You are caring for a patient with a positive TB skin test (15 mm), productive cough for two months, and unintentional weight loss. Which of the following orders will assist with the diagnosis of active tuberculosis? (Select all that apply)

Choice A reason: Administering insulin infusion is the priority in DKA to correct hyperglycemia and halt ketogenesis. Insulin lowers blood glucose by facilitating cellular uptake and inhibits lipolysis, reducing ketone production. This addresses the underlying metabolic derangement, preventing further acidosis and stabilizing the patient’s condition rapidly, critical for life-threatening DKA.

Choice B reason: Providing oral glucose is contraindicated in DKA, as the client already has severe hyperglycemia. Adding glucose would worsen the condition, increasing osmotic diuresis and acidosis. The focus is on lowering blood sugar with insulin and fluids, not adding more glucose, which could exacerbate dehydration and metabolic imbalance.

Choice C reason: Sodium bicarbonate may be used in severe DKA with profound acidosis (pH < 7.0), but it is not the priority. Insulin and fluid resuscitation correct the underlying cause of acidosis by stopping ketone production and restoring perfusion. Bicarbonate is an adjunct and may cause complications like hypokalemia if used prematurely.

Choice D reason: Deep breathing exercises do not address the metabolic cause of DKA. While compensatory hyperventilation (Kussmaul respirations) occurs to correct acidosis, encouraging breathing exercises does not treat hyperglycemia or ketosis. Insulin and fluids are critical to reverse the underlying pathology, making breathing exercises a low-priority intervention in this acute condition.

Choice A reason: Impaired gas exchange is the highest priority in Pneumocystis carinii pneumonia (now Pneumocystis jirovecii pneumonia). This opportunistic infection causes alveolar inflammation, reducing oxygen diffusion across the alveolar-capillary membrane. Hypoxemia results, impairing tissue oxygenation. Prioritizing gas exchange ensures adequate oxygen delivery to vital organs, addressing the life-threatening nature of this respiratory infection.

Choice B reason: Activity intolerance occurs in Pneumocystis pneumonia due to hypoxemia and fatigue from infection. While significant, it is secondary to impaired gas exchange, as oxygen delivery is critical for survival. Addressing hypoxemia through oxygen therapy or ventilation support takes precedence, as it directly impacts the patient’s ability to sustain physical activity.

Choice C reason: Imbalanced nutrition: less than body requirements may occur due to increased metabolic demands or poor appetite in Pneumocystis pneumonia. However, it is not the highest priority, as nutritional deficits are less immediately life-threatening than hypoxemia. Correcting gas exchange ensures oxygenation, which supports metabolic processes before addressing long-term nutritional needs.

Choice D reason: Impaired oral mucous membranes may result from opportunistic infections or treatment side effects in Pneumocystis pneumonia. While uncomfortable, it is not life-threatening compared to impaired gas exchange, which causes hypoxemia and risks organ failure. Addressing respiratory function is critical before managing secondary issues like oral health in this acute infection.