A client with chronic lower back pain has been taking ibuprofen PO twice a day for several months. Which assessment is most important for the nurse to complete?

A. Osteoarthritis: Osteoarthritis is a common condition for which diclofenac is often prescribed. While it is important to monitor the effectiveness of the medication in treating osteoarthritis symptoms, the presence of this condition itself does not pose the greatest concern for the potential side effects or interactions of diclofenac.
B. Chronic alcoholism: Chronic alcoholism is of significant concern when a client is prescribed diclofenac. NSAIDs, including diclofenac, can irritate the gastrointestinal tract and increase the risk of gastrointestinal bleeding or ulcers, a risk that is heightened in individuals with a history of chronic alcoholism. This history makes monitoring for gastrointestinal side effects crucial, as chronic alcohol use can exacerbate these risks.
C. Type 2 diabetes mellitus: While diabetes mellitus can influence overall health and complicate the management of chronic conditions, it is not the most pressing concern related to the use of diclofenac. Diabetes management primarily involves monitoring blood glucose levels and managing diabetes-related complications, rather than the direct side effects of NSAIDs.
D. Migraine headaches: Migraine headaches are not directly related to the side effects or risks associated with diclofenac use. Although NSAIDs can be used to treat migraines, the presence of migraine headaches does not pose as significant a concern regarding the medication’s potential adverse effects as does a history of chronic alcoholism.

A. Check blood glucose levels every six hours: Monitoring blood glucose levels is crucial for managing diabetes, but checking them every six hours may not be frequent enough for clients on insulin lispro. This rapid-acting insulin requires closer monitoring, particularly around mealtimes, to effectively manage blood glucose levels and adjust dosing as needed.
B. Assess for hypoglycemia between meals: Assessing for hypoglycemia is important, but it is not the most critical intervention specifically related to the administration of insulin lispro. This insulin acts quickly and is closely tied to meal timing, so the primary focus should be on ensuring proper meal timing to prevent hypoglycemia.
C. Provide meals at the same time this insulin is given: Insulin lispro is a rapid-acting insulin that begins to work within 15 minutes and peaks around 1-2 hours after administration. It is crucial to provide meals at the same time or shortly after administering insulin lispro to match the timing of the insulin’s peak effect and prevent hypoglycemia. This synchronization helps ensure that the glucose from the meal is available to counterbalance the insulin's action.
D. Keep an oral liquid or glucose source available: While it is important to have a source of glucose available in case of hypoglycemia, the most critical intervention for managing insulin lispro is ensuring that the client receives their meals in sync with the insulin administration. Having a glucose source is a good safety measure, but providing meals at the appropriate time is more directly related to the effective use of rapid-acting insulin.