MEDSURG II: Saunders TPN
A client with parenteral nutrition (PN) infusing has disconnected the tubing from the central line catheter. The nurse assesses the client and suspects an air embolism. The nurse should immediately place the client in which position? 1.On the left side, with the head lower than the feet 2.On the left side, with the head higher than the feet 3.On the right side, with the head lower than the feet 4.On the right side, with the head higher than the feet
Answer: 1 Rationale: Air embolism occurs when air enters the catheter system, such as when the system is opened for intravenous (IV) tubing changes or when the IV tubing disconnects. Air embolism is a critical situation; if it is suspected, the client should be placed in a left side-lying position. The head should be lower than the feet. This position is used to minimize the effect of the air traveling as a bolus to the lungs by trapping it in the right side of the heart. The positions in the remaining options are inappropriate if an air embolism is suspected.
A client receiving total parenteral nutrition (TPN) experiences sudden development of chest pain, dyspnea, tachycardia, cyanosis, and a decreased level of consciousness. What should the nurse suspect as a complication of the TPN? 1.Air embolism 2.Hyperglycemia 3.Catheter-related sepsis 4.Allergic reaction to the catheter
Answer: 1 Rationale: Signs and symptoms of air embolism include decreased level of consciousness, tachycardia, dyspnea, anxiety, feelings of impending doom, chest pain, cyanosis, and hypotension. The signs and symptoms in the question do not indicate hyperglycemia, an infection (catheter-related sepsis), or an allergic reaction.
A client with cancer is placed on permanent total parenteral nutrition (TPN). The nurse considers psychosocial support when planning care for this client when the client makes which correct statement? 1."Death is imminent for me because of this." 2."This treatment requires disfiguring surgery." 3."Nausea and vomiting occur regularly and will prevent social activity." 4."I'll need to adjust to the idea of living without eating by the usual route."
Answer: 4 Rationale: Permanent TPN is indicated for clients who can no longer absorb nutrients via the enteral route. These clients may no longer be able to take nutrition orally and will need to adjust to the idea of living without eating by the usual route. The remaining options are incorrect statements. There are no data in the question that indicate that death is imminent. Port implantation does not require disfiguring surgery. Nausea and vomiting are not associated with administering TPN.
A client receiving total parenteral nutrition (TPN) is demonstrating signs and symptoms of an air embolism. What is the first action by the nurse? 1.Stop the TPN solution. 2.Notify the health care provider (HCP). 3.Place the client in the high Fowler's position. 4.Place the client on the left side in the Trendelenburg's position.
Answer: 1 Rationale: Although stopping the TPN solution will not treat the problem, it will prevent it from worsening, and is a quick action that can be completed first. Lying on the left side may prevent air from flowing into the pulmonary veins. Trendelenburg's position increases intrathoracic pressure, which decreases the amount of blood pulled into the vena cava during inspiration. The high Fowler's position is not helpful at this time. The HCP should be notified, but this is not the first action.
The nurse notes that a client's total parenteral nutrition (TPN) solution is 4 hours behind. Which action should the nurse take? 1. Assess the infusion pump to be sure it is functioning properly and is set at the correct rate. 2. Increase the infusion rate to a rate that allows the infusion volume to correct itself within a 2-hour period. 3. Replace the TPN solution with 10% dextrose, and restart the solution the following day. 4. Administer the TPN solution using gravity flow because the infusion pump is malfunctioning.
Answer: 1 Rationale: If an infusion falls behind schedule, the nurse should not increase the rate in an attempt to catch up, because a hyperosmotic reaction, among other reactions, could result. The solution should not be replaced by another or restarted the next day. An infusion pump should always be used to administer TPN solution.
The nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse should next assess which item? 1.Client's temperature 2.Expiration date on the bag 3.Time of last dressing change 4.Tightness of tubing connections
Answer: 1 Rationale: Redness at the catheter insertion site is a possible indication of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess. The tightness of tubing connections should be assessed each time the PN is checked; loose connections would result in leakage, not skin redness. The expiration date on the bag is a viable option, but this also should be checked at the time the solution is hung and with each shift change. The time of the last dressing change should be checked with each shift change.
