The nurse is caring for a 76-year-old client newly admitted with pneumonia and Clostridium difficile infection. Which of the following would be priority to report to the health care provider?

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Clostridium difficile overgrowth in the intestine often occurs when normal gastrointestinal (GI) flora is destroyed (eg, antibiotic use). Clients with C difficile often have watery diarrhea, nausea, fever, and abdominal pain. Hypovolemia can easily develop through the loss of fluids and electrolytes in the stool, especially in infants and the elderly. Clients with hypovolemia from GI losses will often have hyponatremia, hypokalemia, and elevated blood urea nitrogen (BUN) (poor renal perfusion). This client has hyponatremia (normal, 135-145 mEq/L [135-145 mmol/L]), hypokalemia (normal, 3.5-5.0 mEq/L [3.5-5.0 mmol/L]), and an elevated BUN (normal, 6-20 mg/dL [2.1-7.1 mmol/L]). Hypovolemia can cause hypotension and renal failure, and electrolyte abnormalities can cause cardiac arrhythmias; therefore, these are priority to report. Fluid resuscitation and electrolyte replacement should be initiated promptly to prevent complications. (Option A) Normal blood gas levels are PO₂ 80-100 mm Hg (10.6-13.3 kPa), pCO₂ 35-45 mm Hg (4.7-6.0 kPa), and pH 7.35-7.45. This client has normal results, and these do not need to be reported. (Options C and D) Expected findings of pneumonia include fever, chills, fatigue, crackles, and sputum production. There is nothing to indicate that the client is having respiratory difficulty. Therefore, electrolyte imbalance is a priority. Educational objective: Severe watery diarrhea can lead to hypovolemia. Clients should be monitored for hyponatremia, hypokalemia, elevated blood urea nitrogen, and other electrolyte imbalances. These should be reported and treated immediately to avoid cardiac arrhythmias, hypotension, and renal failure.

The Nurse Is Caring for a 76-Year-Old Client Newly Admitted