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Difficulty: MediumPharmacological Therapies

A client diagnosed with bipolar disorder has been taking lithium carbonate for several months. During a clinic visit, the client reports experiencing persistent nausea, vomiting, and severe diarrhea for the past 48 hours. The practical nurse observes that the client is mildly disoriented and has a resting heart rate of 115 beats per minute. Which action should the practical nurse take first?

  1. Withhold any upcoming doses of the medication and immediately inform the registered nurse of the client's status.Answer
  2. B
    Proceed with administering the next dose alongside a full glass of water to address the client's dehydration.
  3. C
    Instruct the client to strictly limit their dietary sodium intake to prevent further gastrointestinal distress.
  4. D
    Tell the client that these are common, expected side effects of the medication and encourage them to rest.

Answer

The practical nurse should withhold any upcoming doses of the medication and immediately inform the registered nurse.
Lithium carbonate is a medication with a narrow therapeutic index. Conditions that cause dehydration and sodium depletion, such as severe vomiting and diarrhea, reduce the kidneys' ability to excrete lithium, rapidly leading to toxicity. The client's clinical presentation (tachycardia, gastrointestinal distress, and disorientation) strongly points to lithium toxicity and potential hypovolemia. The practical nurse must act safely by withholding the next dose and immediately escalating these critical findings to the registered nurse or healthcare provider for immediate medical intervention.

Step-by-Step Solution

1
Analyze the client's clinical presentation in the context of their medication therapy.
The client taking lithium has severe gastrointestinal fluid loss (vomiting, diarrhea), tachycardia, and disorientation.
Identifying abnormal findings is the first step in clinical data collection and determining client safety.
2
Correlate the symptoms with potential pharmacological complications.
Fluid and sodium loss lead to decreased renal excretion of lithium. The symptoms presented strongly indicate acute lithium toxicity.
Lithium has a very narrow therapeutic index, meaning the difference between a safe dose and a toxic dose is small.
3
Determine the safest, scope-appropriate action.
The nurse must withhold the dangerous medication and immediately escalate the critical findings to the RN or provider.
Practical nurses must prioritize client safety and recognize when a client's condition requires RN-level assessment and intervention.

Key Concept

Recognizing early signs of lithium toxicity and acting within the practical nursing scope of practice to ensure client safety.
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Pharmacological Therapies

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