Exhibits

The nurse is reviewing the client's medical record. Select the four findings that require immediate follow-up:

Obtain client weight twice daily

Anticipated: This intervention is anticipated. Monitoring the client's weight is crucial when they are receiving Total Parenteral Nutrition (TPN) to assess for fluid status, nutritional adequacy, and response to therapy. It helps in adjusting TPN rates and managing fluid balance.

Have 3 nurses verify the TPN solution prescription

Anticipated: Verifying TPN solution prescription by multiple nurses is a critical safety measure to prevent errors in TPN administration, which can have serious consequences. This ensures that the TPN solution matches the prescribed order in terms of content, concentration, and rate.

Request a prescription for insulin

Anticipated: Given the client's hyperglycemia (fasting blood glucose of 140 mg/dL) and potential exacerbation by TPN administration (which can be rich in glucose), requesting insulin is appropriate. Insulin helps manage blood glucose levels and prevent hyperglycemia, especially important in clients with diabetes or those on TPN.

Request an antibiotic to be administered

Anticipated: The client presents with signs of infection (fever, productive cough, yellow sputum) and crackles auscultated in the lungs, indicating a possible respiratory infection. Requesting antibiotics is essential to treat the infection promptly and prevent further complications.

Decrease the client's oxygen to 1.5 L/min oxygen via nasal cannula

Nonessential: The client is currently receiving 2 L/min oxygen via nasal cannula with an oxygen saturation of 90%. Decreasing the oxygen flow may compromise oxygenation further, especially given the crackles and productive cough. It is more appropriate to maintain or potentially increase oxygen support based on the client's oxygen saturation.

Notify provider to increase TPN rate/hr

Contraindicated: The client has diarrhea (3 episodes in the past 4 hours) and an abdominal distension, which may indicate gastrointestinal intolerance to TPN. Increasing the TPN rate could exacerbate diarrhea and worsen fluid and electrolyte imbalances. It is important to address the underlying cause of diarrhea and abdominal symptoms before considering any increase in TPN rate.

A. This is a serious complication in DKA, particularly in children, where the shift in osmolality during treatment can lead to fluid shifts into the brain. It can present with neurological deterioration, headache, altered mental status, and even coma.
B. Septic shock
While infection can precipitate DKA, septic shock itself is not a direct complication of DKA. However, DKA can predispose patients to infections due to impaired immune function, dehydration, and hyperglycemia.
C. Cardiac arrhythmias
Electrolyte imbalances, particularly hypokalemia or hyperkalemia (depending on treatment phase), can predispose individuals with DKA to cardiac arrhythmias such as ventricular arrhythmias (e.g., ventricular tachycardia) or atrial fibrillation.
D. Renal failure
Acute kidney injury (AKI) can occur due to dehydration, electrolyte imbalances, and the direct effects of acidosis. However, with prompt and appropriate treatment, renal function typically recovers.
E. Hypotension
Dehydration and volume depletion are common in DKA due to osmotic diuresis and fluid loss. This can lead to hypovolemic shock and hypotension if not adequately managed with fluid resuscitation.
F Respiratory alkalosis
DKA is associated with metabolic acidosis, not respiratory alkalosis. The body compensates for acidosis by increasing respiratory rate (Kussmaul respirations) to blow off CO2 and normalize pH, but this does not lead to respiratory alkalosis.