A patient has been admitted for surgery for a colostomy. The patient states, "I can't believe this has happened to me." What is the nurse's best response?

A. Excessive thirst and urination:
Excessive thirst and urination are symptoms typically associated with hyperglycemia, where there is a high level of glucose in the blood, often related to diabetes. When TPN is stopped suddenly, the concern is more about hypoglycemia due to the abrupt lack of glucose infusion, not hyperglycemia.

B. Shakiness and diaphoresis:
When TPN is suddenly interrupted, the continuous supply of glucose that the patient relies on is abruptly halted. This can lead to a rapid drop in blood sugar levels, causing hypoglycemia. Symptoms of hypoglycemia include shakiness, diaphoresis (sweating), confusion, and even loss of consciousness if not promptly addressed. Monitoring for shakiness and diaphoresis is crucial in this scenario to prevent severe hypoglycemia.

C. Hypertension and crackles:
These symptoms are typically indicative of fluid overload or heart failure. While TPN can contribute to fluid overload if not managed properly, the immediate concern with the cessation of TPN is the lack of glucose and potential hypoglycemia, not fluid overload.

D. Fever and chills:
Fever and chills are generally signs of an infection, such as sepsis. While infections can be a complication of TPN due to the intravenous route of administration, they are not directly related to the sudden stopping of TPN. The primary concern when TPN stops unexpectedly is the risk of hypoglycemia due to the cessation of glucose infusion.

A) Delayed gastric emptying: This condition refers to a slowdown in the movement of food from the stomach to the small intestine, often leading to symptoms like nausea, vomiting, bloating, and early satiety. It is not related to breath sounds and would not be detected through auscultation of the lungs.

B) Atelectasis: This condition involves the collapse or closure of lung tissue, resulting in reduced or absent gas exchange. It commonly occurs in patients who are immobile or on bedrest for extended periods, such as the client with a lacerated spleen. Decreased breath sounds in the lower lobes of the lungs are a typical finding in atelectasis, as the collapsed or partially collapsed alveoli do not allow air to move through them, leading to diminished or absent breath sounds in the affected areas.

C) An upper respiratory infection: This condition involves infections in the nose, throat, and airways and typically presents with symptoms like cough, nasal congestion, sore throat, and sometimes fever. It can affect breath sounds, but it more commonly causes wheezing, crackles, or rhonchi rather than isolated decreased breath sounds in the lower lobes.

D) Pulmonary edema: This condition is characterized by the accumulation of fluid in the lungs, often due to heart failure or acute lung injury. Auscultation findings typically include crackles or rales, particularly in the lower lung fields, but not necessarily decreased breath sounds unless there is a significant consolidation or fluid volume.