Which of the following signs are shows hyperglycemia in a patient receiving total parenteral nutrition?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2022

Medical Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2022

Explanation

Total Parenteral Nutrition (TPN) solutions are rich in dextrose (glucose), which places the patient at high risk for hyperglycemia (high blood sugar).
The body attempts to excrete excess glucose through the kidneys, causing osmotic diuresis, which manifests as increased urine output (polyuria).
This significant loss of fluid through urination leads to dehydration and triggers intense thirst (polydipsia).
Despite high glucose levels in the blood, the cells cannot utilize it for energy without sufficient insulin, resulting in profound weakness and fatigue.

Option A: Oliguria (decreased urine output) is the opposite of a key sign of hyperglycemia. High blood sugar causes polyuria (increased urine output) due to osmotic diuresis.
Option B: Sweating (diaphoresis) and chills are classic signs of hypoglycemia (low blood sugar), not hyperglycemia. They can also indicate a systemic infection (sepsis).
Option C: While thirst is a correct sign, fever and a weak pulse are more specific to infection/sepsis, a different complication of TPN related to the central venous catheter.

Clinical Relevance

Nursing practice connection: Use the key finding related to Metabolic Complications of Total Parenteral Nutrition (TPN) to guide bedside assessment, documentation, and the next nursing action.
Nurses must perform regular blood glucose monitoring (typically every 4-6 hours) for patients on TPN to ensure early detection and management of hyperglycemia.
Uncontrolled hyperglycemia in a patient receiving TPN can lead to severe dehydration, electrolyte imbalances, and a life-threatening condition known as Hyperosmolar Hyperglycemic State (HHS).
What if? If the patient on TPN suddenly becomes diaphoretic, shaky, and confused, the nurse's priority action is to suspect hypoglycemia. This is a medical emergency requiring an immediate blood glucose check and administration of a rapid glucose source, as per facility protocol. This can happen if the TPN infusion is interrupted or stopped abruptly.

How to Approach the Question

First, identify the core concept of the question, which is a complication of Total Parenteral Nutrition (TPN).
The question specifically asks for the signs of hyperglycemia (high blood sugar).
Recall the basic pathophysiology of hyperglycemia: the body has too much sugar in the blood and tries to eliminate it through the urine.
This physiological response leads to the classic '3 Ps': Polyuria (increased urination), Polydipsia (increased thirst), and Polyphagia (increased hunger). Associated symptoms include weakness and fatigue.
Systematically evaluate each option to see which one aligns with these classic signs.
Option D includes weakness, thirst (polydipsia), and increased urine output (polyuria), making it the most accurate and complete answer.

Concept Tested & Keywords

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