A client receiving parenteral nutrition (PN) complains of shortness of breath and shoulder pain. A nurse notes that client has an increased pulse rate. The nurse determines that client is experiencing which complication of PN rapy?

Correct Answer: D. Pneumothorax.

Pneumothorax might happen during parenteral therapy due to inexact catheter placement. In order to prevent this, the nurse obtains a chest x-ray after insertion of the catheter to ensure proper catheter placement. A pneumothorax occurs when the tip of the catheter enters the pleural space during insertion, causing the lung to collapse. Symptoms include sudden chest pain, difficulty breathing, decreased breath sounds, cessation of normal chest movement on affected side, and tachycardia.

• 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 B: Signs and symptoms include fine crackles in lower lung fields or throughout lung fields, hypoxia (decreased O2 sats). Notify primary health care providers regarding change in condition. The patient may require IV medication, such as Lasix to remove excess fluids. A decrease or discontinuation of IV fluids may also occur. Raise head of bed to enhance breathing and apply O2 for oxygen saturation less than 92% or as per agency protocol. Monitor intake and output. Pulmonary edema may be more common in the elderly, young, and patients with renal or cardiac conditions.
• 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.