Which electrolyte imbalance is most commonly associated with refeeding syndrome?

Rationale:

• Potential Condition: The client developed new onset of severe, frequent diarrhea after receiving IV antibiotics (cefazolin), along with fever, abdominal cramping, dehydration (dry mucous membranes), and hyperactive bowel sounds. These are hallmark features of Clostridioides difficile colitis.
• Actions to Take:
  • Contact precautions (gown and gloves) are essential to prevent transmission since C. difficile is highly contagious.
  • IV fluids help correct dehydration and electrolyte losses caused by frequent diarrhea.
• Parameters to Monitor:
  • Serum potassium should be monitored because diarrhea causes large potassium losses, risking hypokalemia.
  • Blood pressure should be tracked closely since dehydration and electrolyte loss can lead to hypotension and hemodynamic instability.

Rationale:
A. Tap water enemas are hypotonic, and repeated or large-volume use can lead to hyponatremia or other electrolyte disturbances, particularly in infants, elderly clients, or those with renal or cardiac issues.

B. Administering a tap water enema in a client with suspected appendicitis can increase intra-abdominal pressure, potentially causing perforation or worsening the condition.

C. Tap water enemas can further disrupt fluid and electrolyte balance in clients who are already dehydrated, exacerbating their condition.

D. Regular use of laxatives is not a strict contraindication for a tap water enema but may reduce its effectiveness over time due to bowel adaptation.

E. Clients with recent bowel surgery or structural abnormalities are at higher risk for perforation or injury when receiving an enema.

F. Tap water enemas are not indicated for clients with normal bowel function because they are unnecessary and can cause discomfort or dependence.

G. While maintaining hydration is important, it does not contraindicate the use of a tap water enema; it may actually support bowel function.