A nurse is preparing to discharge a child who has a new prescription for an oral antibiotic. Which of the following information should the nurse include in the discharge instructions? (Select all that apply)

Choice A reason:

The arterial blood gas (ABG) values of pH 7.26, HCO₃ 14, and PaCO₂ 30 indicate metabolic acidosis with partial respiratory compensation. Acute kidney injury (AKI) often leads to metabolic acidosis due to the kidneys’ inability to excrete acid and reabsorb bicarbonate. The low pH indicates acidosis, the low bicarbonate (HCO₃) reflects metabolic acidosis, and the low PaCO₂ shows that the respiratory system is trying to compensate by blowing off CO₂.

Choice B reason:

The ABG values of pH 7.49, HCO₃ 30, and PaCO₂ 40 indicate metabolic alkalosis. This condition is characterized by an elevated pH and bicarbonate level. Metabolic alkalosis is not typically associated with acute kidney injury. Instead, it can result from excessive bicarbonate intake, loss of gastric acid (e.g., vomiting), or diuretic use.

Choice C reason:

The ABG values of pH 7.26, HCO₃ 24, and PaCO₂ 46 suggest respiratory acidosis. The low pH indicates acidosis, but the normal bicarbonate level and elevated PaCO₂ point to a respiratory cause rather than a metabolic one. Respiratory acidosis occurs when the lungs cannot remove enough CO₂, leading to its accumulation. This is not a typical presentation of AKI.

Choice D reason:

The ABG values of pH 7.49, HCO₃ 24, and PaCO₂ 30 indicate respiratory alkalosis. The high pH and low PaCO₂ suggest that the patient is hyperventilating, leading to excessive CO₂ loss. This condition is not commonly associated with acute kidney injury, which more frequently causes metabolic acidosis.

Choice A reason: Reinforce discharge teaching to clients

While reinforcing discharge teaching is important, it is not the immediate priority during a disaster situation with limited staff. The focus should be on addressing urgent and life-threatening needs first. Discharge teaching can be addressed once the immediate crisis is managed and resources are more available.

Choice B reason: Instruct the assistive personnel (AP) to focus on clients’ ADLs

Instructing assistive personnel to focus on clients’ activities of daily living (ADLs) is important for maintaining basic care, but it is not the highest priority in a disaster situation. The primary focus should be on preventing life-threatening emergencies and ensuring the safety of all clients.

Choice C reason: Stock additional unit supplies

Stocking additional unit supplies is a proactive measure, but it is not the immediate priority during a disaster with limited staff. Ensuring that clients are safe and that life-threatening emergencies are prevented takes precedence over restocking supplies.

Choice D reason: Focus on providing care that prevents life-threatening emergencies

Focusing on providing care that prevents life-threatening emergencies is the highest priority in a disaster situation. With limited staff, it is crucial to prioritize interventions that ensure the immediate safety and well-being of clients. This includes monitoring for and addressing any critical changes in clients’ conditions and providing necessary emergency care.