The nurse is reviewing new laboratory values. Which client would be the priority to report to the health care provider?

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11ecbb05_cbe7_5a66_b433_a53d9bb0cdfe_MD0009_00 Rhabdomyolysis occurs when muscle tissue is damaged and myoglobin (protein found in muscle tissue) is released into the blood, usually after an injury from overexertion, dehydration, severe vasoconstriction (eg, cocaine use), heat stroke, or trauma. Acute kidney injury can occur when myoglobin overwhelms the kidneys' filtration ability. As myoglobin is excreted, the urine becomes very dark and is described as being a cola-brown color. Severely elevated creatine kinase levels, typically >15,000 U/L (>250 µkat/L), are observed with severe muscle damage and can be a precursor to kidney injury (Option B). Forced saline diuresis with intravenous fluids (to prevent blockage of the renal tubules with myoglobin) is necessary to prevent permanent kidney damage. (Option A) Postoperative leukocytosis (leukocytes >11,000 mm³ [>11X10⁹/L]) is common in the first 48 hours after orthopedic surgery from normal inflammatory immune responses. (Option C) Clients with end-stage renal disease commonly have elevated creatinine and blood urea nitrogen levels. These are expected findings. (Option D) Increased brain natriuretic peptide levels can indicate stretching of the chambers of the heart in heart failure. Levels >100 pg/mL (>100 pmol/L) can indicate heart failure and would be expected in this client. Educational objective: Rhabdomyolysis occurs when large amounts of muscle tissue break down and is associated with elevated creatine kinase levels, myoglobinemia, and myoglobinuria. Acute kidney injury, a complication of rhabdomyolysis, can be prevented by prompt administration of intravenous fluids.

The Nurse Is Reviewing New Laboratory Values