A nurse is caring for a female client who is receiving intravenous gentamicin. Which of the following laboratory values is the priority to report to the provider?

Rationale for Correct Choices

• Blood glucose: A blood glucose level of 250 mg/dL is critically elevated and puts the client at risk for complications such as delayed wound healing, infection, dehydration, and diabetic ketoacidosis (DKA) if unmanaged. Hyperglycemia impairs immune function and must be addressed promptly to stabilize the client's condition and support healing.
• Wound : The draining, non-healing foot ulcer with purulent discharge indicates infection. However, uncontrolled glucose is a major contributing factor to poor wound healing and increased infection risk. Once glucose levels are addressed, wound care becomes the next critical focus to prevent systemic infection and further tissue damage.

Rationale for Incorrect Choices

• Temperature: While the client has a low-grade fever (38.3°C), which may be related to the infected wound, treating the source of infection and controlling glucose will have a greater and more direct impact on resolving the fever.
• Blood pressure: The blood pressure of 98/74 mm Hg is slightly low but not emergent and does not pose immediate risk. It can be monitored while more pressing concerns—like glucose and wound infection—are managed.
• WBC count: The WBC count of 9,500/mm³ is within normal limits. Although it helps in evaluating infection, it does not require direct intervention and is not a clinical priority compared to glucose control and wound care.

A. Log roll the client onto the operative side: After hip replacement surgery, the client should avoid lying directly on the operative side to prevent dislocation of the new joint. The client should be log rolled onto the unaffected side instead, using proper body alignment.
B. Keep client's affected heel on the bed: The heel of the affected leg should not be placed flat on the bed to prevent pressure ulcers and promote proper alignment. The nurse should ensure that the affected leg is elevated and properly supported.
C. Use an elevated toilet seat: Using an elevated toilet seat is essential for a client after hip replacement surgery. It helps the client avoid excessive flexion of the hip joint, which can increase the risk of dislocation or complications in the immediate postoperative period.
D. Perform internal and external rotation exercises of the hip: Internal and external rotation exercises should be avoided immediately after a total hip replacement as they can put the joint at risk for dislocation. The focus should be on maintaining proper alignment and performing safe range-of-motion exercises.