The 24-year-old otherwise healthy patient with bipolar disorder is found unconscious and brought to the emergency department. The patient is mildly febrile, significantly tachycardic, tachypneic, and hypotensive, with poor skin turgor and 5 second capillary refill. The patient’s EKG is notable for inverted T waves and sinus tachycardia. Which orders does the nurse anticipate for this patient? Select all that apply.

Question

The 24-year-old otherwise healthy patient with bipolar disorder is found unconscious and brought to the emergency department. The patient is mildly febrile, significantly tachycardic, tachypneic, and hypotensive, with poor skin turgor and 5 second capillary refill. The patient&rsquo;s EKG is notable for inverted T waves and sinus tachycardia. Which orders does the nurse anticipate for this patient? Select all that apply.

Accepted Answer

Infuse 2 L 0.9% NaCl at 250 mL/h  , Obtain blood specimens for a serum lithium level and basic metabolic panel , Prepare the patient for insertion of a subclavian venous catheter pending lab results. The drug of choice for bipolar disorder is lithium, which can cause nephrotoxicity that is associated with severe volume depletion and places the patient at risk for circulatory collapse. The patient requires fluid resuscitation with normal saline. A lithium level must be drawn as well as a BMP, which will provide insight into the patient&rsquo;s renal function. A subclavian catheter may need to be inserted for hemodialysis if the lithium level is above 4 mEq/L. If the patient is managed appropriately, long term solutions such as an AV fistula for hemodialysis is unnecessary. Potassium chloride is not indicated in the patient with nephrotoxicity. The otherwise healthy patient is unlikely to have sepsis; the patient&rsquo;s symptoms can be explained by lithium toxicity rather than systemic infection.

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