A nurse is caring for a client who has pneumonia.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

A. Poorly coordinated care and nosocomial infections are examples of errors: While poorly coordinated care can lead to adverse events, nosocomial infections are typically classified as healthcare-associated infections rather than errors. Errors generally refer to mistakes made in clinical practice that can lead to harm, whereas nosocomial infections are outcomes that arise from the healthcare environment.
B. As many as 90% of medication errors are preventable: This statement is true and highlights the significant opportunity for improvement in patient safety. Recognizing that a large percentage of medication errors can be prevented underscores the importance of implementing safety protocols, effective communication, and education to reduce the likelihood of errors occurring in clinical practice.
C. Errors of execution are usually intentional and occur because of time or resource constraints: This statement is misleading, as errors of execution typically refer to mistakes made during the performance of a task rather than intentional actions. These errors often occur due to lack of knowledge, skill, or attention rather than being intentional, and they are not solely attributed to time or resource constraints.
D. Medication errors are adverse events: While medication errors can lead to adverse events, not all medication errors result in harm. An adverse event is defined as an injury caused by medical management rather than the underlying condition of the patient, so this statement is not entirely accurate. Medication errors can be classified as near misses or adverse events, depending on whether they resulted in harm to the patient.

• Clostridium difficile infection is likely because the client has pneumonia and is receiving ceftriaxone, an antibiotic known to disrupt gut flora and cause opportunistic infections like C. difficile. The presence of frequent, liquid, foul-smelling stools further supports this diagnosis.
• Myocardial infarction is unlikely because while the client has chest pain, it is pleuritic and related to inspiration rather than the typical crushing, non-pleuritic chest pain seen in an MI. There is no mention of radiating pain, diaphoresis, or hemodynamic instability.
• Pulmonary edema is unlikely since it typically presents with dyspnea, crackles throughout the lung fields, pink frothy sputum, and signs of fluid overload such as peripheral edema and weight gain. The client’s symptoms do not align with this condition.
• Pulmonary embolism is also unlikely, as it presents with sudden-onset dyspnea, pleuritic chest pain, tachycardia, and often calf swelling or a history of deep vein thrombosis. The client lacks the risk factors and clinical signs of PE.
• Placing the client on contact precautions is necessary because C. difficile is highly contagious and spreads through the fecal-oral route. Gloves and gowns should be used to prevent transmission.
• Obtaining a stool culture is necessary to confirm the presence of C. difficile toxins in the stool, which is essential for accurate diagnosis and treatment.
• Requesting a prescription for an anticoagulant is not necessary because the client does not show any signs of thromboembolic disease such as deep vein thrombosis or pulmonary embolism. Anticoagulation could increase the risk of bleeding in the gastrointestinal tract, which would worsen the diarrhea.
• Requesting a prescription for a diuretic is not needed because the client is more likely to be dehydrated due to diarrhea. Diuretics would exacerbate fluid loss and electrolyte imbalances.
• Restricting fluids is not appropriate because dehydration is a major concern with C. difficile infection. Instead, fluid intake should be encouraged to prevent complications from excessive fluid loss.
• Level of consciousness should be monitored because severe dehydration and electrolyte imbalances can lead to confusion, weakness, and altered mental status. While altered mental status can occur with severe dehydration or sepsis, it is not the primary concern at this stage.
• Potassium level should be monitored because diarrhea can cause significant potassium loss, leading to hypokalemia, which can result in muscle weakness, cardiac arrhythmias, and fatigue.
• Urine output is not the most specific parameter for monitoring C. difficile infection. While dehydration is a concern, tracking electrolyte levels and neurological status is more critical.
• Calf swelling is not relevant since the client does not have signs or risk factors for deep vein thrombosis or pulmonary embolism.
• Weight: C. difficile infection can cause significant fluid loss due to persistent diarrhea, leading to dehydration and weight loss. Tracking daily weight helps assess hydration status and the effectiveness of fluid replacement therapy.