The nurse continues to care for the client.

Exhibits

For each assessment finding, click to specify if the finding is consistent with psychosis or mania. Each finding may support more than one diagnosis.

Rationale:

A. You will be placed on a low-sodium diet while taking this medication: A low-sodium diet is contraindicated with lithium because reduced sodium increases lithium reabsorption in the kidneys, raising serum levels and toxicity risk. Clients should instead maintain a consistent and adequate sodium intake.

B. Blurred vision is an expected adverse effect of this medication: Blurred vision is not a typical or expected side effect of lithium. If it occurs, it may suggest toxicity or an unrelated visual issue requiring further evaluation. Routine lithium education focuses on tremor, GI upset, and polyuria not visual changes.

C. This medication can cause nausea and drowsiness: Nausea, fatigue, and mild drowsiness are common side effects of lithium, especially during the initial stages of treatment. These effects are usually transient but should still be monitored, particularly as they may impact adherence.

D. It will take at least a week before this medication reaches a therapeutic level: Lithium has a slow onset of action, and it typically takes 7 to 14 days to achieve therapeutic plasma concentrations. Symptom improvement may not be noticeable until this range is reached, so early expectations must be managed.

E. This medication can cause weight gain: Weight gain is a common long-term side effect of lithium therapy, partly due to its effect on metabolism and fluid retention. Clients should be educated about dietary management and regular monitoring of weight.

Rationale:

A. 2+ deep-tendon reflexes: This is a normal reflex response and indicates that the client is not yet experiencing magnesium toxicity, which would be marked by decreased or absent reflexes. It does not require immediate intervention.

B. Respiratory rate 10/min: A respiratory rate below 12/min is a critical indicator of magnesium toxicity. Magnesium sulfate can depress the central nervous system, leading to respiratory depression, which can be life-threatening and demands immediate action.

C. Urinary output 35 mL/hr: Although slightly below the typical threshold of 30 mL/hr for safe magnesium clearance, this finding is still adequate. It should be monitored closely but is not the most urgent concern at this moment.

D. 3+ pedal edema: Pedal edema is common in preeclampsia due to fluid retention and vascular changes. While notable, it does not take priority over signs of potentially life-threatening respiratory depression.