A nurse is caring for a 28-year-old male client with type 1 diabetes mellitus in the medical-surgical unit on day 3 of hospitalization. Below are the exhibits to guide your answer:

Exhibits

Select the two findings that require immediate follow-up:

The client is at risk for developing Hyponatremia due to dehydration and hypovolemia. This risk may result in Confusion.

Choice A rationale: Hypernatremia is a condition characterized by high sodium levels in the blood. It typically results from water loss exceeding sodium loss, such as in cases of inadequate water intake, excessive sweating, or osmotic diuresis. Symptoms can include thirst, irritability, confusion, and muscle twitching. However, this client's presentation of dehydration and low blood pressure is more indicative of hyponatremia rather than hypernatremia.

Choice B rationale: Hyperkalemia refers to elevated potassium levels in the blood. This condition can occur due to kidney dysfunction, excessive potassium intake, or certain medications. Symptoms of hyperkalemia include muscle weakness, fatigue, numbness, and irregular heart rhythms. While dehydration can impact electrolyte levels, the client's presentation does not specifically suggest hyperkalemia.

Choice C rationale: Hypercalcemia is a condition where calcium levels in the blood are elevated. It can result from hyperparathyroidism, certain cancers, excessive calcium or vitamin D intake, or prolonged immobilization. Symptoms include nausea, vomiting, constipation, abdominal pain, and confusion. The client's symptoms do not align with hypercalcemia, as dehydration and hypovolemia are not primary causes of elevated calcium levels.

Choice D rationale: Hyponatremia occurs when sodium levels in the blood are abnormally low. This can result from excessive fluid loss, such as through vomiting, diarrhea, sweating, or inadequate sodium intake. Symptoms include headache, nausea, vomiting, confusion, seizures, and coma. Given the client's dehydration, low blood pressure, and symptoms of weakness and dizziness, hyponatremia is the most likely risk.

Options for Response 2:

Choice A rationale: Confusion is a common symptom of hyponatremia due to the brain's response to low sodium levels, which affects neuron function and water balance within brain cells. As sodium levels fall, osmotic imbalances cause cerebral edema, leading to altered mental status, lethargy, and confusion.

Choice B rationale: Seizures can occur in severe cases of hyponatremia when the brain's neurons are significantly impacted by osmotic shifts. However, the client's symptoms do not indicate imminent seizure activity, making confusion the more appropriate choice for this scenario.

Choice C rationale: Nausea and vomiting can be symptoms of hyponatremia but are not specific enough to be the primary concern here. The client's symptoms of confusion and lethargy take precedence due to their more direct impact on overall neurological function.

Choice D rationale: Abdominal cramps can result from various electrolyte imbalances, including hyponatremia. However, this symptom is less critical compared to the neurological implications of hyponatremia, such as confusion.

Choice A rationale

Encouraging the client to ambulate within 30 minutes following the procedure is not recommended as it could lead to complications such as bleeding or hematoma at the insertion site.

Choice B rationale

Keeping the client NPO for at least 2 hours following the procedure is not typically necessary and does not relate directly to the care required after a cardiac catheterization.

Choice C rationale

Assessing pulses in the client's affected arm is crucial to ensure that there is adequate blood flow and no compromise in circulation following the procedure.

Choice D rationale

Applying light pressure to the insertion site may help in preventing bleeding initially, but it is more critical to monitor for signs of bleeding or hematoma formation over time. .