An 80-year-old client is brought to the

An 80-year-old client is brought to the emergency department from their long-term care facility. Complete the following sentences by choosing from the lists of options. The nurse knows this client is at higher risk for ____. Therefore, the nurse will ____ and ensure ____ is available at the bedside.

Provider’s Note

5/9

1000

Client brought to emergency department via emergency medical services from long-term care (LTC) facility.

Medical history includes hypertension, coronary artery disease, and osteoporosis. Home medications include hydrochlorothiazide, amlodipine, losartan, vitamin D supplement, and senna. LTC nursing staff report 4-day history of upper respiratory infection. Client had decreased oral intake of food and fluid with onset of illness. Chest x-ray confirms bacterial respiratory infection. Client to be admitted to medical unit with diagnoses of bacterial respiratory infection and secondary dehydration. Treatment with IV antibiotics and fluid replacement prescribed.

Nurse’s Notes

5/9

1045

On assessment client alert to voice, oriented to person only. Client slightly confused. Coarse crackles to bilateral lung fields on auscultation. S1, S2 on auscultation of heart sounds. Hypoactive bowel sounds with last BM reported 4 days ago. Client with significantly decreased skin turgor, skin dry and pale. Peripheral pulses weak on palpation. Capillary refill greater than 4 seconds. Client denies pain. Client voids 75 mL of dark amber urine. PIV started in right forearm and 5% dextrose in 0.9% normal saline intravenous infusion started. Blood cultures collected and first antibiotic administered.

1200

Client admitted to medical unit from ED. Client with patent PIV in right forearm infusing 5% dextrose in 0.9% normal saline at 125 mL/hr. Labs drawn in emergency department resulted. Client assessment remains unchanged. Client fever reduced with acetaminophen administration. Client sleeping and did not eat any lunch.

2200

Client labs redrawn. Client sleeping most of day. Client consumed 10% of dinner with encouragement. Client drinking more, reporting increased thirst, mucous membranes dry and sticky. Client remains lethargic and reports increased weakness. Client with mild productive cough but remains on room air with stable respiratory effort. New non-pitting edema noted to bilateral lower extremities.

5/10

0700

Client difficult to arouse this morning. Does open eyes to touch but doesn't answer questions. Client with increased pitting edema to bilateral lower extremities and generalized non-pitting edema. Labs drawn.

Vital Signs

Time	Blood Pressure	Heart Rate	Respiratory Rate	Temperature	SpO₂
1000	100/66	102	18	101.4°F (38.5°C)	96% RA

Laboratory Results

Test	Reference Range	5/9 1030	5/9 2200	5/10 0800
WBC	4,000–10,000/mm³	22,000	19,500	17,200
Hemoglobin	12–17 g/dL	15	17	18
Hematocrit	36–51%	55	58	62
Sodium	135–145 mEq/L	148	150	155
Potassium	3.5–5.0 mEq/L	3.7	3.5	3.6
Urine specific gravity	1.005–1.030	1.025	1.030	1.038

Answer & explanation

Correct:

This client has progressive hypernatremia with sodium levels rising to 155 mEq/L by 5/10, accompanied by worsening neurological deterioration — confusion progressing to near-unresponsiveness. Severe hypernatremia causes neuronal shrinkage and cerebral irritability, placing the client at significant risk for seizures. This is the most clinically urgent complication given the sodium level and altered mental status trajectory. Because seizure risk is elevated, the nurse should pad the side rails to protect the client from injury if a seizure occurs. This is the standard safety intervention for seizure precautions. Simply reorienting the client or administering glucose gel would not address seizure risk. Ensuring oxygen is available at the bedside is the correct third selection because oxygen delivery is a priority during and after a seizure, as seizure activity increases metabolic demand and can cause hypoxia. Orange juice would be appropriate for hypoglycemia, not hypernatremia or seizures. Cardiac monitoring, while useful in some electrolyte disturbances, is not the primary bedside priority for seizure management. The clinical reasoning connects the severely elevated sodium, the neurological changes, and the evidence-based nursing response: implement seizure precautions by padding side rails and having oxygen immediately accessible.

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An 80-year-old client is brought to the emergency department from their long-term care facility. Complete the following sentences by choosing from the lists of options. The nurse knows this client is at higher risk for . Therefore, the nurse will and ensure is available at the bedside.

Answer & explanation

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