A nurse is assessing the abdominal wound of a client who is 3 days postoperative following a colon resection. Which of the following findings should the nurse report to the provider?

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus characterized by hyperglycemia, ketosis, and metabolic acidosis due to insulin deficiency. It leads to severe dehydration from osmotic diuresis and electrolyte imbalances. Management follows a priority sequence focusing first on fluid resuscitation, then insulin therapy, and correction of electrolyte disturbances. Restoring circulating volume is essential to stabilize perfusion and support organ function.

A. Initiating a continuous IV insulin infusion is essential in DKA management because insulin stops ketone production and lowers blood glucose. However, it is not the first priority because fluids must be replaced first to restore circulation and renal perfusion before insulin administration is fully effective.

B. Bicarbonate infusion is rarely used in DKA and is reserved only for severe acidosis (typically pH < 6.9). Routine administration is not recommended because it can worsen hypokalemia and delay recovery. Therefore, it is not a priority intervention.

C. Administration of 0.9% sodium chloride is the priority intervention because it rapidly restores intravascular volume depleted by osmotic diuresis. Fluid resuscitation improves tissue perfusion, supports blood pressure, and enhances renal clearance of glucose and ketones. This is the first step in stabilizing a client with DKA.

D. Checking potassium levels is important in DKA because insulin therapy and acidosis correction can significantly shift potassium levels. However, this is an assessment action rather than an immediate treatment priority. Fluid replacement must occur first before electrolyte management and insulin therapy are initiated.

Iron deficiency anemia occurs when the body has inadequate iron stores to produce sufficient hemoglobin for oxygen transport. Clients commonly present with fatigue, weakness, pallor, tachycardia, and exertional shortness of breath due to reduced oxygen-carrying capacity. Oral iron therapy with Ferrous sulfate is the standard treatment, but proper administration and dietary teaching are necessary to improve absorption and reduce adverse effects. Nursing education helps ensure effective treatment and prevention of recurrence.

A. Increasing intake of milk and dairy products is not recommended when taking iron supplements because calcium interferes with iron absorption in the gastrointestinal tract. Dairy products can reduce the effectiveness of oral iron therapy if taken close to the medication time. The client should separate calcium-rich foods from iron administration.

B. Taking an antacid within 30 minutes after medication administration is incorrect because antacids decrease gastric acidity, which is needed for optimal iron absorption. Reduced stomach acidity limits the conversion of iron into its absorbable form. Antacids should be avoided close to the time of iron supplementation.

C. Taking the medication on an empty stomach is correct because iron is absorbed best in an acidic gastric environment without interference from food. Although some clients may need to take it with food if gastrointestinal upset occurs, the preferred teaching is to take it before meals for maximum absorption.

D. Increasing sources of fiber in the diet is appropriate because iron supplements commonly cause constipation as a side effect. Adding fiber-rich foods such as fruits, vegetables, legumes, and whole grains helps promote bowel regularity and reduces discomfort associated with therapy. Adequate fluid intake should also be encouraged.

E. Taking the medication with a source of vitamin C is correct because vitamin C enhances the absorption of non-heme iron by converting it into a more absorbable form. Drinking orange juice or consuming citrus fruits with iron supplements improves therapeutic effectiveness and supports correction of anemia.