A nurse is planning care for a client who has hyponatremia and is receiving IV fluid therapy with 3% sodium chloride solution. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

Choice A reason:

Hypernatremia is not a likely complication of fluid therapy for diabetic ketoacidosis (DKA) Hypernatremia occurs when there is a loss of water or an excess of sodium in the body. Fluid therapy for DKA usually involves normal saline and dextrose, which do not cause hypernatremia. In fact, fluid therapy may help correct the dehydration and hyperosmolality that are associated with DKA.

Choice B reason:

Hyperkalemia is also not a likely complication of fluid therapy for DKA. Hyperkalemia occurs when there is an excess of potassium in the blood. Fluid therapy for DKA usually involves insulin infusion, which helps lower the potassium level by driving it into the cells. Insulin also helps lower the blood glucose level and reverse the acidosis that are characteristic of DKA.

Choice C reason:

Fluid volume deficit is a common manifestation of DKA, not a complication of fluid therapy. Fluid volume deficit occurs when there is a loss of fluid and electrolytes from the body due to osmotic diuresis, vomiting, and increased respiratory rate. Fluid therapy for DKA aims to restore the fluid volume and correct the electrolyte imbalances that result from fluid loss.

Choice D reason:

Cerebral edema is a potential complication of fluid therapy for DKA, especially in children and young adults. Cerebral edema occurs when there is an increase in intracranial pressure due to swelling of the brain tissue. Fluid therapy for DKA may cause cerebral edema by altering the osmotic gradient between the blood and the brain, leading to fluid shifts into the brain cells. Cerebral edema can cause neurological symptoms such as headache, confusion, seizures, and coma.

Choice A reason:

Kussmaul respirations are a type of deep, rapid breathing that occurs in response to metabolic acidosis. The body tries to compensate for the excess acid by blowing off carbon dioxide through the lungs. Kussmaul respirations are a common manifestation of diabetic ketoacidosis (DKA), which is a severe form of metabolic acidosis caused by the accumulation of ketones in the blood. The nurse should monitor the client's respiratory rate, depth, and pattern, as well as the arterial blood gas results, to assess the severity of metabolic acidosis and the effectiveness of treatment.

Choice B reason:

Bradypnea is a condition of abnormally slow breathing, usually less than 12 breaths per minute. Bradypnea can result from respiratory acidosis, which is a condition of excess carbon dioxide in the blood due to hypoventilation or impaired gas exchange. Bradypnea is not a manifestation of metabolic acidosis, which is a condition of excess acid in the blood due to increased production or decreased elimination of hydrogen ions. Therefore, choice B is incorrect.

Choice C reason:

Muscle spasms are involuntary contractions of the skeletal muscles that can cause pain and discomfort. Muscle spasms can result from hypocalcemia, which is a condition of low calcium levels in the blood. Hypocalcemia can occur in metabolic acidosis due to the binding of calcium with excess hydrogen ions, reducing the availability of free calcium for muscle contraction. However, muscle spasms are not a specific or common manifestation of metabolic acidosis, and they can have other causes such as dehydration, electrolyte imbalance, or muscle injury. Therefore, choice C is incorrect.

Choice D reason:

Numbness and tingling of extremities are sensations of reduced or abnormal feeling in the arms or legs. Numbness and tingling can result from hypokalemia, which is a condition of low potassium levels in the blood. Hypokalemia can occur in metabolic acidosis due to the movement of potassium from the intracellular to the extracellular space in exchange for hydrogen ions, which are then excreted by the kidneys. However, numbness and tingling are not specific or common manifestations of metabolic acidosis, and they can have other causes such as nerve compression, peripheral neuropathy, or hyperventilation. Therefore, choice D is incorrect.