A nurse is performing a skin assessment for a client who has been on bed rest for 1 week. The nurse notes reddened areas on the client's scapulae. Which of the following actions should the nurse take?

Rationale for Correct Choices:

• Antibiotic therapy: The client’s symptoms (flank pain, painful urination, reddish-brown urine), elevated white blood cell count (15,000/mm³), positive nitrites, leukocyte esterase, and blood in the urine suggest a urinary tract infection (UTI) or pyelonephritis. Antibiotics are needed to treat this infection.
• Urinary tract infection: The urinalysis findings of turbid, dark red urine with blood, positive nitrites, and leukocyte esterase, along with symptoms like painful urination, flank pain, and fever, strongly point to a UTI, possibly involving the kidneys.

Rationale for Incorrect Choices:

• Lithotripsy: Lithotripsy is used for kidney stones, but the client’s symptoms don’t suggest kidney stones, as there is no sharp, colicky pain. The symptoms are more aligned with a UTI.
• Indwelling urinary catheter: An indwelling catheter is not needed for this UTI unless there’s urinary retention. The client's main issue is a UTI, and there is no mention of retention or obstruction requiring a catheter.
• Kidney failure: Although BUN and creatinine are elevated, the primary issue is a UTI, not kidney failure. Kidney failure would be characterized by more severe, prolonged renal dysfunction.
• Pneumonia: The symptoms do not suggest pneumonia. The primary symptoms of pneumonia include cough and difficulty breathing, which are not present here. Crackles are more likely due to fluid overload.

Rationale:

A. Check the client's airway and level of consciousness: The first priority is to assess the client's airway and level of consciousness to ensure that they are breathing properly and to gauge the severity of the condition.

B. Assess vital signs to determine hydration status: After assessing the airway and consciousness, it’s crucial to evaluate vital signs to determine the client's hydration status, as dehydration is a significant concern in diabetic ketoacidosis.

C. Administer prescribed IV fluids: IV fluids should be administered promptly to treat dehydration, restore electrolyte balance, and help improve circulation. This is typically the next step after assessing vital signs and hydration status.

D. Monitor for pulmonary edema: Once the IV fluids are being administered, the nurse should monitor for potential complications, such as pulmonary edema, which can occur due to fluid overload or other factors related to treatment.