Upon testing a client on total parenteral nutrition (TPN) who has a blood glucose level of 410 mg/dL, what should the nurse do first?

In a situation where a client on total parenteral nutrition (TPN) presents with a significantly elevated blood glucose level of 410 mg/dL, the priority is to notify the healthcare provider. The client’s hyperglycemia indicates that the current TPN formula may not be appropriately tailored to the individual's metabolic needs, which requires a professional assessment for potential adjustment or intervention.

Notifying the healthcare provider ensures that the client can receive a prompt and comprehensive evaluation of their condition and the management of their TPN. The healthcare provider may decide on the best course of action, which could include adjusting the TPN formulation, prescribing insulin for immediate glycemic control, or considering other medical interventions.

While decreasing the TPN rate or administering insulin could be considered actions to take in response to hyperglycemia, these steps should be guided by the healthcare provider’s orders. Stopping TPN feeding without appropriate physician guidance could lead to nutritional deficits and other complications, as TPN is essential for providing nutrients and maintaining the client's overall health, especially if they are unable to intake food orally.

Thus, the immediate step of notifying the healthcare provider is critical for ensuring the client’s safety and proper management of their hyperglycemia in the context of ongoing parenteral nutrition