Question

a nurse is caring for a client in an outpatient mental health clinic.
exhibit 1 exhibit 2 exhibit 3 exhibit 4.
nurses’ notes
3 weeks ago:
client is following up from hospital discharge 3 days ago. reports taking lithium 300 mg by mouth 3 times daily as prescribed per discharge instructions. client reports insomnia and decreased appetite. client had stopped taking hydrochlorothiazide for hypertension before hospitalization but has resumed daily dosage.
today:
client reports nausea and diarrhea for the last 2 days. client is speaking loudly and rapidly. client reports sleeping 2 to 3 hr per night. appetite had improved before nausea started. client reports increased urination.
click to highlight the findings that indicate adverse effects from the client’s prescribed medication. to deselect a finding, click on the finding again.
nurses’ notes
today:
client reports nausea and diarrhea for the last 2 days. client is speaking loudly and rapidly. client reports sleeping 2 to 3 hr per night. appetite had improved before nausea started. client reports increased urination.
vital signs
today:
temperature 38.5°c (101.3°f)
heart rate 92/min
respiratory rate 20/min
blood pressure 136/90 mm hg
laboratory results
today:
lithium 1.4 meq/l (0.8 to 1.2 meq/l)
wbc count 14,000 mm³/l (5,000 to 10,000 mm³/l)
serum glucose 112 mg/dl (74 to 106 mg/dl)
sodium 140 meq/l (135 to 145 meq/l)
potassium 4.3 meq/l (3.5 to 5.0 meq/l)

Explanation:

To identify adverse effects of lithium (the prescribed medication), we analyze each finding:

• Nausea and diarrhea: Common gastrointestinal adverse effects of lithium.
• Speaking loudly and rapidly: Could indicate lithium toxicity or mania exacerbation, but also an adverse effect manifestation.
• Sleeping 2 - 3 hr per night: Insomnia or sleep disturbance, can be an adverse effect of lithium or related to mood changes, but combined with other symptoms, relevant.
• Increased urination: Polyuria is a known adverse effect of lithium (due to its effect on the kidneys, causing nephrogenic diabetes insipidus).
• Temperature 38.5°C (101.3°F): Fever, which can be associated with lithium toxicity or infection, but in the context of other lithium - related symptoms, relevant.
• Lithium 1.4 mEq/L: The therapeutic range for lithium is 0.8 - 1.2 mEq/L, so this is a toxic level, indicating lithium toxicity (a severe adverse effect).
• WBC count 14,000 mm³/L: Leukocytosis, lithium can cause an increase in white blood cells (a hematological adverse effect).
• Serum glucose 112 mg/dL: While slightly elevated, lithium can affect glucose metabolism, but this is less specific compared to other lithium - related adverse effects.

The key findings indicating adverse effects of lithium are: Nausea and diarrhea, Speaking loudly and rapidly, Sleeping 2 - 3 hr per night, Increased urination, Temperature 38.5°C (101.3°F), Lithium 1.4 mEq/L, WBC count 14,000 mm³/L. (These are the findings to highlight as they are related to lithium's adverse effects or toxicity.)

Answer:

The findings indicating adverse effects from the client’s prescribed medication (lithium) are:

• Client reports nausea and diarrhea for the last 2 days.
• Client is speaking loudly and rapidly.
• Client reports sleeping 2 to 3 hr per night.
• Client reports increased urination.
• Temperature 38.5°C (101.3°F)
• Lithium 1.4 mEq/L (0.8 to 1.2 mEq/L)
• WBC count 14,000 mm³/L (5,000 to 10,000 mm³/L)