A post-surgical client on TPN via a central venous infusion reports nausea, fatigue, and headache during the fourth hour, with hourly urine output doubling. What action should the nurse take first?

A post-surgical client on TPN via a central venous infusion reports nausea, fatigue, and headache during the fourth hour, with hourly urine output doubling. What action should the nurse take first?

• A. Check the serum glucose level
• B. Obtain an oxygen saturation level
• C. Administer a prescribed analgesic
• D. Elevate the head of the bed

Answer: (A)

When a patient receives total parenteral nutrition, a large glucose load is delivered directly into the bloodstream, so hyperglycemia is a common and urgent risk. The symptoms described—nausea, fatigue, headache, and especially a doubling of hourly urine output—fit osmotic diuresis from elevated blood glucose. The first thing to do is check the serum glucose level to confirm whether hyperglycemia is occurring and to guide immediate management (such as adjusting the TPN rate or adding insulin per protocol). Other options don’t address the likely problem as directly: measuring oxygen saturation would assess respiratory status, which isn’t the primary issue here; giving an analgesic doesn’t treat the underlying glucose problem; elevating the head of the bed doesn’t impact glucose levels.

When a patient receives total parenteral nutrition, a large glucose load is delivered directly into the bloodstream, so hyperglycemia is a common and urgent risk. The symptoms described—nausea, fatigue, headache, and especially a doubling of hourly urine output—fit osmotic diuresis from elevated blood glucose. The first thing to do is check the serum glucose level to confirm whether hyperglycemia is occurring and to guide immediate management (such as adjusting the TPN rate or adding insulin per protocol).

Other options don’t address the likely problem as directly: measuring oxygen saturation would assess respiratory status, which isn’t the primary issue here; giving an analgesic doesn’t treat the underlying glucose problem; elevating the head of the bed doesn’t impact glucose levels.