The nurse is caring for a client who is receiving total parenteral nutrition (TPN) via a central line. Which nursing intervention would specifically provide assessment data related to the most common complication associated with TPN? 1.Weighing the client daily 2.Monitoring the temperature 3.Monitoring intake and output (I&O) 4.Monitoring the blood urea nitrogen (BUN) level
Answer: 2 Rationale: The most common complication associated with TPN is infection. Monitoring the temperature provides assessment data that would indicate infection in the client. Weighing the client daily and monitoring I&O provides information related to fluid volume overload. Monitoring the BUN level does not provide information about infection and is most closely related to assessing renal function.
The nurse notes redness, warmth, and a yellowish drainage at the insertion site of a central venous catheter in a client receiving total parenteral nutrition. What is the nurse's initial action? 1.Administer diphenhydramine. 2.Decrease the rate of infusion. 3.Notify the health care provider (HCP). 4.Evaluate for signs of septicemia.
Answer: 4 Rationale: Redness, warmth, and purulent drainage are signs of an infection, not of an allergic reaction. Infiltration causes the surrounding tissue to become cool and pale. An infection of a central venous catheter site can lead to septicemia. The nurse should assess for signs of septicemia and then notify the HCP so that all of the assessment data can be reported. If infection is suspected, the infusion should be stopped. Diphenhydramine is prescribed for allergic reactions.
The nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse asks the client to take which essential action during the tubing change? 1.Breathe normally. 2.Turn the head to the right. 3.Exhale slowly and evenly. 4.Take a deep breath, hold it, and bear down.
Answer: 4 Rationale: The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tubing changes. The nurse asks the client to take a deep breath, hold it, and bear down. If the intravenous line is on the right, the client turns his or her head to the left. This position increases intrathoracic pressure. Breathing normally and exhaling slowly and evenly are inappropriate and could enhance the potential for an air embolism during the tubing change.
The nurse monitors the client receiving parenteral nutrition (PN) for complications of the therapy and should assess the client for which manifestations of hyperglycemia? 1.Fever, weak pulse, and thirst 2.Nausea, vomiting, and oliguria 3.Sweating, chills, and abdominal pain 4.Weakness, thirst, and increased urine output
Answer: 4 Rationale: The high glucose concentration in PN places the client at risk for hyperglycemia. Signs of hyperglycemia include excessive thirst, fatigue, restlessness, confusion, weakness, Kussmaul respirations, diuresis, and coma when hyperglycemia is severe. If the client has these symptoms, the blood glucose level should be checked immediately. The remaining options do not identify signs specific to hyperglycemia.
A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse notifies the health care provider (HCP), and the HCP initially prescribes that the solution and tubing be changed. What should the nurse do with the discontinued materials? 1.Discard them in the unit trash. 2.Return them to the hospital pharmacy. 3.Save them for return to the manufacturer. 4.Prepare to send them to the laboratory for culture.
Answer: 4 Rationale: When the client who is receiving PN develops a fever, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for infectious organisms per HCP prescription. The other options are incorrect. Because culture for infectious organisms is necessary, the discontinued materials are not discarded or returned to the pharmacy or manufacturer.
A client receiving total parenteral nutrition (TPN) through a single-lumen central intravenous (IV) line is scheduled to receive an antibiotic by the IV route. Which action by the nurse is appropriate before hanging the antibiotic solution? 1.Ensure a separate IV access for the antibiotic. 2.Turn off the solution for 30 minutes before administering the antibiotic. 3.Flush the central IV line with 60 mL of normal saline before giving the antibiotic. 4.Check with the pharmacy to be sure the antibiotic can be given through the TPN solution line.
Answer: 1 Rationale: The TPN solution line is used only for the administration of the solution. Any other IV medication must be run though a separate IV access site; therefore, the remaining options are incorrect.
