A nurse is providing care for a client who is scheduled for electroconvulsive therapy. Which of the following conditions should the nurse identify as an increased risk for complications?

Rationale for Correct Choices

• Reye's syndrome: The toddler presents with acute onset of vomiting, lethargy, and altered mental status following a recent viral illness (influenza A). These are hallmark signs of Reye’s syndrome, a rare but serious condition causing hepatic and cerebral dysfunction in children.

• Aspirin administration: Use of aspirin during viral infections in children is strongly associated with the development of Reye’s syndrome. The guardians reported alternating aspirin with acetaminophen, directly increasing the toddler’s risk for this potentially life-threatening condition.

Rationale for Incorrect Choices

• Gastroenteritis: Gastroenteritis typically presents with diarrhea, abdominal cramping, and vomiting. While vomiting is present, the toddler also demonstrates lethargy and neurologic changes, which are not characteristic of routine gastroenteritis.

• Bronchitis: Bronchitis usually causes productive cough, wheezing, or respiratory distress. This toddler has a non-productive cough and clear lung sounds, making bronchitis an unlikely explanation for the current acute neurological and systemic symptoms.

• Oseltamivir administration: Oseltamivir is an antiviral used to treat influenza and is not associated with the development of Reye’s syndrome. The toddler’s severe symptoms are unrelated to this medication.

• Acetaminophen administration: Acetaminophen is generally safe in children at recommended doses. While it can cause liver toxicity in overdose, the scenario indicates appropriate use, making it an unlikely contributor to the toddler’s presentation.

Rationale:
A. Serum albumin: Serum albumin is a key indicator of a client’s nutritional status, particularly protein intake and synthesis. Low albumin levels can reflect malnutrition, chronic illness, or liver dysfunction, while normal levels suggest adequate nutritional support and protein reserves.

B. Troponin level: Troponin is a cardiac biomarker used to diagnose myocardial injury or infarction. It is not related to nutrition and does not provide any information about the client’s dietary intake or protein status.

C. Serum sodium: Serum sodium reflects fluid and electrolyte balance rather than nutritional status. Abnormal sodium levels are typically associated with dehydration, fluid overload, or endocrine disorders, not with protein or calorie malnutrition.

D. Erythrocyte sedimentation rate: The erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation and infection. It may rise with inflammatory conditions but does not provide direct information about a client’s nutritional health.