The nurse is completing a plan of care for a client on lithium therapy to manage bipolar symptoms. Which nursing intervention(s) will be included? Select all that apply.

A. Right extremity comparable in size to left: Reduction in swelling indicates improved venous return and resolution of the thrombus. Symmetry between extremities suggests successful clot dissolution and reduced obstruction in the affected vein.
B. No bleeding or bruising noted: While this is a desirable side effect outcome, it is not a direct measure of thrombolytic effectiveness. Thrombolytics carry bleeding risk, but the absence of bruising doesn’t confirm clot resolution.
C. Right extremity pink: A pink, well-perfused extremity suggests adequate blood flow, which reflects successful reperfusion. This indicates improved circulation after clot breakdown and is a positive therapeutic result.
D. Client denies pain: Pain is a hallmark symptom of DVT due to inflammation and obstruction. Decreased or absent pain after thrombolytic therapy reflects clinical improvement and reduced clot burden.
E. Pedal pulse thready: A thready pulse may indicate decreased perfusion and is not a reassuring finding. Effective thrombolytic therapy should lead to strong, palpable pulses if circulation has improved.

A. Monitor kidney and liver functioning: Lithium is excreted by the kidneys and can cause nephrotoxicity with long-term use. Monitoring kidney function is essential to detect early signs of renal impairment. Liver monitoring may be less emphasized but is often included in general lab panels.
B. Increase fluid intake to 3000 mL/day: Adequate hydration helps maintain stable lithium levels and reduces the risk of toxicity. Dehydration can lead to lithium retention and increase serum concentrations to dangerous levels.
C. Monitor intake and output: Close tracking of fluid balance helps identify dehydration or fluid overload, both of which can impact lithium levels. Intake and output records also support safe dosing and prevent renal complications.
D. Limit sodium intake daily: Sudden sodium restriction can increase lithium reabsorption in the kidneys, raising the risk of toxicity. Consistency in sodium intake is recommended rather than limiting it unnecessarily.
E. Instruct client that it may take up to 6 weeks to reach therapeutic level: Lithium typically reaches steady-state levels in 5–7 days, and clinical improvement often occurs within 1–3 weeks. Six weeks is longer than expected and may delay appropriate follow-up or adjustment.
F. Monitor for symptoms of nausea, vomiting, muscle weakness, and lack of coordination: These are early signs of lithium toxicity and require immediate assessment. Prompt detection prevents progression to more severe neurological and renal complications.