The home care nurse is monitoring a client's response to total parenteral nutrition (TPN). The client's weight 1 week earlier was 114 lbs (52 kg). The nurse determines that the client is gaining weight as expected if which morning weight is noted? 1.116 lbs (52.6 kg) 2.119 lbs (53.9 kg) 3.120 lbs (54.4 kg) 4.122 lbs (55.3 kg)
Answer: 1 Rationale: The client receiving TPN should not gain more than 3 lbs (1.4 kg) per week, with optimal weight gain being 1 to 2 lbs (0.5 to 1 kg) per week. The weight goal for the client on TPN is individual and depends on the client's metabolic needs and baseline weight (whether underweight, overweight, or at optimal weight). The correct option identifies a reasonable weight gain of 2 lbs (1 kg) per week. The remaining options indicate weekly weight gains that are greater than expected.
The nurse is caring for a client receiving total parenteral nutrition (TPN) via a central line. What assessment should the nurse perform to detect the most common complication of TPN? 1.Vital signs 2.Auscultate lungs 3.Kidney function tests 4.Listen for bowel sounds
Answer: 1 Rationale: The most common complication associated with TPN is infection. Monitoring the temperature would provide data that would indicate infection in the client. Monitoring kidney function tests would not provide information related to infection. Auscultating lungs assists in identifying if fluid overload is present, not infection. Listening for bowel sounds does not assist in assessing for infection in this case.
The nurse, caring for a group of adult clients on an acute care medical-surgical nursing unit, determines that which clients would be the most likely candidates for parenteral nutrition (PN)? Select all that apply. 1.A client with extensive burns 2.A client with cancer who is septic 3.A client who has had an open cholecystectomy 4.A client with severe exacerbation of Crohn's disease 5.A client with persistent nausea and vomiting from chemotherapy
Answer: 1,2,4,5 Rationale: PN is indicated in clients whose gastrointestinal tracts are not functional or must be rested, cannot take in a diet enterally for extended periods, or have increased metabolic need. Examples of these conditions include those clients with burns, exacerbation of Crohn's disease, and persistent nausea and vomiting due to chemotherapy. Other clients would be those who have had extensive surgery, have multiple fractures, are septic, or have advanced cancer or acquired immunodeficiency syndrome. The client with the open cholecystectomy is not a candidate because this client would resume a regular diet within a few days following surgery.
The health care provider (HCP) prescribes fat emulsion, given intravenously, for a client. The nurse should consult with the HCP before administering the fat emulsion solution if which is noted in the client's record? 1.The client has an allergy to iodine. 2.The client has an allergy to egg yolks. 3.The client is receiving total parenteral nutrition. 4.The client has a blood glucose level of 120 mg/dL (6.9 mmol/L).
Answer: 2 Rationale: Before administering any medication, the nurse must assess for allergy or hypersensitivity to substances used in producing the medication. Fat emulsions may contain an emulsifying agent obtained from egg yolks. Clients sensitive to eggs are at risk for developing hypersensitivity reactions. Options 1, 3, and 4 are not contraindications to the administration of fat emulsions.
The nurse is preparing to hang fat emulsion (lipids) and notes that fat globules are visible at the top of the solution. The nurse should take which action? 1.Roll the bottle of solution gently. 2.Obtain a different bottle of solution. 3.Shake the bottle of solution vigorously. 4.Run the bottle of solution under warm water.
Answer: 2 Rationale: Fat emulsion (lipids) is a white, opaque solution administered intravenously during parenteral nutrition therapy to prevent fatty acid deficiency. The nurse should examine the bottle of fat emulsion for separation of emulsion into layers of fat globules or for the accumulation of froth. The nurse should not hang a fat emulsion if any of these are observed and should return the solution to the pharmacy. Therefore, the remaining options are inappropriate actions.
Which nursing action is essential prior to initiating a new prescription for 500 mL of fat emulsion (lipids) to infuse at 50 mL/hour? 1.Ensure that the client does not have diabetes. 2.Determine whether the client has an allergy to eggs. 3.Add regular insulin to the fat emulsion, using aseptic technique. 4.Contact the health care provider (HCP) to have a central line inserted for fat emulsion infusion.
Answer: 2 Rationale: The client beginning infusions of fat emulsions must be first assessed for known allergies to eggs to prevent anaphylaxis. Egg yolk is a component of the solution and provides emulsification. The remaining options are unnecessary and are not related specifically to the administration of fat emulsion.
