The husband of an older adult woman, diagnosed with pernicious anemia, calls the clinic to report that his wife still has memory loss and some confusion since she received the first dose of nasal cyanocobalamin two days ago. He tells the nurse that he is worried that she may be getting Alzheimer's disease. Which action should the nurse take?

Rationale:

• Convert the client's weight from pounds (lb) to kilograms (kg).

Weight in kg = 132 lb / 2.2 lb/kg

= 60 kg.

• Calculate the desired dose per minute in micrograms (mcg).

Desired dose per minute (mcg/min) = Desired dose (mcg/kg/min) × Weight (kg)

= 5 mcg/kg/min × 60 kg

= 300 mcg/min.

• Convert the desired dose from micrograms per minute (mcg/min) to milligrams per hour (mg/hr).

1 mg = 1000 mcg

1 hr = 60 min

Desired dose in mg/hr = (300 mcg/min / 1000 mcg/mg) × 60 min/hr

= 0.3 mg/min × 60 min/hr

= 18 mg/hr.

• Determine the concentration of the available Dopamine solution in milligrams per milliliter (mg/mL).

Available concentration = Total medication (mg) / Total volume (mL)

= 1600 mg / 500 mL

= 3.2 mg/mL.

• Calculate the IV pump rate in milliliters per hour (mL/hr).

IV pump rate (mL/hr) = Desired dose (mg/hr) / Available concentration (mg/mL)

= 18 mg/hr / 3.2 mg/mL

= 5.625 mL/hr.

• Round the answer to the nearest tenth.

= 5.6

Rationale:

• Palpate and compare radial pulses: It is important to check radial pulses to assess circulation to the injured limb. Decreased pulse strength, especially in the left arm, could indicate vascular injury, which requires immediate attention.
• Administer ondansetron 4 mg IV: The client is feeling nauseated and worries about vomiting, likely due to postoperative effects, pain medication, or anesthesia. Ondansetron is an antiemetic, which is appropriate to administer to manage nausea and prevent vomiting.
• Check capillary refill on bilateral upper extremities: Checking capillary refill is essential to assess perfusion to both arms. The client’s left arm is experiencing coolness, and diminished pulses were noted earlier, so this is necessary to monitor blood flow and prevent complications like compartment syndrome.
• Inspect the bandage for drainage: After surgery, it is important to inspect the surgical site for any drainage, bleeding, or signs of infection. This helps ensure that there are no complications or issues with wound healing.

• Perform range of motion: Performing range of motion exercises is contraindicated immediately after trauma, especially with a fracture or suspected injury to the shoulder. The shoulder should be immobilized to prevent further damage and to facilitate proper healing. Early movement may worsen the injury or cause additional pain.
• Provide morphine 2 mg IV push (IVP): While he had a nerve block, its effectiveness will wane, and he will likely experience significant pain from the fracture and surgical manipulation. Administering prescribed analgesia like morphine is a priority for pain management.