A client who has a recent closed head injury reports a severe headache and is restless. Which of the following is an appropriate nursing intervention?

Choice A reason: Hypermagnesemia, or high levels of magnesium in the blood, is not typically associated with refeeding syndrome. Instead, refeeding syndrome can lead to hypomagnesemia, which is a low level of magnesium in the blood, due to shifts of magnesium into the cells during insulin secretion in the refeeding process.

Choice B reason: Hyponatremia, or low levels of sodium in the blood, is not a hallmark of refeeding syndrome. While fluid shifts can affect sodium levels, the key electrolyte disturbances in refeeding syndrome involve phosphorus, potassium, and magnesium.

Choice C reason: Hyperkalemia, or high levels of potassium in the blood, is not a common finding in refeeding syndrome. Similar to magnesium, potassium can shift into cells during refeeding, which can actually lead to hypokalemia, or low levels of potassium in the blood.

Choice D reason: Hypophosphatemia, or low levels of phosphorus in the blood, is the hallmark of refeeding syndrome. When a malnourished individual is refed, insulin secretion is stimulated by the increased carbohydrate intake. Insulin promotes cellular uptake of glucose, which is accompanied by phosphate, potassium, and magnesium, leading to a decrease in the serum levels of these electrolytes. Phosphorus is critical for cellular processes, and its deficiency can lead to muscle weakness, respiratory failure, hemolysis, and impaired cardiac function. During refeeding, careful monitoring of electrolytes is essential to prevent and manage refeeding syndrome. Hypophosphatemia is the most significant laboratory finding to anticipate in a patient with refeeding syndrome, and it requires prompt recognition and treatment to prevent serious complications.

- Step 1: Identify the child's weight in pounds. The child weighs 33 lbs.

- Step 2: Convert the child's weight from pounds to kilograms. We know that 1 kg = 2.2 lbs. So, 33 lbs = 33 ÷ 2.2 kg. Calculating the division gives us approximately 15 kg.

- Step 3: Identify the prescribed dose in mcg/kg/day. The child is scheduled to receive 8 mcg/kg/day of digoxin, divided equally every 12 hours.

- Step 4: Calculate the total daily dose in mcg. We can do this by multiplying the child's weight in kg by the prescribed dose in mcg/kg:

- Total daily dose = 8 mcg/kg/day × 15 kg.

- Calculating the multiplication gives us: Total daily dose = 120 mcg/day.

- Step 5: Since the dose is divided equally every 12 hours, we divide the total daily dose by 2 to get the dose per administration:

- Dose per administration = Total daily dose ÷ 2.

- Dose per administration = 120 mcg ÷ 2.

- Calculating the division gives us: Dose per administration = 60 mcg.

- Step 6: Identify the concentration of the available solution. The available solution contains 0.05 mg/mL of digoxin. Convert this to mcg/mL for consistency with the dose per administration. We know that 1 mg = 1000 mcg. So, 0.05 mg = 0.05 × 1000 mcg = 50 mcg/mL.

- Step 7: Calculate the volume of solution needed to deliver the required dose. We can set up a proportion to solve for this:

- 50 mcg is to 1 mL as 60 mcg is to X mL.

- In other words, 50 mcg : 1 mL = 60 mcg : X mL.

- Step 8: Solve for X using cross-multiplication and division:

- Cross-multiplication gives us: 50 mcg × X mL = 60 mcg × 1 mL.

- Simplifying this gives us: 50X = 60.

- Dividing both sides by 50 gives us: X = 60 ÷ 50.

- Calculating the division gives us: X = 1.2.

Administer 1.2 mL of the digoxin elixir per dose.