For which of the following patients would the RN anticipate an order for sodium bicarbonate IVP?

Choice A rationale:

Seizure precautions are necessary because:

The patient has ingested multiple drugs, some of which can lower the seizure threshold, such as benzodiazepines. Naloxone, while reversing opioid overdose, can also precipitate seizures in some individuals.

Flumazenil, used to reverse benzodiazepine overdose, can also induce seizures, especially in patients with a history of epilepsy or benzodiazepine dependence.

The potential for drug interactions and unpredictable effects of multiple drug ingestion further increases the risk of seizures. Specific seizure precautions include:

Placing the patient in a bed with padded side rails. Having oxygen and suction equipment readily available.

Keeping intravenous access open for potential administration of anticonvulsant medications. Closely monitoring the patient's neurological status for any signs of seizure activity.

Choice B rationale:

Aspiration precautions are crucial due to:

The patient's unconscious state, which impairs their ability to protect their airway.

The possibility of vomiting, which can occur as a side effect of naloxone or flumazenil administration.

The potential for aspiration of gastric contents, which can lead to serious respiratory complications, such as pneumonia. Specific aspiration precautions include:

Positioning the patient on their side in the recovery position. Continuously monitoring the patient's respiratory status.

Having suction equipment ready to clear the airway if necessary.

Considering intubation and mechanical ventilation if the patient's airway is compromised.

Choice D rationale:

Fall precautions are essential because:

The patient is unconscious and may be disoriented or uncoordinated upon regaining consciousness.

The effects of the ingested drugs, as well as the medications administered, can impair balance and coordination. Falls can result in serious injuries, such as head trauma or fractures.

Specific fall precautions include:

Keeping the bed in a low position with side rails up.

Assisting the patient with ambulation when they are able to move. Ensuring the patient's environment is free of tripping hazards.

Providing close supervision and assistance as needed.

Choice C rationale:

Suicide precautions are not routinely implemented in this scenario because:

The patient's primary presentation is drug overdose, not active suicidal ideation or attempts.

The focus of care is on addressing the immediate medical complications of the overdose and stabilization.

However, a thorough suicide risk assessment should be conducted once the patient is medically stable to determine if ongoing suicide precautions are necessary.

Choice A rationale:
NPH insulin is an intermediate-acting insulin that typically peaks 6-12 hours after administration.
Given that the insulin was administered at 1700 (5:00 PM), the peak action would be expected to occur between 2100 (9:00 PM) and 0500 (5:00 AM).
This time frame aligns with the known pharmacokinetics of NPH insulin.
It's crucial for nurses to be aware of the peak action times of different insulin types to effectively manage blood glucose levels and adjust insulin doses accordingly.
Choice B rationale:
Incorrect. NPH insulin does have a peak action, as explained above.
It's important to understand that even intermediate-acting insulins have a period of peak activity when they exert their strongest glucose-lowering effect.
Choice C rationale:

Incorrect. This time frame is too early to represent the peak action of NPH insulin. The peak action typically occurs later, between 6-12 hours after administration.
Choice D rationale:
Incorrect. This time point is too specific to accurately represent the peak action of NPH insulin.
The peak action can vary within the 6-12 hour window, depending on individual factors and injection site.