0730

• Admit to the surgical floor
• Dextrose 59% and 0.9% sodium chloride to infuse at 125 ml/hr
• Advance diet as tolerated
• Insulin glargine 12 units subcutaneous every 12 hours
• Ceftriaxone 2 g IV every 24 hours for 3 days, first dose given in surgery
• Insulin lispro 1 unit subcutaneously per 15 carbohydrates
• Insulin lispro sliding scale:

180-240 mg/dL (10-13.3 mmol/L)- 1 unit

241-300 mg/dl. (13.4-16.7 mmol/L)-2 units

300-360 mg/dL (16.7-30 mmol/L)-3 units

over 360 mg/dL (30 mmol/L)-call the physician

• Glucagon 1 syringe subcutaneously for blood glucose less than 60 mg/dL (3.3 mmol/L) and unresponsiveness

It is 1800, and the client has a schedule dose of insulin glargine due. The client has a regular diet tray ordered with 60 carbohydrates. The tray has not yet arrived in the room.

For each nursing action below, click to specify If the action is indicated, contraindicated or non-essential.

When preparing a discharge teaching plan for a client taking ciprofloxacin hydrochloride tablets due to suspected anthrax exposure, the following instructions should be included:

A. Limit exposure to sunlight and avoid tanning beds.

Explanation: Ciprofloxacin can increase the risk of sunburn, so it's important to limit sun exposure and avoid tanning beds while taking this medication.

B. Report any tendon pain or swelling to the healthcare provider immediately.

Explanation: Ciprofloxacin is associated with an increased risk of tendonitis and tendon rupture, especially in certain populations like older adults. Clients should be advised to report any signs of tendon pain or swelling promptly to their healthcare provider.

C. Increase fluid intake while taking the medication.

Explanation: Staying well-hydrated is important when taking ciprofloxacin to help prevent potential side effects and ensure proper drug elimination.

Why the other choices are not appropriate:

D. Crush and mix the tablets with pudding if you have trouble swallowing the tablets:

Ciprofloxacin tablets should not be crushed or mixed with food. They should be taken whole with a full glass of water unless otherwise instructed by the healthcare provider.

E. Use nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve mild joint aches and pains caused by the medication:

NSAIDs are not recommended to relieve joint aches and pains caused by ciprofloxacin. If a client experiences joint pain while taking the medication, they should contact their healthcare provider for guidance on managing the discomfort.

Before administering the first dose of a broad-spectrum antibiotic to a client with a gram-negative infection, it is most important for the nurse to implement:

A. Wound and blood specimens for culture and sensitivity.

Explanation: Collecting wound and blood specimens for culture and sensitivity is crucial before starting antibiotic therapy. This step allows healthcare providers to identify the specific pathogen causing the infection and determine its sensitivity to various antibiotics. It helps in selecting the most appropriate antibiotic and ensuring effective treatment. This is especially important in cases of gram-negative infections, as antibiotic resistance patterns can vary among different strains.

Why the other choices are not the most important at this stage:

B. Irrigation and topical antibiotic application to wound area:

While wound care is important, especially for localized infections, collecting specimens for culture and sensitivity takes precedence to determine the appropriate antibiotic treatment.

C. Complete blood count and serum electrolytes:

While monitoring blood counts and electrolytes is essential in overall client care, it may not be the most critical step before administering the first dose of an antibiotic to address a suspected infection.

D. Monitor for signs of sodium and fluid retention:

Monitoring for signs of sodium and fluid retention is important, but it is not the primary action needed before initiating antibiotic therapy for a gram-negative infection. Identifying the causative organism and selecting the appropriate antibiotic should come first to target the infection directly.