The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (PN) bag of an assigned client is empty. Which solution should the nurse hang until another PN solution is mixed and delivered to the nursing unit? 1.5% dextrose in water 2.10% dextrose in water 3.5% dextrose in Ringer's lactate 4.5% dextrose in 0.9% sodium chloride
Answer: 2 Rationale: The client is at risk for hypoglycemia; therefore, the solution containing the highest amount of glucose should be hung until the new PN solution becomes available. Because PN solutions contain high glucose concentrations, the 10% dextrose in water solution is the best of the choices presented. The solution selected should be one that minimizes the risk of hypoglycemia. The remaining options will not be as effective in minimizing the risk of hypoglycemia.
A client has been discharged to home on parenteral nutrition (PN). With each visit, the home care nurse should assess which parameter most closely in monitoring this therapy? 1.Pulse and weight 2.Temperature and weight 3.Pulse and blood pressure 4.Temperature and blood pressure
Answer: 2 Rationale: The client receiving PN at home should have her or his temperature monitored as a means of detecting infection, which is a potential complication of this therapy. An infection also could result in sepsis because the catheter is in a blood vessel. The client's weight is monitored as a measure of the effectiveness of this nutritional therapy and to detect hypervolemia. The pulse and blood pressure are important parameters to assess, but they do not relate specifically to the effects of PN.
The nurse is assigned to a client receiving total parenteral nutrition (TPN) who had a blood glucose measurement done at 06:00. The nurse documents on the client's clinical worksheet for the day that the blood glucose level should be checked next at which time? 1.08:00 2.12:00 3.16:00 4.18:00
Answer: 2 Rationale: The client's blood glucose level should be monitored every 4 to 6 hours during TPN therapy. Depending on agency policy, this may be done every 8 hours instead. Monitoring the blood glucose level every 2 hours is unnecessary. Monitoring every 10 or 12 hours is insufficient.
Fat emulsion is prescribed for the client receiving total parenteral nutrition. The nurse is preparing to administer the fat emulsion and notes the presence of fat globules in the solution. What should the nurse do? 1.Call the health care provider (HCP). 2.Return the solution to the pharmacy. 3.Shake the solution to dissolve the globules. 4.Place the solution in a bath of warm water until the globules dissolve.
Answer: 2 Rationale: The nurse should not hang a fat emulsion that has visible fat globules. Another solution should be obtained and used instead. Shaking the solution or placing the solution in a warm-water bath is not an appropriate action. Contacting the HCP also is inappropriate; the HCP's permission is not needed to obtain another bottle of solution.
A client is being weaned from parenteral nutrition (PN) and is expected to begin taking solid food today. The ongoing solution rate has been 100 mL/hour. The nurse anticipates that which prescription regarding the PN solution will accompany the diet prescription? 1. Discontinue the PN. 2. Decrease PN rate to 50 mL/hour. 3. Start 0.9% normal saline at 25 mL/hour. 4. Continue current infusion rate prescriptions for PN.
Answer: 2 Rationale: When a client begins eating a regular diet after a period of receiving PN, the PN is decreased gradually. PN that is discontinued abruptly can cause hypoglycemia. Clients often have anorexia after being without food for some time, and the digestive tract also is not used to producing the digestive enzymes that will be needed. Gradually decreasing the infusion rate allows the client to remain adequately nourished during the transition to a normal diet and prevents the occurrence of hypoglycemia. Even before clients are started on a solid diet, they are given clear liquids followed by full liquids to further ease the transition. A solution of normal saline does not provide the glucose needed during the transition of discontinuing the PN and could cause the client to experience hypoglycemia.
The nurse is creating a plan of care for a client who is receiving total parenteral nutrition (TPN). Which assessment should be included in the plan of care? 1.Apical rate every hour 2.Continuous pulse oximetry 3.Blood glucose levels every 6 hours 4.Hemoglobin and hematocrit every 8 hours
Answer: 3 Rationale: Complications associated with TPN therapy include hypoglycemia or hyperglycemia, infection, fluid overload, air embolism, and electrolyte imbalance. It is standard care to monitor blood glucose levels at 6-hour intervals to assess for hyperglycemia. The remaining options contain assessments that are not routine for a client receiving TPN.
