The practical nurse (PN) is administering multiple medications to an older adult client. The client has been receiving all of the same medications for one week. Which assessment is most important for the PN to make?

A. Spray the area with a mild periwash solution: Using a mild periwash solution gently cleanses the skin without causing additional irritation. It removes fecal material effectively while preserving skin integrity, which is crucial for preventing further breakdown in areas already inflamed.
B. Gently massage around the outside of the reddened area: Massaging near inflamed or reddened skin can worsen irritation, increase discomfort, and potentially lead to further tissue damage. Handling should be as gentle and non-traumatic as possible to promote healing.
C. Rinse the inflamed area with dilute hydrogen peroxide: Hydrogen peroxide can be too harsh for already inflamed skin and may delay healing by damaging healthy tissue. It is generally avoided for routine cleansing of delicate perineal areas.
D. Apply a thick coating of antibiotic ointment: Antibiotic ointment is not routinely indicated unless there is evidence of infection. Overuse can alter normal skin flora and may promote resistance; protecting the skin barrier with gentle cleansing and moisture barriers is preferred.

• 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.