An older client is being admitted to a rehabilitation unit from a medical-surgical unit following a left hip replacement. When reviewing the client's prescribed medications, which intervention should the nurse implement first?

A. Teach the client how to count carbohydrates - Non-urgent. While essential for long- term management of diabetes, carbohydrate counting is not immediately critical in the acute management phase of HHS in the ICU. This teaching should be delayed until the patient is stabilized.
B. Stop the insulin infusion - Contraindicated. Stopping insulin in a patient with HHS, which is characterized by severe hyperglycemia, would be harmful. Insulin therapy is critical to reduce blood glucose levels safely.

C. Decrease the frequency of blood glucose tests - Contraindicated. Frequent monitoring is crucial in managing HHS, especially when insulin therapy is being administered, to prevent hypoglycemia and to monitor the effectiveness of treatment.
D. Start the client on a regular diet - Contraindicated. Introducing a regular diet during the acute phase of HHS could exacerbate the hyperglycemia. Nutritional needs should be assessed and managed carefully, typically starting with IV fluids and gradually transitioning to enteral or oral feeding as the patient stabilizes.
E. Decrease the insulin IV infusion to 0.05 units/kg/hr- Indicated. As blood sugar levels decrease, the insulin infusion rate may be cautiously reduced to prevent hypoglycemia.

Pain relief: One of the primary goals and indications of effective epidural anesthesia is significant reduction or elimination of pain associated with labor contractions, as reflected in the patient asking for and receiving the epidural to manage increasing pain levels.
Progression of labor: Effective epidural anesthesia should allow the labor to progress without adding undue stress or causing significant delays. Monitoring cervical dilation and effacement as well as the baby's descent (station) helps determine if labor is progressing normally even after epidural administration.
Vital signs: Stable vital signs are important indicators that the epidural anesthesia is not causing adverse effects such as severe hypotension or bradycardia, which can sometimes occur with regional anesthesia due to the blockade of sympathetic nerves. Regular monitoring and stability of these signs are crucial for demonstrating effective and safe epidural anesthesia management.