A nurse is collecting data from a client who is taking levodopa-carbidopa to treat Parkinson's disease. Which of the following findings should the nurse document as an adverse effect of this medication?

Rationale for Correct Options:

• Heart rate. The heart rate has increased from 90/min on Day 1 to 132/min on Day 2. This significant elevation is concerning for worsening systemic inflammation, hypovolemia, or sepsis and requires immediate intervention.
• Respiratory status. The client initially had diminished breath sounds at the lung bases, but by Day 2, breath sounds are diminished throughout. This suggests worsening respiratory function, possibly due to acute respiratory distress syndrome (ARDS) or pleural effusion, both of which can complicate severe pancreatitis. Immediate assessment and intervention are necessary.
• Mental confusion. The client was alert and oriented on Day 1 but is now disoriented to person, place, and time on Day 2. This change in mental status can indicate worsening systemic inflammation, sepsis, hypoxia, or metabolic disturbances such as hypocalcemia. Immediate evaluation is needed.
• Blood pressure. While the client’s initial blood pressure was stable at 126/78 mm Hg, the current reading is not provided. If the client is experiencing hypotension, it could indicate worsening shock, requiring urgent intervention.
• Temperature. The client’s temperature increased from 37.2 °C (99 °F) on Day 1 to 38.9 °C (102 °F) on Day 2. This suggests a developing infection, such as infected pancreatic necrosis or sepsis, which requires immediate reporting and further evaluation.
• Cold, clammy skin. Cold, clammy skin is a sign of poor perfusion, which may indicate impending shock due to worsening sepsis or hypovolemia. This is an urgent finding requiring immediate attention.

Rationale for Incorrect Options:

• Urine output. The client’s urine output was documented as 60 mL/hr, which is within the normal range. There is no indication of oliguria or anuria that would require immediate reporting.
• Sodium level. The sodium level of 142 mEq/L is within the normal range and does not indicate a critical electrolyte imbalance requiring urgent intervention.
• Pain. The client’s pain has increased from 8/10 to 10/10 despite receiving morphine via a PCA pump. While pain management is crucial, worsening pain alone is not the most urgent concern compared to systemic complications like respiratory failure or hemodynamic instability.
• Serum amylase level. Although the serum amylase level is significantly elevated at 498 units/L, this is expected in acute pancreatitis and does not necessarily indicate an immediate life-threatening emergency. Trends in amylase and lipase levels are important for monitoring, but they do not require urgent reporting unless accompanied by other signs of deterioration.

A. Prolonged PT/INR. Prolonged PT/INR may occur due to liver dysfunction or vitamin K deficiency, but it is not a direct result of pancreatitis. In pancreatitis, the liver is usually functioning normally unless there is concurrent liver disease.
B. Elevated lipase. Elevated lipase is a hallmark laboratory finding in pancreatitis. Lipase is an enzyme produced by the pancreas, and its levels rise significantly during episodes of pancreatitis, making it a key indicator in diagnosing the condition.
C. Elevated ammonia. Elevated ammonia levels are more commonly associated with liver dysfunction, such as hepatic encephalopathy, rather than pancreatitis. Pancreatitis primarily affects the digestive system, not the liver directly.
D. Decreased albumin. Decreased albumin can be seen in various conditions, including liver disease and malnutrition, but it is not a specific finding for pancreatitis. In acute pancreatitis, albumin levels may not be significantly affected, while chronic pancreatitis can lead to malabsorption and potentially lower albumin levels over time.