A nurse is caring for a client who is 36 weeks of gestation and experiences a spontaneous rupture of membranes. Which of the following actions should the nurse take?

Rationale:

A. Increased hemoglobin: Elevated hemoglobin levels are generally associated with dehydration, high altitude, or chronic hypoxia, but they are not specific indicators of infection. Hemoglobin does not provide direct evidence of a bacterial process.

B. Increased absolute neutrophils: Neutrophils are the primary white blood cells involved in fighting bacterial infections. An elevated absolute neutrophil count suggests an acute bacterial infection or an inflammatory response caused by bacterial pathogens.

C. Decreased C-reactive protein: CRP is a marker of inflammation, often elevated during bacterial infections. A decreased CRP level makes bacterial infection less likely and is not consistent with the inflammatory response usually seen in such cases.

D. Decreased platelets: Low platelet counts (thrombocytopenia) can result from viral infections, autoimmune diseases, or bone marrow disorders. While they may be altered in sepsis, they are not a reliable or primary marker of a typical bacterial infection.

Rationale:

• Encourage the client to discuss their feelings: Encouraging emotional expression is a key therapeutic approach in managing bulimia nervosa. It allows the client to explore underlying psychological issues, such as anxiety and fear of weight gain, which often contribute to disordered eating behaviors.
• Provide a reduced sodium diet: Sodium restriction is not indicated in this client. In fact, the client has a slightly low sodium level (134 mEq/L), and further restriction could worsen electrolyte imbalances, which are already contributing to cardiac instability.
• Request a prescription for fluoxetine: Fluoxetine, an SSRI, is approved for the treatment of bulimia nervosa and can reduce the frequency of binge-purge episodes. It is also effective in treating coexisting anxiety or depressive symptoms, which are common in this population.
• Request a prescription for bupropion: Bupropion is contraindicated in clients with eating disorders due to its seizure risk. In clients with bulimia, frequent vomiting and low electrolytes increase this risk significantly, making bupropion an inappropriate choice.
• Monitor daily intake and output: Monitoring intake and output helps evaluate hydration status and kidney function, both of which may be compromised due to chronic purging. It also helps track nutritional rehabilitation and prevent complications from electrolyte shifts.