A nurse is caring for a group of older adult clients who receive home care.
Which of the following clients should the nurse interview about the possibility of caregiver abuse or neglect?

Choice A rationale

Liver enzymes (such as ALT and AST) are primarily monitored for medications known to cause liver toxicity. While lithium can have various side effects, it is not typically associated with significant liver damage requiring routine monitoring of liver enzyme levels. Normal ranges for ALT are typically 7 to 55 units per liter (U/L) for men and 5 to 40 U/L for women, and for AST are typically 10 to 40 U/L for men and 9 to 32 U/L for women.

Choice B rationale

Lithium is a mood stabilizer with a narrow therapeutic range, and its levels are closely linked to sodium balance in the body. Hyponatremia (low sodium levels) can increase the risk of lithium toxicity because the kidneys reabsorb lithium in an attempt to compensate for the sodium loss. Therefore, regular monitoring of serum sodium levels is crucial to ensure lithium remains within the therapeutic range (typically 0.6 to 1.2 mEq/L for maintenance) and to prevent toxicity. Normal serum sodium levels are generally 135 to 145 mEq/L.

Choice C rationale

Uric acid levels are primarily monitored in conditions like gout or kidney disease, or as a side effect of certain medications affecting purine metabolism. Lithium does not typically have a significant impact on uric acid levels requiring routine monitoring. Normal uric acid levels are typically 3.5 to 7.2 mg/dL for men and 2.6 to 6.0 mg/dL for women.

Choice D rationale

Erythrocyte sedimentation rate (ESR) is a non-specific marker of inflammation in the body. While lithium can have various effects, it is not typically associated with significant changes in ESR that would necessitate routine monitoring. Normal ESR values are generally 0 to 15 mm/hr for men and 0 to 20 mm/hr for women. .

Choice A rationale

While a bruise on the shin could indicate abuse, it could also result from an accidental bump or fall, which are common in older adults due to factors like impaired balance or decreased bone density. A single bruise alone is not definitive evidence of caregiver abuse or neglect and requires further assessment to determine the cause.

Choice B rationale

Being 9 kg (20 lb) over the recommended weight is indicative of potential overeating or a sedentary lifestyle, both of which are health concerns but not direct indicators of caregiver abuse or neglect. Weight management is related to dietary habits and physical activity levels, not necessarily the actions of a caregiver.

Choice C rationale

A caregiver paying a client's bills is not necessarily indicative of abuse or neglect. It could be a sign of assistance and support, especially if the client has difficulty managing their finances. Financial arrangements between a client and caregiver need to be assessed within the context of their relationship and the client's capacity.

Choice D rationale

Wearing soiled clothing suggests a lack of proper hygiene and care, which could be a sign of neglect by the caregiver. Inadequate attention to basic needs like cleanliness can lead to skin breakdown, infections, and a decline in the client's overall health and well-being. This warrants further investigation into the care provided.