A nurse is reviewing the medical records of four clients. The nurse should identify which of the following client findings that requires follow-up care.

A. Incorrect. Postural drainage is usually performed multiple times a day, usually three to four times, to effectively mobilize respiratory secretions.
B. Incorrect. Percussions are typically performed using cupped hands to create vibrations. Holding the hand flat would not produce the desired effect.
C. Bronchodilator should be administered PRIOR to procedure if prescribed
D. Postural drainage should be performed before meals or at least 1-2 hours after meals to prevent vomiting or aspiration.

Choice A rationale:

A capillary glucose level of 198 mg/dL in a client receiving total parenteral nutrition (TPN) suggests hyperglycemia, which is a common complication of TPN. TPN solutions are high in glucose, and clients receiving TPN are at risk of developing hyperglycemia. Regular monitoring of blood glucose levels is necessary to detect and manage hyperglycemia promptly.

Choice B rationale:

Serum albumin level of 3.9 g/dL is within the normal range (3.5-5.5 g/dL) and does not indicate a complication of TPN. Low serum albumin levels could suggest malnutrition or liver disease, but in this case, the level is normal.

Choice C rationale:

Hemoglobin (Hgb) level of 15.6 g/dL is within the normal range for both men and women, indicating an adequate oxygen-carrying capacity of the blood. This result does not suggest a complication related to TPN.

Choice D rationale:

White blood cell (WBC) count of 7,000/mm³ is within the normal range (4,500-11,000/mm³) and does not indicate a complication of TPN. Elevated WBC count could suggest an infection, but in this case, the count is normal.