Which nursing intervention should be included in the nursing plan of care for a patient with hepatic impairment and hypochloremia?
A) Administer ammonium chloride.
B) Discontinue a loop diuretic and change to another class of drug.
C) Infuse a hypotonic saline solution.
D) Encourage intake of low-chloride foods.
B) Discontinue a loop diuretic and change to another class of drug.
Explanation: A) Ammonium chloride can be given to a patient with metabolic acidosis. However, this medication should be avoided for patients with hepatic or renal impairment.
B) Changing the patient from a loop diuretic therapy to another class of drugs may be beneficial in preventing further hypochloremia. Loop diuretics act on the ascending portion of the loop of Henle, which prevents sodium, potassium, and chloride resorption, therefore contributing to hypochloremia.
C) Depending on the etiology, the treatment plan may consist of isotonic saline or hypertonic saline as well as replacement with oral sodium chloride.
D) Chloride-rich foods such as tomato juice, bananas, dates, eggs, cheese, milk, salty broth, canned vegetables, and processed meals can help correct hypochloremia.
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