A client receiving parenteral nutrition (PN) complains of a headache. A nurse notes that client has a bounding pulse, jugular distension, and weight gain greater than desired. The nurse determines that client is experiencing which complication of PN rapy?

Correct Answer: B. Hypervolemia.

The client’s signs and symptoms are consistent with hypervolemia. This happens when the client receives excessive fluid administration or administration of fluid too rapidly. Increased central venous pressure is noticed first as distention of the jugular veins. Maintaining the head of bed elevated will promote ease in breathing. This position also allows pooling of fluid in the bases and for gas exchange to be more available to the lung tissue.

• Option A: An air embolism may occur if IV tubing disconnects and is open to air, or if part of the catheter system is open or removed without being clamped. Symptoms include sudden respiratory distress, decreased oxygen saturation levels, shortness of breath, coughing, chest pain, and decreased blood pressure.
• Option C: Hyperglycemia related to sudden increase in glucose after a recent malnourished state. After starvation, glucose intake suppresses gluconeogenesis by leading to the release of insulin and the suppression of glycogen. Excessive glucose may lead to hyperglycemia, with osmotic diuresis, dehydration, metabolic acidosis, and ketoacidosis. Excess glucose also leads to lipogenesis (again caused by insulin stimulation). This may cause fatty liver, increased CO2 production, hypercapnia, and respiratory failure.
• Option D: CR-BSI, which starts at the hub connection, is the spread of bacteria through the bloodstream. There’s an increased risk of CR-BSI with TPN, due to the high dextrose concentration of TPN. Symptoms include tachycardia, hypotension, elevated or decreased temperature, increased breathing, decreased urine output, and disorientation.