A nurse is preparing an in-service presentation about the use of automated external defibrillators (AEDs). Which of the following instructions should the nurse include in the teaching?

Rationale:

A. Administer a laxative to prevent constipation: Laxatives are contraindicated in the acute phase of diverticulitis, as they can worsen symptoms by increasing bowel motility. The priority is to allow the bowel to rest, not stimulate it.

B. Ensure the client is on bed rest: Bed rest is often recommended for patients with diverticulitis to reduce abdominal strain and decrease the risk of perforation or worsening of the condition.

C. Ensure the client is NPO: The client’s CT scan shows thickening of the bowel in the left lower quadrant, suggesting diverticulitis. In the acute phase, the client should be NPO to rest the bowel and prevent further irritation, allowing the gastrointestinal system to recover.

D. Prepare to insert a nasogastric tube: In acute diverticulitis, particularly when there is abdominal distention and vomiting, a nasogastric (NG) tube may be needed to decompress the stomach. This will help relieve pressure, prevent aspiration, and remove gastric contents in case of bowel obstruction or ileus.

E. Position client in high-Fowler's position: High-Fowler’s position is not appropriate for this client, as it could increase intra-abdominal pressure. A position that reduces strain on the abdomen (such as low or semi-Fowler’s) is more beneficial.

F. Provide the client with foods that are high in fiber: High-fiber foods are generally advised for managing diverticular disease in the chronic phase, but they should be avoided during acute diverticulitis. Inflammation of the diverticula requires a low-residue diet to prevent irritation of the bowel.

G. Administer an enema to promote bowel evacuation: Administering an enema is contraindicated in diverticulitis because it can cause bowel perforation, particularly if the diverticula are inflamed. The focus should be on resting the bowel.

Rationale:

A. Renal failure: The client has elevated creatinine levels (1.7 mg/dL), which suggests kidney impairment. This could be due to dehydration and osmotic diuresis associated with hyperglycemia, which is commonly seen in diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar state (HHS).

B. Hypotension: The client’s blood pressure is low (96/65 mm Hg), which can be attributed to dehydration caused by excessive urination and hyperglycemia. Hypotension can worsen as the client becomes more dehydrated, potentially progressing to shock.

C. Cerebral edema: Cerebral edema is a rare but serious complication of diabetic ketoacidosis (DKA), particularly in younger patients and those with severe electrolyte imbalances. The rapid correction of hyperglycemia can cause osmotic shifts that may lead to cerebral edema. The client’s altered fluid balance increases this risk.

D. Septic shock: Although the client has a history of bronchitis and pneumonia, there is no evidence of active sepsis at this time. Septic shock is characterized by signs of infection, such as fever and widespread infection leading to organ dysfunction. This client’s symptoms point more toward a metabolic complication rather than sepsis.

E. Respiratory alkalosis: Respiratory alkalosis occurs when there is excessive loss of carbon dioxide due to hyperventilation. In this client, there is no indication of Kussmaul respirations to suggest respiratory alkalosis. The client is more likely to develop metabolic acidosis due to the presence of ketones and a low pH (7.30).

F. Cardiac arrhythmias: Elevated potassium levels (5.5 mEq/L) and the potential for rapid fluctuations in electrolytes in a client with DKA or HHS can increase the risk of cardiac arrhythmias. Potassium imbalances hyperkalemia or hypokalemia, are closely linked to arrhythmias.