A nurse is caring for a client receiving total parenteral nutrition who weighs 160 lb. If the RDA of protein is 0.8 g/kg of body weight, how many grams of protein should the client receive daily? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Rationale:

A. Respiratory syncytial virus: Respiratory syncytial virus (RSV) is a common viral infection, especially in infants and young children, but it is not typically considered a reportable communicable disease.

B. Mumps: Mumps is a viral infection that is reportable in many regions. It can cause severe complications such as meningitis, encephalitis, and hearing loss, which is why it must be reported to public health authorities for tracking and control.

C. Group A streptococcus: While infections like streptococcal throat infections are common, only more severe complications like invasive Group A streptococcal disease (e.g., necrotizing fasciitis, toxic shock syndrome) are reportable, not all cases of throat infection.

D. Rubeola: Although rubeola (measles) is a reportable disease, mumps, is more frequently emphasized about in reportable vaccine-preventable illnesses alongside rubella and pertussis.

Rationale:

• Hold the client's metoprolol: The client's heart rate is 112/min and irregular, and the ECG shows atrial fibrillation. Metoprolol helps manage heart rate. Holding it would worsen the tachycardia and the symptoms of heart failure. The blood pressure is also still elevated (146/82 mm Hg), indicating that the metoprolol is still needed.
• Increase the dosage of furosemide: The client’s weight has increased by 1.8 kg (4 lbs) within 24 hours, indicating fluid retention, which is a common symptom of heart failure. Increasing the dosage of furosemide will help manage fluid overload by promoting diuresis and reducing symptoms such as edema and shortness of breath.
• Decrease the client's oxygen to 1 L/min via nasal cannula: The client's oxygen saturation has decreased from 93% to 90% while on 2 L/min of oxygen. This indicates worsening oxygenation or increased oxygen demand due to fluid overload. The client needs continued or even increased oxygen.
• Restrict the client's fluid intake to 2 L per day: The client is showing signs of fluid overload (weight gain, decreased SpO2, elevated BNP). Fluid restriction is a necessary intervention in heart failure to manage fluid balance and prevent further accumulation of fluid
• Weigh the client daily: Daily weight monitoring is crucial in clients with heart failure to detect fluid retention early. A significant increase in weight can indicate worsening heart failure or fluid overload, which requires immediate intervention.

• Begin a 24-hr urine collection for the client: A 24-hour urine collection is used for assessing kidney function, electrolytes, and proteinuria. There is no immediate indication for this test in the current clinical scenario.