A nurse in a community mental health clinic is assessing a client who began taking lithium carbonate 5 days ago. The client reports fine hand tremors and has a current lithium level of 1.2 mEq/L. Which of the following actions should the nurse take?
A.
Instruct the client to consume a low-sodium diet to decrease hand tremors.
B.
Teach the client to take the lithium in a single daily dose
C.
Contact the provider for a possible decrease in the lithium dosage.
D.
Encourage the client to take naproxen sodium to decrease tremors.
The correct answer and Explanation is :
The correct answer is C. Contact the provider for a possible decrease in the lithium dosage.
Explanation:
Lithium carbonate is a medication commonly used to treat bipolar disorder. It has a narrow therapeutic range, which means that the difference between a therapeutic dose and a toxic dose is small. The therapeutic range for lithium is typically between 0.6 and 1.2 mEq/L. In this case, the client’s lithium level is 1.2 mEq/L, which is at the upper end of the therapeutic range.
Fine hand tremors are a common side effect of lithium, especially when blood levels are at or near the higher end of the therapeutic range. Since the client’s current level is on the higher end, it’s possible that the tremors could be a result of elevated lithium levels. The fine hand tremors might suggest that the client is experiencing side effects related to the lithium level being at the upper limit.
Why not the other options?
- A. Instruct the client to consume a low-sodium diet to decrease hand tremors: Sodium intake can affect lithium levels in the body. A low-sodium diet can actually increase lithium levels, not decrease them. The goal is to maintain a consistent sodium intake to avoid fluctuations in lithium levels.
- B. Teach the client to take the lithium in a single daily dose: Lithium is often taken in multiple doses throughout the day to maintain stable blood levels and minimize side effects. Switching to a single daily dose might not be advisable as it could lead to fluctuating levels.
- D. Encourage the client to take naproxen sodium to decrease tremors: Naproxen sodium is an NSAID and could actually increase lithium levels by reducing renal clearance of the drug. This could worsen the tremors and increase the risk of toxicity.
Given the client’s current lithium level and the presence of tremors, it is prudent to contact the provider to discuss the possibility of adjusting the lithium dosage. The provider can evaluate whether a dose reduction is appropriate to mitigate the tremors and maintain safe lithium levels.