A nurse is caring for a client who has diabetic ketoacidosis secondary to an infection. Which of the following prescriptions is the highest priority?
Obtain blood for culture and sensitivity.
Initiate IV infusion of regular insulin.
Initiate 0.9% sodium chloride 1,000 mL IV at 500 mL/hr.
Insert an indwelling urinary catheter.
The Correct Answer is B
A) Obtain blood for culture and sensitivity: While identifying the infection is important for treatment, it does not address the immediate metabolic crisis of diabetic ketoacidosis (DKA). This action is essential but secondary to stabilizing the client's current condition.
B) Initiate IV infusion of regular insulin: Administering insulin is critical in the management of DKA, as it helps to reduce blood glucose levels and halt the production of ketones, which are responsible for the acidosis. This intervention is vital for quickly correcting the metabolic derangement and stabilizing the patient.
C) Initiate 0.9% sodium chloride 1,000 mL IV at 500 mL/hr: While fluid replacement is important in the management of DKA to address dehydration and electrolyte imbalances, it is still not as immediately life-saving as starting insulin therapy. Fluid resuscitation typically follows the administration of insulin.
D) Insert an indwelling urinary catheter: This may be necessary for monitoring urine output and assessing kidney function, but it is not a priority intervention when addressing the acute complications of DKA. Insulin administration takes precedence in the immediate management plan.
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Correct Answer is C
Explanation
A) Lidocaine: Lidocaine is primarily used for the management of ventricular arrhythmias, particularly in cases of ventricular tachycardia or ventricular fibrillation. It is not indicated for treating sinus bradycardia and ST segment elevation.
B) Digoxin: Digoxin is used to treat atrial fibrillation and heart failure but is not appropriate for acute management of sinus bradycardia. In fact, digoxin can potentially worsen bradycardia by increasing vagal tone.
C) Atropine: Atropine is the drug of choice for acute management of symptomatic bradycardia. It works by blocking the effects of the vagus nerve on the heart, which can increase heart rate. Given the client's symptoms of shortness of breath and dizziness, atropine is appropriate to help stabilize their condition.
D) Sotalol: Sotalol is an antiarrhythmic medication used primarily for atrial fibrillation and ventricular arrhythmias. It is not indicated for the treatment of bradycardia and may even exacerbate the condition.
Correct Answer is D
Explanation
A) Access the catheter using a non-coring needle: A non-coring needle is typically used for accessing implanted ports, not for PICC lines. PICC lines are accessed with a standard IV catheter or a specific type of needle designed for central lines. Therefore, this action is not appropriate for a PICC line.
B) Maintain a continuous IV infusion through the PICC line: While PICC lines can be used for continuous infusions, it is not necessary to maintain a continuous infusion if the client is only receiving intermittent IV bolus antibiotics. The line can remain capped between doses if there are no other infusions required.
C) Change the transparent membrane dressing daily: Transparent dressings for PICC lines should typically be changed every 7 days or if they become damp, soiled, or loose. Daily changes are not required and could increase the risk of infection.
D) Flush the catheter with a 0.9% sodium chloride solution after each use: Flushing the PICC line with a 0.9% sodium chloride solution after each use is the correct action to maintain patency and reduce the risk of clot formation. This is standard practice after administering medications through a central line.