The nurse is performing an assessment on a client who has been receiving total parenteral nutrition (TPN) at 125 mL/hour. On assessment, the nurse notes the presence of bilateral crackles in the lungs and 2+ pedal edema. The nurse also notes that the client has gained 3 pounds (1.5 kg) in 5 days. Which nursing action would be most appropriate for this client? 1.Slow the infusion rate to 100 mL/hour. 2.Encourage the client to cough and deep breathe. 3.Notify the health care provider (HCP) of the assessment findings. 4.Administer the prescribed daily diuretic and reassess the client in 2 hours.
Answer: 3 Rationale: Crackles, edema, and weight gain signify fluid shifts from intravascular spaces to the interstitial spaces and indicate signs of fluid retention and possible excess fluid intake. The problem may or may not be related to the TPN. Other possible causes of fluid retention are impaired respiratory and cardiovascular function and impaired kidney function. Deep breathing and coughing will have little, if any, effect on peripheral edema and weight gain. Administering the prescribed daily diuretic and reassessing in 2 hours may delay necessary and immediate treatment and is incorrect. Decreasing the rate of infusion by 25 mL is not very helpful; in addition, the nurse should obtain an HCP prescription for doing so because increasing or decreasing the rate of the infusion presents the potential for hyperosmolar diuresis, hypoglycemia, or hyperglycemia.
A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally. The nurse determines that the client is experiencing which complication of PN therapy? 1.Sepsis 2.Air embolism 3.Hypervolemia 4.Hyperglycemia
Answer: 3 Rationale: Hypervolemia is a critical situation and occurs from excessive fluid administration or administration of fluid too rapidly. Clients with cardiac, renal, or hepatic dysfunction are also at increased risk. The client's signs and symptoms presented in the question are consistent with hypervolemia. The increased intravascular volume increases the blood pressure, whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The increased volume also causes neck vein distention and shifting of fluid into the alveoli, resulting in lung crackles. The signs and symptoms presented in the question do not indicate sepsis, air embolism, or hyperglycemia.
The nurse is preparing to administer lipid emulsion to a client who has just been started on total parenteral nutrition. Before administering the lipid emulsion, the nurse asks the client about allergies. The nurse should withhold the lipid emulsion and contact the health care provider if the client identifies an allergy to which food item? 1.Milk 2.White bread 3.Soybean oil 4.Strawberries
Answer: 3 Rationale: Most fat emulsions are prepared from soybean oil, and the primary components are linoleic, oleic, palmitic, linolenic, and stearic acids. The nurse would ask the client about an allergy to soybean oil. The remaining options are not a concern.
The nurse hears that a client receiving total parenteral nutrition (TPN) at 100 mL/hr has bilateral crackles and 1+ pedal edema during shift report. When the nurse obtains a daily weight, the nurse notes that the client has gained 4 lbs (1.8 kg) in 2 days. Which action should the nurse take first? 1.Administer the prescribed daily diuretic. 2.Encourage the client to cough and deep breathe. 3.Compare the intake and output records of the past 2 days. 4.Slow the TPN infusion rate to 50 mL/hr per infusion pump.
Answer: 3 Rationale: The client is showing signs of fluid retention and possible excess fluid intake, as noted by the presence of crackles, edema, and weight gain. Noting the client's intake and output records adds to the database of information, which should then be reported. The problem may or may not be related to the TPN. (Other possible causes are impaired respiratory, cardiovascular, or renal function.) The nurse should not decrease the infusion rate without a health care provider's (HCP's) prescription. In addition, it is not recommended to increase or decrease the rate of TPN infusions because of the problems of hyperosmolar diuresis, hypoglycemia, or hyperglycemia. Coughing and deep breathing will have little, if any, effect on peripheral edema and weight gain. Administering a daily diuretic may delay necessary and immediate treatment and is incorrect.
