A nurse is planning discharge to home for a client who has a high risk of developing sepsis. Which of the following Instructions should the nurse include in the teaching?

A. Metabolic alkalosis: In metabolic alkalosis, the pH is elevated (above 7.45), and the bicarbonate (HCO3) is increased (above 28 mEq/L). In this scenario, the pH is low (7.12), and HCO3 is low (20 mEq/L), which is not consistent with alkalosis.

B. Metabolic acidosis: In metabolic acidosis, the pH is low (below 7.35), and the bicarbonate (HCO3) is low (below 21 mEq/L), which is consistent with the client's ABG values (pH 7.12, HCO3 20 mEq/L). This suggests the client has metabolic acidosis, which is common in chronic kidney failure due to impaired excretion of acid and decreased bicarbonate.

C. Respiratory acidosis: In respiratory acidosis, the pH is low, and the PaCO2 is elevated (above 45 mm Hg). The PaCO2 in this client is within the normal range (40 mm Hg), making respiratory acidosis unlikely.

D. Respiratory alkalosis: In respiratory alkalosis, the pH would be high, and the PaCO2 would be low (below 35 mm Hg). The client's pH is low (7.12), and the PaCO2 is normal, so respiratory alkalosis is not present.

Rationale for Correct Findings:

• Open wound with purulent drainage: A non-healing wound with purulent drainage indicates a possible localized infection. In clients with hyperglycemia or diabetes, wounds are at higher risk for complications, including delayed healing and progression to systemic infection.
• Client reports frequent urination, increased thirst, and recent 4.5 kg (10 lb) weight loss without trying. These are classic symptoms of hyperglycemia and potential new-onset diabetes mellitus which should be further evaluated.
• Client reports experiencing nausea which could be related to hyperglycemia, infection, or other systemic issues.
• Blood glucose 250 mg/dL: This value is significantly elevated and suggests poorly controlled blood glucose levels. Hyperglycemia impairs wound healing, increases infection risk, and can be a sign of undiagnosed or uncontrolled diabetes.
• Temperature 38.3° C (100.9°F): A fever indicates a systemic inflammatory or infectious process. In combination with a draining wound and hyperglycemia, this raises concern for a potential infection requiring medical intervention.
• Blood pressure 98/74 mm Hg: While not critically low, this borderline hypotensive value may reflect early signs of systemic infection or dehydration. It is especially concerning in the context of fever, tachycardia, and possible sepsis.
• Heart rate 104/min: Tachycardia can be a compensatory response to fever, infection, or hypotension. When paired with fever and possible infection, it may indicate early sepsis or systemic involvement and warrants immediate reporting.

Rationale for Incorrect Findings:

• WBC Count 9,500/mm³: This value falls within the normal range and does not alone suggest infection. However, WBC counts may remain normal in some clients with infections, especially those who are immunocompromised or have chronic conditions.
• Respiratory rate 19/min: This is within the normal range and does not independently indicate respiratory distress or systemic compromise at this time.
• Oxygen saturation 97% on room air: Oxygen saturation is adequate and suggests no immediate respiratory compromise. It does not require urgent attention in this scenario.
• Triiodothyronine (T3) 200 mg/dL: This is within the normal range and unrelated to the client’s current presenting issues. Thyroid dysfunction is not suggested by the symptoms or labs at this time.