The nurse knows that which of the following routes is the SAFEST to infuse total parenteral nutrition (TPN)? (SELECT ALL THAT APPLY)

Choice A rationale

Orthopnea, or shortness of breath when lying flat, is a classic symptom of heart failure. Patients often need to sleep in an elevated position to ease breathing, which indicates a potential worsening of heart function that needs urgent evaluation.

Choice B rationale

Night sweats and overall diaphoresis can be symptoms of myocardial infarction (heart attack) or other acute cardiac conditions. This requires prompt medical assessment to prevent further cardiac events or complications.

Choice C rationale

Nocturnal angina, or chest pain at night, can indicate a severe underlying cardiac issue such as unstable angina or coronary artery disease. This symptom warrants immediate cardiac evaluation to manage and mitigate potential risks.

Choice D rationale

Headaches after eating are not typically associated with cardiac issues but may relate to other conditions such as hypoglycemia or migraines. This symptom alone does not usually prompt immediate cardiac evaluation.

Choice E rationale

Postprandial somnolence, or sleepiness after eating, is generally not linked directly to cardiac status but rather to digestive or metabolic processes. This symptom is less likely to require urgent cardiac assessment. .

Choice D rationale

Sudden, sharp abdominal pain is a key indicator of gastrointestinal perforation. This severe symptom results from the leakage of gastrointestinal contents into the abdominal cavity, causing intense pain and requiring urgent medical attention.

Choice A rationale

Elevated blood pressure is not a specific indicator of gastrointestinal perforation. While stress or pain might cause temporary increases in blood pressure, it is not a reliable diagnostic sign for perforation.

Choice B rationale

Low heart rate is not typically associated with gastrointestinal perforation. Instead, tachycardia or increased heart rate might occur due to pain and the body's response to infection or sepsis from a perforation.

Choice C rationale

Hyperactive bowel sounds do not indicate gastrointestinal perforation. In fact, bowel sounds may be absent if a perforation occurs due to the body's response to abdominal infection and inflammation. Hyperactive sounds are more related to increased intestinal activity, not perforation.