A nurse in a provider's office is caring for a client.

Which of the following findings require follow-up? Select all that apply.

Total parenteral nutrition (TPN) provides complete nutritional support intravenously and is often administered through a central venous catheter. Because of its high fluid volume and concentrated nutrient content, careful monitoring is required to detect complications such as fluid volume overload, infection, and metabolic disturbances. Fluid overload occurs when excess fluid accumulates in the intravascular and interstitial spaces, affecting cardiovascular and respiratory function. Early recognition helps prevent complications such as heart failure and pulmonary edema.

A. +1 pedal pulses indicate diminished but present peripheral pulses and are not a direct sign of fluid volume overload. Fluid overload is more commonly associated with bounding pulses due to increased circulating volume. Therefore, weak pedal pulses do not strongly support the presence of excess fluid volume.

B. Urinary output of 20 mL in the past hour suggests decreased renal perfusion or possible renal impairment rather than fluid overload. In fluid overload, urine output may be normal or increased depending on renal function and compensatory mechanisms. Oliguria alone is not the most specific indicator of excess fluid volume in this situation.

C. An S3 heart sound is a classic sign of fluid volume overload and occurs when excess blood enters a ventricle that is already volume overloaded. It is often associated with heart failure and indicates increased ventricular filling pressures. In a client receiving TPN, this finding suggests the cardiovascular system is struggling to handle the excess circulating fluid.

D. A temperature of 38°C (100.4°F) is more suggestive of infection, especially in a client receiving TPN through a central venous catheter. Fever may indicate catheter-related bloodstream infection or another inflammatory process. It is not a typical finding used to identify fluid volume overload.

Diabetes insipidus is a disorder characterized by insufficient antidiuretic hormone (ADH) activity, leading to excessive production of dilute urine and increased thirst. Clients experience polyuria, dehydration, and hypernatremia due to the inability of the kidneys to concentrate urine. Management focuses on replacing the missing ADH effect and restoring fluid balance. Medication therapy is aimed at reducing urine output and preventing complications related to severe fluid loss.

A. Spironolactone is a potassium-sparing diuretic used mainly for conditions such as heart failure, hypertension, and hyperaldosteronism. It promotes sodium and water excretion while conserving potassium, which would worsen polyuria in a client with diabetes insipidus. It does not address the ADH deficiency causing the disorder.

B. Desmopressin acetate is a synthetic form of antidiuretic hormone (ADH) and is the primary treatment for central diabetes insipidus. It works by increasing water reabsorption in the renal tubules, thereby decreasing urine output and concentrating the urine. This helps correct dehydration and stabilize serum sodium levels.

C. Dopamine is a vasoactive medication used to improve cardiac output, renal perfusion, or blood pressure in critically ill patients depending on the dose. It has no role in replacing ADH or treating the excessive urine output seen in diabetes insipidus. Therefore, it is not the expected.

D. Furosemide is a loop diuretic that increases urine production by inhibiting sodium and chloride reabsorption in the kidneys. Since the client already has excessive urine output, administering this medication would worsen dehydration and electrolyte imbalance. It is contraindicated in managing untreated diabetes insipidus.