A nurse is caring for a client who received 50, 000 units of IV heparin rather than the prescribed 5,000 units. Which of the following actions should the nurse take first?

Rationale:

A. Oliguria: Clients with end-stage kidney disease (ESKD) often experience oliguria or significantly reduced urine output due to severe loss of nephron function. This contributes to fluid retention, electrolyte imbalances, and accumulation of waste products in the body.

B. Hypotension: ESKD more commonly leads to hypertension rather than hypotension because of fluid overload and activation of the renin-angiotensin-aldosterone system. Hypotension may occur only during dialysis or with certain medications but is not an expected finding in untreated ESKD.

C. Edema: Fluid retention caused by decreased glomerular filtration and impaired renal excretion leads to peripheral and sometimes generalized edema. Edema is a classic sign of ESKD and indicates compromised fluid balance.

D. Anemia: Impaired kidney function reduces erythropoietin production, leading to decreased red blood cell synthesis and resultant anemia. Clients often require erythropoiesis-stimulating agents or supplemental iron to manage this complication.

E. Bradypnea: Respiratory rate is not typically decreased in ESKD. If present, bradypnea would suggest a separate neurologic or respiratory issue rather than a direct effect of kidney failure. Clients may develop Kussmaul respirations if metabolic acidosis is severe, but bradypnea is not expected.

Rationale:

A. Respiratory therapist: A respiratory therapist is essential in arranging home oxygen by evaluating the client’s respiratory needs, determining appropriate oxygen flow rates, and ensuring proper use of equipment. They also provide education on safety and maintenance, which is critical for clients newly diagnosed with COPD who must manage oxygen therapy at home.

B. Physical therapist: A physical therapist focuses on mobility and strength training, which can benefit clients with COPD but is not directly responsible for arranging or coordinating home oxygen therapy. Their role becomes more relevant after respiratory support is established and the client begins working on endurance and safe activity levels.

C. Social worker: A social worker assists with social support, financial resources, and coping needs but is not typically involved in arranging clinical respiratory equipment. Their involvement may be helpful later if the client requires community services, but they are not the primary referral for initiating oxygen therapy.

D. Case manager: A case manager plays a key role in long-term discharge planning and may eventually coordinate services, but the immediate need for oxygen setup requires a respiratory therapist’s specialized assessment. Once the respiratory plan is initiated, the case manager can support broader continuity of care needs.