Assessment of a client taking lithium reveals dry mouth, nausea, thirst, and mild hand tremor. Based on an analysis of these findings, which of the following should the nurse do next? 1. Hold the lithium and obtain a stat lithium level to determine therapeutic effectiveness. 2. Continue the lithium and immediately notify the physician about the assessment findings. 3. Continue the lithium and reassure the client that these temporary side effects will subside. 4. Hold the lithium and monitor the client for signs and symptoms of increasing toxicity.
The correct answer and explanation is :
Based on the analysis of the findings, the correct answer is 2. Continue the lithium and immediately notify the physician about the assessment findings.
Explanation:
The symptoms reported by the client—dry mouth, nausea, thirst, and mild hand tremor—are common, early, and generally mild side effects of lithium therapy. Lithium has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is small. While these specific symptoms are not indicative of severe lithium toxicity (which would involve more pronounced neurological changes like coarse tremor, confusion, ataxia, slurred speech, vomiting, and diarrhea), they are still physiological responses to the medication.
It is crucial for the nurse to continue administering the lithium dose because the symptoms are mild and do not warrant immediate discontinuation of the medication without a physician’s order. Abruptly holding the lithium could potentially destabilize the client’s mood disorder.
However, even mild side effects, especially with a drug like lithium, need to be reported to the healthcare provider. Notifying the physician allows them to assess the overall clinical picture, consider the client’s current lithium level (which they may order to check), evaluate the severity and persistence of the symptoms, and determine if any intervention is necessary, such as adjusting the dose, monitoring the level more closely, or reassuring the client.
Option 1 and 4 are incorrect because holding the lithium is not indicated for these mild symptoms; it’s typically reserved for signs of moderate to severe toxicity. While obtaining a lithium level is important, holding the dose based solely on these mild symptoms is premature. Option 3 is incorrect because while reassuring the client is part of the nurse’s role, it is not sufficient clinical action when monitoring a client on lithium; the physician must be informed to manage the medication appropriately.