The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the central line of an assigned client. The nurse should obtain which most essential piece of equipment before hanging the solution? 1.Urine test strips 2.Blood glucose meter 3.Electronic infusion pump 4.Noninvasive blood pressure monitor
Answer: 3 Rationale: The nurse obtains an electronic infusion pump before hanging a PN solution. Because of the high glucose content, use of an infusion pump is necessary to ensure that the solution does not infuse too rapidly or fall behind. Because the client's blood glucose level is monitored every 4 to 6 hours during administration of PN, a blood glucose meter also will be needed, but this is not the most essential item needed before hanging the solution because it is not directly related to administering the PN. Urine test strips (to measure glucose) rarely are used because of the advent of blood glucose monitoring. Although the blood pressure will be monitored, a noninvasive blood pressure monitor is not the most essential piece of equipment needed for this procedure.
The nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 1 hour behind. Which action should the nurse take? 1.Adjust the infusion rate to catch up over the next hour. 2.Increase the infusion rate to catch up over the next 2 hours. 3.Ensure that the fat emulsion infusion rate is infusing at the prescribed rate. 4.Adjust the infusion rate to run wide open until the solution is back on time.
Answer: 3 Rationale: The nurse should not increase the rate of a fat emulsion to make up the difference if the infusion timing falls behind. Doing so could place the client at risk for fat overload. In addition, increasing the rate suddenly can cause fluid overload. The same principle (not increasing the rate) applies to parenteral nutrition or any intravenous infusion. Therefore, the remaining options are incorrect.
A client with pancreatitis is being weaned from total parenteral nutrition (TPN). The client asks the nurse why the TPN cannot just be stopped. What is the nurse's best response? 1.Dehydration can result. 2.Hypokalemia may occur. 3.Hypernatremia will occur. 4.Rebound hypoglycemia is a risk.
Answer: 4 Rationale: Clients receiving TPN are receiving high concentrations of glucose. To give the pancreas time to adjust to decreasing glucose loads, the infusion rates are tapered down. Before discontinuing the TPN, the body must adjust to the lowered glucose level. If the TPN were suddenly withdrawn, the client could have rebound hypoglycemia. Although the other options are potential complications, they are not risks associated with discontinuing TPN abruptly.
A client who has been receiving total parenteral nutrition (TPN) by way of a central venous access device complains of shakiness and is diaphoretic. Based on these findings, the nurse should perform which assessment next? 1.Lung sounds 2.Mental status 3.Blood pressure 4.Blood glucose level
Answer: 4 Rationale: Hypoglycemia is one of the potential complications associated with TPN. Shakiness and diaphoresis are signs of hypoglycemia; therefore, based on these findings, the nurse should first check the blood glucose level. Lung sounds may provide information about refeeding syndrome, which is a complication of TPN causing fluid overload. However, the assessment findings do not indicate that this is occurring. Mental status could be affected by hypoglycemia; however, the nurse has enough information to suspect this complication already and therefore should assess the blood glucose before assessing mental status. Blood pressure is not specifically related to the information in the question and the associated complication of TPN.
The nurse discovers that an infusion of total parenteral nutrition (TPN) through a central line is empty, and a replacement bag is not yet ready. What should the nurse do next while waiting for the replacement bag? 1.Hang an intravenous infusion of normal saline. 2.Convert the intravenous infusion to a saline lock. 3.Hang an intravenous infusion of 5% dextrose in water. 4.Hang an intravenous infusion of 10% dextrose in water.
Answer: 4 Rationale: If TPN is discontinued abruptly, rebound hypoglycemia may occur because the pancreas has not yet had time to adjust its secretion of insulin in response to the lower amount of glucose. Therefore, a dextrose in water solution of 10% or 20% is infused temporarily until the replacement bag is available.
A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse should next assess the client for the presence of which condition? 1.Thirst 2.Polyuria 3.Decreased blood pressure 4.Crackles on auscultation of the lungs
Answer: 4 Rationale: Optimal weight gain when the client is receiving PN is 1 to 2 lb/week. The client who has a weight gain of 5 lb/week while receiving PN is likely to have fluid retention. This can result in hypervolemia. Signs of hypervolemia include increased blood pressure, crackles on lung auscultation, a bounding pulse, jugular vein distention, headache, peripheral edema, and weight gain more than desired. Thirst and polyuria are associated with hyperglycemia. A decreased blood pressure is likely to be noted in deficient fluid volume.
