The nurse is caring for a client receiving total parenteral nutrition (TPN). During the assessment, the nurse notes absence of breath sounds on the right side, where the central catheter is placed. Which of the following does the nurse suspect is responsible for this abnormal assessment finding?

  • air embolism
  • fluid overload
  • pneumothorax
  • refeeding syndrome
Number 3 is correct.
A pneumothorax is one of the complications of TPN. It is caused by improper central catheter placement or by a catheter that has migrated. Absence of breath sounds on the affected side, chest or shoulder pain, tachycardia, cyanosis, and sudden shortness of breath are indications of pneumothorax. The nurse should notify the health care provider and prepare the client for a portable chest X-ray. An air embolism is another complication of TPN. Signs and symptoms of air embolism include respiratory distress; a weak, rapid pulse; chest pain; dyspnea; hypotension; and a loud churning sound auscultated over the pericardium. Fluid overload would not present as absence of breath sounds; instead, expected findings include hypertension, bounding pulses, increased respiratory rate, distended veins in the hands and neck, and moist crackles. Signs of refeeding syndrome include arrhythmias, vomiting, shortness of breath, weakness, ataxia, and seizures. It occurs in severely malnourished clients who are undergoing nutritional replacement therapy.