A client presents with a possible bowel obstruction, and the nurse completes a detailed abdominal assessment. Which of the following clinical manifestations are consistent with a large bowel obstruction? (Select all that apply).

Choice A reason:Profuse vomiting with a fecal odor can occur in large bowel obstructions due to the backward flow of bowel contents.

Choice B reason:Epigastric abdominal distention is a common finding in bowel obstructions due to the accumulation of gas and fluids.

Choice C reason:Intermittent abdominal cramping results from the bowel's attempt to push contents through the obstructed area.

Choice D reason:Ribbon-like stools or diarrhea may occur if there is a partial obstruction allowing some contents to pass.

Choice E reason:Metabolic acidosis can develop due to the accumulation of lactic acid from tissue hypoxia and decreased perfusion.

Choice F reason:Severe fluid and electrolyte imbalance can result from vomiting and the inability to absorb fluids and nutrients properly.

Choice A: Fever and chills Fever and chills are not typically associated with the abrupt cessation of TPN. These symptoms are more commonly related to infections or inflammatory processes in the body. While infections can be a complication of TPN due to the invasive nature of the therapy, they are not a direct result of the discontinuation of the infusion. Total Parenteral Nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the nutrients the body needs. The sudden stop in the infusion of TPN can lead to a rapid drop in blood sugar levels, known as hypoglycemia, because the body has become accustomed to the continuous influx of glucose from the TPN solution.

Choice B: Hypertension and crackles Hypertension (high blood pressure) and crackles (sounds heard on lung auscultation indicative of fluid in the air spaces) are not expected clinical manifestations due to the stopping of TPN. These symptoms are more commonly associated with cardiovascular and pulmonary conditions, respectively.

Choice C: Excessive thirst and urination Excessive thirst and urination could be symptoms of hyperglycemia (high blood sugar), which might occur if TPN is infused too quickly or if the patient has an increased insulin requirement. However, these are not the immediate concerns when TPN is abruptly stopped.

Choice D: Shakiness and diaphoresis Shakiness and diaphoresis (sweating) are common signs of hypoglycemia, which can occur if TPN is stopped suddenly. The body may have been receiving a steady supply of glucose from the TPN, and a sudden halt can cause blood sugar levels to drop quickly. This can lead to symptoms such as weakness, shakiness, sweating, and even confusion or loss of consciousness if not addressed promptly. When TPN is abruptly discontinued, the nurse should monitor the client for signs of hypoglycemia, including shakiness and diaphoresis. It is important to restart the TPN infusion as soon as possible or provide an alternative source of glucose to prevent hypoglycemia and its potential complications.