A nurse is caring for a client who weighs 190 lb and is receiving total parenteral nutrition. If the RDA of protein is 0.8 g/kg of body weight, how many grams of protein should the client receive daily? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A. Applying medicated powder under the vest is not recommended as it can interfere with the fit of the device, cause skin irritation, or affect the traction. The nurse should avoid using powders or lotions in the area.

B. The nurse should not loosen or tighten the screws on the halo traction device, as this requires a healthcare provider with the appropriate expertise to adjust it. Any adjustments should be made by the physician or specialist.

C. Ensuring that there is space for one finger between the vest and the client's skin is important for preventing skin breakdown and ensuring proper fit of the device. The vest should be snug but not tight enough to cause discomfort or pressure.

D. The nurse should not move the client by holding onto the halo traction device, as this can cause injury or disrupt the device's alignment. Instead, the nurse should use proper techniques and support to move the client safely.

A. Hypotension
The client is at risk for hypotension due to significant dehydration from osmotic diuresis caused by hyperglycemia. The low blood pressure of 96/65 mm Hg indicates a trend toward hypovolemia, which could worsen if fluid losses are not corrected.
B. Respiratory alkalosis
This is unlikely, as the client has metabolic acidosis (pH 7.30), a hallmark of DKA. The respiratory rate of 18/min does not indicate hyperventilation typically associated with respiratory alkalosis.
C. Renal failure
Elevated creatinine (1.7 mg/dL) and BUN (21 mg/dL) suggest early signs of impaired renal function, likely due to dehydration. If the hypovolemia is not addressed, the client could develop acute kidney injury.

D. Cardiac arrhythmias
The elevated potassium level (5.5 mEq/L) and potential for electrolyte imbalances, such as hypokalemia during insulin therapy, increase the risk of cardiac arrhythmias. Potassium levels must be closely monitored and managed during treatment.

E. Cerebral edema
Although rare, cerebral edema is a possible complication of diabetic ketoacidosis (DKA), particularly if fluid resuscitation is overly rapid or excessive. This condition can lead to neurological deterioration and requires careful monitoring of fluid therapy.

F. Septic shock
While the client has a history of recent infections (bronchitis and pneumonia), there are no current signs of sepsis or septic shock, such as fever, leukocytosis, or hemodynamic instability.