A nurse is reviewing the medical record of a client who had abdominal surgery 2 days ago. The nurse should identify that which of the following findings indicates the client is at risk for delayed wound healing?

Rationale:
A. Instruct the parent to give the infant water every 3 hr between feedings: Giving water to infants under 6 months can displace nutrient intake and increase the risk of hyponatremia. Breast milk or formula should remain the exclusive source of nutrition at this age.

B. Recommend the parent mix the milk with rice cereal for feedings: Introducing rice cereal at 3 months is not developmentally appropriate and can increase the risk of choking. Cow’s milk lacks the proper nutrient balance, and adding cereal does not correct these deficiencies.

C. Instruct the parent to give 5 mcg of vitamin D daily: While vitamin D supplementation is important for infants, the concern in this scenario is the use of cow’s milk, not vitamin D deficiency. Breastfed infants should receive supplementation, but formula-fed infants typically get adequate vitamin D through fortified formula.

D. Advise the parent to avoid giving cow's milk to the infant prior to 1 year of age: Cow’s milk should not be introduced before 12 months because it lacks iron, vitamin E, and essential fatty acids, and can cause gastrointestinal irritation and occult blood loss.

Rationale for Correct Choices:

• Serotonin syndrome: The client’s symptoms recent SSRI dose increase indicate possible serotonin toxicity. Serotonin syndrome occurs when excessive serotonin accumulates in the body, typically following dose escalation or interaction between serotonergic medications. It is a medical emergency that can progress to seizures or death if not promptly identified and treated.

• Adverse effects of paroxetine: The increase in paroxetine dosage one week prior likely triggered excessive serotonergic activity. Paroxetine, an SSRI, elevates serotonin levels, and dose escalation can precipitate serotonin syndrome.

Rationale for Incorrect Choices:

• Generalized anxiety disorder: Although the client has a history of anxiety, the acute onset of fever, disorientation, and autonomic instability points to a physiological reaction rather than worsening anxiety. Anxiety may cause restlessness but does not produce hyperthermia or confusion.

• Neuroleptic malignant syndrome: This condition is associated with antipsychotic drugs, not SSRIs like paroxetine. While both syndromes can present with fever and altered mental status, the client’s medication profile and timing support serotonin toxicity instead.

• Feelings of hopelessness: Although ongoing hopelessness is part of the client’s depression, it does not explain the acute physical manifestations. Emotional symptoms may persist with depression, but fever and disorientation indicate a pharmacologic rather than psychological cause.

• Anxiety: Anxiety alone cannot account for the client’s fever, disorientation, or abdominal pain. These findings suggest a systemic reaction consistent with serotonin excess, not a purely psychological state.