A nurse is caring for a postoperative client who has shown a gradual decline in level of consciousness and reduced urine output over the past few hours.

The client is most likely experiencing:

Select answer choice

Tumor lysis syndrome (TLS) is an oncologic emergency that occurs when rapid destruction of malignant cells releases intracellular contents such as potassium, phosphate, and uric acid into the bloodstream. This leads to metabolic disturbances including hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury due to uric acid crystal deposition in renal tubules. Prevention of renal failure through aggressive hydration is a key priority in management. Nursing care focuses on maintaining renal perfusion and promoting excretion of toxic metabolites.

Rationale:
A. Administering a bisphosphonate is not a primary intervention for tumor lysis syndrome. Bisphosphonates are mainly used to treat hypercalcemia associated with malignancy, not the metabolic disturbances seen in TLS. While calcium imbalances may occur, the primary concern in TLS is preventing renal failure through hydration and metabolic correction.

B. Obtaining blood cultures is not relevant to tumor lysis syndrome because TLS is not an infectious process. It is a metabolic complication caused by rapid tumor cell breakdown following chemotherapy or radiation therapy. Blood cultures are indicated for suspected infection, not for metabolic emergencies like TLS.

C. Encouraging fluid intake of 3 L daily is the priority intervention because it promotes renal perfusion and enhances excretion of uric acid, potassium, and phosphate. Adequate hydration helps prevent crystal precipitation in the renal tubules, reducing the risk of acute kidney injury. In some cases, intravenous fluids are also used to maintain high urine output as part of aggressive prophylaxis and treatment.

D. Placing the client in a semi-Fowler’s position does not address the underlying metabolic and renal complications of tumor lysis syndrome. While positioning may support breathing comfort in some conditions, it has no effect on electrolyte imbalance or uric acid clearance. The priority remains fluid management and renal protection.

Transfusion-associated circulatory overload (TACO) occurs when the infusion rate exceeds the cardiovascular system's capacity, leading to pulmonary edema, impaired gas exchange, and elevated central venous pressure.

A. Stopping the transfusion is the immediate priority when any transfusion reaction or complication is suspected. Halting the infusion prevents further volume from entering the intravascular space, which is essential to mitigate the worsening of pulmonary congestion and cardiac strain in a client experiencing circulatory overload.

B. Epinephrine is primarily indicated for anaphylactic reactions or cardiac arrest to induce bronchodilation and vasoconstriction. It is not indicated for circulatory overload, as it would increase cardiac workload and potentially exacerbate the hypertensive stress often associated with the fluid volume excess seen in TACO.

C. Diuretics, such as furosemide, are a standard treatment for circulatory overload to facilitate the rapid excretion of excess intravascular fluid. Removing surplus fluid helps reduce the preload on the heart, alleviates pulmonary venous pressure, and clears the fluid from the alveolar spaces to improve breathing.

D. Administering supplemental oxygen is critical for a client exhibiting hypoxia and lung crackles. Enhancing the fraction of inspired oxygen helps maintain adequate arterial oxygen saturation while the body compensates for the fluid-filled alveoli, ensuring that vital organs receive sufficient oxygenation during the acute respiratory distress.

E. Placing the client in a high-Fowler's position promotes maximal chest expansion and uses gravity to shift fluid to the lung bases, thereby improving ventilation-perfusion matching. This position reduces the work of breathing and decreases venous return to the heart, which helps alleviate the symptoms of acute pulmonary edema.