Exhibits

The practical nurse (PN) calls the healthcare provider to notify them that the heart rate is too low to administer the digoxin.

Place the nurse statements in Situation, Background, Assessment, Recommendation (SBAR) format. Each column must have at only one answer selected.

• Hyponatremia: The client's sodium level of 130 mEq/L is below the normal range (136–145 mEq/L), indicating hyponatremia. Symptoms like weakness, brain fog, and dehydration are typical signs. Immediate correction is necessary to prevent complications such as seizures or coma.
• Metabolic Alkalosis: Metabolic alkalosis is unlikely here, as vomiting typically leads to a loss of acid, not an increase. The client's symptoms and lab results suggest hyponatremia rather than alkalosis, which doesn’t match the clinical presentation.
• Hyperkalemia: The potassium level of 3.4 mEq/L is slightly below the normal range, not elevated. Hyperkalemia, which causes muscle weakness and arrhythmias, is not supported by the client's lab values, making it an unlikely diagnosis.
• Hypovolemia: While the client may be experiencing hypovolemia due to fluid loss, the primary concern is hyponatremia. The signs of dehydration (poor skin turgor, dry mucous membranes) are secondary to the electrolyte imbalance, not the primary issue.
• Infuse a bolus of IV fluids: Given the client’s dehydration and low sodium level, infusing a bolus of IV fluids, especially those containing sodium, is essential. This helps correct fluid loss and addresses the hyponatremia, improving hydration status and electrolyte balance.
• Request prescription for antiemetic: Controlling the client’s vomiting with an antiemetic is necessary to prevent further fluid and electrolyte loss. This will allow for better fluid retention and reduce the risk of exacerbating hyponatremia and dehydration.
• Monitor lab values every six hours: Regular lab tests every six hours allow for monitoring the client’s sodium and potassium levels, as well as assessing the effectiveness of the fluid resuscitation. This will ensure the condition is progressing and adjustments can be made if needed.
• Neurological status: Hyponatremia can cause neurological symptoms, including confusion and lethargy. Monitoring the client’s neurological status is crucial to assess the severity of the condition and detect any worsening of symptoms that may indicate more severe imbalances.
• Oral intake: Although oral intake is important, the client is likely unable to tolerate enough fluids due to vomiting. IV fluid administration is the immediate solution for rehydration, with oral intake becoming more relevant once vomiting is controlled.
• Electrocardiogram: Monitoring the ECG is critical to detect arrhythmias, which can result from electrolyte imbalances like hyponatremia. Sodium and potassium disturbances can affect heart rhythms, so regular ECG monitoring helps identify any cardiac complications.
• Oxygen saturation: While important, oxygen saturation is not the primary concern here. The immediate need is to correct fluid and electrolyte imbalances. Oxygen levels should still be monitored, but they are secondary to managing the hyponatremia and dehydration.

A. Notify the unit charge nurse of the client's reported symptoms immediately: Tingling and numbness can be signs of hyperkalemia, a serious and potentially life-threatening complication from potassium supplementation. Immediate reporting is necessary for prompt evaluation and intervention to prevent cardiac or neuromuscular complications.
B. Reassure the client that the supplement will soon relieve those symptoms: Symptoms like tingling and numbness are not expected side effects of potassium therapy. Reassurance without investigation could delay necessary medical treatment and worsen the client’s condition.
C. Explain that a calcium supplement may be necessary: Calcium supplementation is not the standard response to symptoms of potassium imbalance. Without a clear diagnosis, recommending additional supplements could complicate the clinical situation further.
D. Encourage the client to decrease the intake of dietary sodium: Although reducing sodium is generally beneficial for health, it does not address the acute issue of possible potassium imbalance causing neuromuscular symptoms. Immediate clinical evaluation takes priority.