An older client receiving continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory results are related to this finding, and should be reported to the health care provider immediately?

Choice A reason: Lispro (Humalog) is a type of insulin that is used for mealtime coverage. It is a rapid-acting insulin that starts to work within 15 minutes, peaks in about an hour, and lasts for 2 to 4 hours. It mimics the natural insulin response to food intake, and helps to lower the blood glucose level after meals. The nurse will discuss using lispro for mealtime coverage, and instruct the patient to inject it within 15 minutes before or after eating.

Choice B reason: NPH (Humulin N) is a type of insulin that is not used for mealtime coverage. It is an intermediate-acting insulin that starts to work within 2 to 4 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours. It provides a steady background of insulin throughout the day, and helps to control the blood glucose level between meals and overnight. The nurse will discuss using NPH for basal coverage, and instruct the patient to inject it once or twice a day, usually in the morning and/or evening.

Choice C reason: Detemir (Levemir) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using detemir for basal coverage, and instruct the patient to inject it once or twice a day, depending on the individual needs.

Choice D reason: Glargine (Lantus) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using glargine for basal coverage, and instruct the patient to inject it once a day, usually at the same time every day.

Choice A reason: This statement is false. Glucose: 88 mg/dL is a normal blood sugar level and does not indicate any problem with fluid or electrolyte balance¹.

Choice B reason: This statement is false. WBCs: 4000 is slightly below the normal range, but not significantly low. It may indicate a mild infection or inflammation, but not a serious fluid or electrolyte imbalance².

Choice C reason: This statement is false. K+: 3.4 mEq/L is slightly below the normal range, but not dangerously low. It may indicate a mild potassium deficiency, which can cause muscle weakness, but not restlessness or agitation.

Choice D reason: This statement is true. Na+: 154 mEq/L is above the normal range and indicates hypernatremia, or high blood sodium level. This can cause dehydration, confusion, restlessness, agitation, and seizures. It is a medical emergency that requires immediate treatment. Continuous tube feedings can increase the risk of hypernatremia if the formula is too concentrated or the fluid intake is inadequate⁵.