The healthcare provider (HCP) prescribes 1 liter of 0.9% sodium chloride, USP IV to be infused over 12 hours for a client. How many mL/hr should the nurse program the infusion pump to deliver?

(Enter numerical value only. If rounding is required, round to the nearest whole number.)

A. Serum liver enzymes: Statins are metabolized in the liver and can cause hepatotoxicity. Baseline liver enzyme levels, such as ALT and AST, should be reviewed before starting statin therapy to ensure the liver is functioning properly and to monitor for potential adverse effects.

B. Serum electrolytes: Electrolytes are important for overall health, but they are not specifically impacted by statin therapy. Reviewing electrolyte levels is not a priority before initiating statins unless other conditions warrant it.

C. Complete blood count: A complete blood count (CBC) provides valuable information about infection or anemia, but it is not directly related to the safety or monitoring of statin medications.

D. Capillary blood glucose: Statins have been associated with a slight risk of elevated blood glucose over long-term use, but an initial capillary blood glucose reading is not required prior to starting therapy. Liver function assessment is the priority.

Potential Conditions

Anemia: Anemia commonly causes fatigue and weakness, but it does not typically explain diarrhea. Additionally, the use of spironolactone, a potassium-sparing diuretic, makes electrolyte imbalance a more likely cause of these symptoms rather than anemia.

Hepatic failure: While hepatic failure could cause fatigue and systemic symptoms, it usually presents with jaundice, ascites, or confusion in advanced cases. There are no signs of liver-related symptoms in this scenario, making hepatic failure less likely.

Hyperkalemia: Hyperkalemia is the most likely condition because spironolactone can cause potassium retention. Symptoms such as fatigue, muscle weakness, and gastrointestinal disturbances like diarrhea are classic early signs of elevated potassium levels.

Hyperuricemia: Hyperuricemia is characterized by elevated uric acid levels, often leading to gout attacks rather than gastrointestinal symptoms or muscle weakness. Therefore, it is not the primary concern with this client’s current presentation.

Actions to take

Check the client's oxygen saturation: Although oxygen saturation is important in many acute settings, the client’s symptoms suggest a metabolic issue rather than a respiratory problem. Checking oxygenation would not directly address suspected hyperkalemia.

Do a point of care glucose check: Checking glucose is appropriate for clients with symptoms of hyperglycemia or hypoglycemia, but this client’s symptoms and medication history point more toward an electrolyte imbalance rather than a glucose-related disorder.

Measure the client's abdominal girth: Measuring abdominal girth is useful for detecting fluid accumulation, such as ascites in liver failure, but it is not relevant in the assessment of hyperkalemia. It would not provide information needed for the client’s immediate concern.

Ask the client about their diet: Dietary habits, particularly potassium intake, can significantly impact potassium levels when using potassium-sparing medications like spironolactone. Understanding the client's diet can help identify factors contributing to hyperkalemia.

Do a blood chemistry panel: A blood chemistry panel would provide critical information about serum electrolytes, including potassium levels. It is essential for diagnosing and confirming hyperkalemia and guiding further treatment decisions.

Parameters to Monitor

Edema: While edema monitoring is important in some chronic conditions like heart failure, it is not a primary concern with hyperkalemia. Hyperkalemia affects muscle and cardiac conduction, not typically fluid balance or peripheral swelling.

Skin color: Monitoring skin color can reveal perfusion issues but does not directly help detect or manage hyperkalemia. Changes in skin color would not provide early or specific warning signs of worsening potassium levels.

Pedal pulses: Pedal pulses are useful in assessing circulatory problems such as peripheral arterial disease but are not directly related to the cardiac conduction disturbances seen in hyperkalemia. Focus should instead be on heart rhythm.

Potassium level: Potassium level monitoring is essential because hyperkalemia can progress quickly and lead to life-threatening cardiac complications. Keeping track of potassium levels helps assess the severity of the imbalance and the response to treatment.

Heart Rhythm: Monitoring heart rhythm is critical, as hyperkalemia can cause bradycardia, peaked T waves, and even cardiac arrest. Continuous cardiac monitoring allows for early detection of dangerous arrhythmias resulting from elevated potassium.