A patient, receiving total parenteral nutrition, has elevated serum blood urea nitrogen and serum sodium levels. Which of the following do these assessment findings suggest to the nurse?
1. catheter related sepsis
2. hepatic dysfunction
3. hyperglycemia
4. prerenal azotemia
4
Rationale: Prerenal azotemia is caused by overaggressive protein administration and is aggravated by underlying dehydration. Presenting signs and symptoms include an elevated serum BUN, serum sodium, and clinical signs of dehydration. Signs and symptoms of catheter related sepsis include: sudden onset of fever, rigors, or chills that coincide with parenteral infusion; erythema, swelling, tenderness, or purulent drainage from the catheter site; sudden temperature elevation that resolves on catheter removal; leukocytosis; sudden glucose intolerance that may occur up to 12 hours before temperature elevation; and bacteremia/septicemia/septic shock. Hepatic dysfunction would be assessed with serum liver function tests and bilirubin levels. Hyperglycemia would be a blood glucose level of greater than 220 mg/dL while receiving total parenteral nutrition.
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