What complication should the nurse monitor for post TPN initiation in an unstable patient?

Monitoring for complications in patients receiving Total Parenteral Nutrition (TPN) is critical, particularly in unstable patients. The correct approach involves acknowledging that all the listed complications—hyperglycemia, fluid overload, and electrolyte imbalances—are pertinent concerns.

Hyperglycemia may occur due to the high concentration of dextrose in TPN solutions, especially when the patient's insulin response is impaired or when the infusion rate is too rapid. This is particularly relevant in unstable patients who might already have significant stress responses affecting their glucose metabolism.

Fluid overload is another serious risk, as TPN can lead to an excess of fluid intake that overwhelms the patient's cardiovascular system, particularly in those with pre-existing heart or renal issues. Close monitoring of fluid balance and signs of overload, such as edema or altered vital signs, is essential.

Electrolyte imbalances can arise due to the rapid changes in the body’s electrolyte composition that TPN may induce, particularly if electrolytes are not adequately supplemented or if the patient has renal dysfunction affecting their ability to manage electrolytes.

Each of these complications warrants careful observation, especially in an unstable patient who may be more susceptible to adverse effects from TPN. Thus, the comprehensive monitoring approach encapsulated in the answer reflects a holistic