A patient with total parenteral nutrition (TPN) is behind by 500 mL. The solution is running at 200 mL per hour. What should the practical nurse do, in accordance with agency policies?

• A. Do not make up the 500 mL.
• B. Increase the ordered flow to 220 mL until the 500 mL is made up.
• C. Take the solution off the infusion pump and increase the rate to 300 mL per hour.
• D. Offer Mr. Ford increased fluids by mouth.

Answer: (B)

When a total parenteral nutrition (TPN) infusion is behind schedule, the approach is to adjust the flow within agency policy to replenish the deficit in a safe, controlled way. In this scenario, the patient is 500 mL behind and the current rate is 200 mL/h. Increasing the ordered flow to 220 mL/h provides a small, safe increment that shortens the time needed to make up the 500 mL without causing a large, abrupt change in glucose load or fluid balance. This is done temporarily and with ongoing monitoring, following the facility’s protocols for PN adjustments.

Raising the rate to 300 mL/h or attempting to “make up” the entire deficit by a large jump would be unsafe and not in line with typical PN policies, and offering fluids by mouth does not substitute for the intravenous nutrition and can introduce aspiration risk or fluid imbalance. The goal is to correct the deficit promptly but carefully, with appropriate monitoring and documentation.