Exhibits

Which of the following should the nurse plan to include when providing teaching for the client? Select all that apply.

Rationale for Correct Choices:

• Infection: A low WBC count of 4,100/mm³ indicates a suppressed immune system, which is a complication in HIV. White blood cells play a key role in fighting infections, so a drop below the normal range places the client at increased risk for opportunistic and routine infections.
• WBC count: The client's WBC count has declined from 4,500/mm³ at diagnosis to 4,100/mm³, now falling below the standard range of 5,000–10,000/mm³. This trend suggests worsening immunosuppression, commonly seen in clients with HIV as the virus affects CD4+ T cells, reducing the body’s ability to fight infections.

Rationale for Incorrect Choices:

• Seizures: Seizure risk is usually associated with electrolyte imbalances, especially hyponatremia or hypernatremia. The client’s sodium level is 139 mEq/L, which is within the normal range, indicating that the risk for seizures is not elevated.
• Bleeding: Although the client’s platelet count has slightly decreased from 164,000 to 162,000/mm³, it remains within the normal range of 150,000–400,000/mm³. Significant bleeding risk generally arises when platelet levels fall well below 100,000/mm³.
• Dysrhythmias: The potassium level is 3.8 mEq/L, within the normal range of 3.5–5.0 mEq/L. Abnormal potassium levels, particularly hypo- or hyperkalemia, are key contributors to cardiac dysrhythmias, which are not suggested by the current lab values.
• Renal failure: The client’s BUN is 18 mg/dL, well within the normal range of 10–20 mg/dL. There is no elevation in BUN or signs of impaired kidney function, making renal failure an unlikely concern at this time.
• Platelet count: The platelet count is slightly lower than before but still within normal limits. A count of 162,000/mm³ does not pose a clinical concern for bleeding, and it does not indicate a serious hematologic issue requiring immediate intervention.
• Sodium level: The sodium level is 139 mEq/L, which is normal. It does not contribute to neurological symptoms such as seizures and is not associated with infection risk or other critical conditions in this scenario.
• Potassium level: The potassium level of 3.8 mEq/L is also within normal range. There is no evidence of potassium-related complications such as dysrhythmias or muscle weakness in the current context.
• BUN level: The client's BUN level is within the normal range (18 mg/dL), indicating normal kidney function and not a risk factor for any of the listed conditions.

A. Partial pressure of CO2 50 mm Hg (35 to 45 mm Hg): In DKA the partial pressure of CO2 decreases due to hyperventilation, which is the body’s compensatory mechanism to blow off CO2 and correct metabolic acidosis. A CO2 level of 50 mm Hg would suggest insufficient compensation.

B. Serum bicarbonate 9 mEq/L (21 to 28 mEq/L): In DKA, serum bicarbonate levels decrease due to the accumulation of ketoacids, leading to metabolic acidosis. A level of 9 mEq/L is significantly lower than the normal range and indicates the severity of acidosis.

C. Blood glucose 230 mg/dL (74 to 106 mg/dL): Blood glucose levels in DKA are typically much higher than 230 mg/dL. Blood glucose levels in DKA can exceed 250 mg/dL, often reaching 600 mg/dL or higher, due to insufficient insulin.

D. pH 7.5 (7.35 to 7.45): The pH in DKA is usually low, indicating acidosis. A pH of 7.5 is higher than the normal range, suggesting alkalosis, which is not consistent with DKA. Typically, the pH in DKA is below 7.35 due to metabolic acidosis.