A nurse is caring for a client who has a pulmonary embolism and has been on a heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

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.

Choice A: Lactated Ringer’s

Lactated Ringer’s solution is an isotonic crystalloid that contains electrolytes similar to those found in blood plasma. While it is commonly used for fluid resuscitation, it does not provide a significant source of calories and therefore is not the best option to temporarily replace TPN.

Choice B: 0.9% sodium chloride

0.9% sodium chloride, also known as normal saline, is an isotonic solution that is used to expand volume and correct electrolyte imbalances. Like Lactated Ringer’s, it does not contain a significant amount of calories and is not suitable as a temporary replacement for TPN.

Choice C: 3% sodium chloride

3% sodium chloride is a hypertonic saline solution used in controlled settings to treat specific conditions such as hyponatremia. Due to its high concentration of sodium, it is not appropriate for routine fluid replacement and does not provide calories.

Choice D: Dextrose 10% in water

D10W is the preferred choice in this scenario because it provides a source of glucose, which can help maintain blood glucose levels when TPN is not available. It is important to monitor the patient’s blood glucose levels while infusing D10W to ensure they remain within a safe range. When a TPN container is delayed, Dextrose 10% in water is the most appropriate temporary solution to infuse until the next container becomes available, as it provides necessary calories in the form of glucose to the patient.