A nurse is caring for a client on a medical-surgical unit. N…
A nurse is caring for a client on a medical-surgical unit. Nurses’ Notes 0800: A male client is admitted with a 3-day history of abdominal cramps and diarrhea of 4 to 5 liquid stools/day. Stool contains mucous and is foul-smelling. Stool sent for culture. Client was taking PO amoxicillin/clavulanate for a respiratory tract infection, 500 mg q 12 h for 10 days. Antibiotics completed 7 days ago. Prescribed labs drawn. 0830: Client assessment performed. Heart rate 102/min Respiratory rate 20/min Breath sounds clear and equal bilaterally Blood pressure 128/66 mm Hg Temperature 38.9° C (102° F) Oxygen saturation 95% on room air Abdomen soft, nondistended with hyperactive bowel sounds audible in 4 quadrants. Hematocrit 47% (37% to 47%) Hemoglobin 16 g/dL (12 g/dL to 16 g/dL) Potassium 3.3 mEq/L (3.5 to 5.0 mEq/L) Diagnostic Results Day 2, 0800: Stool culture positive for Clostridium difficile (negative) Which of the findings below would require further action by the nurse?