A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse identify as an adverse effect of TPN
A.
2+ deep tendons reflexes
B.
Casual blood glucose 100 mg/dl
C.
Potassium 4.8 mEq/L
D.
2+ peripheral pitting Edema
The correct answer and Explanation is :
The correct answer is D. 2+ peripheral pitting edema.
Explanation:
Total parenteral nutrition (TPN) is an intravenous method of supplying nutrients to clients who cannot use their gastrointestinal tract for nutrition. While TPN is essential for meeting the nutritional needs of patients who are unable to take food orally or enterally, it is not without potential complications and adverse effects.
Peripheral Pitting Edema (2+) as an Adverse Effect:
Peripheral pitting edema indicates fluid overload, a common complication of TPN. TPN solutions contain a high concentration of nutrients, including electrolytes, dextrose, and proteins, all of which contribute to osmotic pressure and can lead to fluid retention. Clients receiving TPN are at risk of developing hypervolemia if the solution is infused too rapidly or if fluid management is not well monitored. Edema can be observed as swelling in the lower extremities due to excess fluid accumulating in tissues, which is what peripheral pitting edema represents.
Potential Causes of Edema in TPN Patients:
- Excessive Fluid Administration: TPN may contain large volumes of fluids that, if not carefully monitored, can exceed the body’s capacity to manage, leading to fluid retention and pitting edema.
- Hypoalbuminemia: Albumin, a key plasma protein, is vital for maintaining oncotic pressure in the blood vessels. When TPN is deficient in protein or the client has a pre-existing liver or kidney disease, hypoalbuminemia can occur, leading to fluid leakage into the interstitial spaces, causing edema.
- Electrolyte Imbalance: The imbalance of sodium and potassium due to TPN or the underlying health conditions can contribute to edema as well.
Other Findings in the Question:
- 2+ Deep Tendon Reflexes (DTRs): This is a normal finding and not related to TPN complications.
- Casual Blood Glucose 100 mg/dL: Blood glucose levels in this range are considered normal and not an indication of an adverse effect of TPN.
- Potassium 4.8 mEq/L: This is within the normal range for potassium levels and does not indicate an adverse effect of TPN.
Thus, D (2+ peripheral pitting edema) is the most appropriate answer, indicating a potential complication from TPN therapy.