A charge nurse in a newborn nursery is providing information to a group of nurses about risk factors for hypoglycemia. Which of the following risk factors should the charge nurse include? (Select all that apply.)

Rationale:

A. Blood pressure: Orthostatic hypotension is evident from the drop in systolic and diastolic pressure when standing, indicating fluid and electrolyte imbalance. This may reflect volume depletion due to purging and requires monitoring to prevent fainting or falls.

B. Syncope: The client reports repeated fainting episodes, a red flag when paired with orthostatic hypotension and electrolyte disturbances. This suggests unstable cardiovascular status and raises the risk of injury or sudden cardiac events.

C. ECG: Sinus tachycardia with premature ventricular contractions indicates cardiac irritability likely due to electrolyte imbalance, especially hypokalemia. Continuous cardiac monitoring and correction of abnormalities are needed.

D. Albumin: An albumin level of 2.6 g/dL indicates significant malnutrition and protein deficiency, compromising immune function and wound healing. This also suggests a chronic issue requiring dietetic intervention and nutritional rehabilitation.

E. Potassium: Potassium at 3.0 mEq/L is dangerously low and a known contributor to cardiac arrhythmias and muscle weakness. Replenishment and close monitoring are critical to avoid complications such as cardiac arrest.

F. Sodium: Although sodium is only slightly low at 134 mEq/L, in the context of purging and poor intake, this could indicate dilutional hyponatremia. It increases seizure risk and needs assessment of fluid status and intake behaviors.

Rationale:

A. "Preventing readmissions will decrease overutilization of services.": Preventing avoidable hospital readmissions reduces repeated use of costly healthcare resources, improves patient outcomes, and avoids financial penalties tied to excessive readmissions.

B. "Hiring travel nurses is an effective method of cost containment.": While travel nurses fill staffing gaps, they often come at a higher cost due to agency fees, housing, and incentives. Relying on them long-term is generally not considered cost-effective.

C. "Purchasing more expensive items will improve quality health outcomes.": Higher cost does not always translate to better outcomes. Cost-effectiveness involves achieving the best results at the lowest possible cost, not simply spending more on supplies or equipment.

D. "Planning a 10-year budget will ensure cost-effective care.": Long-term planning is helpful, but health care demands and costs change rapidly. Effective cost management requires regular review and adjustment, not just extended projections.