted metabolism needs a gradual restart with dashboard monitoring.
Memory hook High osmolarity goes central; high refeeding risk goes slow with labs.
NCLEX decision rule Match vascular access to final osmolarity and match advancement speed to metabolic risk.
Why the other choices are wrong A peripheral line is inappropriate for this osmolarity, and rapid full-rate nutrition can worsen refeeding shifts.
References
1DailyMed: CLINIMIX ERoute selection by osmolarity and refeeding monitoring
Parenteral-nutrition startVerify final osmolarity, vascular route, glucose, fluid status, and phosphorus, potassium, and magnesium before and during advancement.