Page 2360 - Saunders Comprehensive Review For NCLEX-RN

gastrointestinal irritation.
3. Instruct the client to avoid excessive amounts of
coffee, tea, or cola, which have a diuretic effect.
4. Do not administer diuretics while the client is taking
lithium.
5. Instruct the client to avoid alcohol.
6. Instruct the client to avoid OTC medications.
7. Instruct the client that she or he may take a missed
dose within 2 hours of the scheduled time; otherwise,
the client should skip the missed dose and take the
next dose at the scheduled time.
8. Instruct the client not to adjust the dosage or stop the
medication without consulting the PHCP, because
lithium should be tapered and not discontinued
abruptly.
9. Instruct the client about the signs and symptoms of
lithium toxicity.
10. Instruct the client to notify the PHCP if polyuria,
prolonged vomiting, diarrhea, or fever occurs.
11. Instruct the client that the therapeutic response to the
medication is noted in 1 to 3 weeks.
12. Monitor the ECG, renal function tests, and thyroid
tests (ensure that these tests are performed before the
start of therapy).
13. Monitor weight.

Instruct the client taking lithium to maintain a fluid intake of 6 to

8 glasses of water a day and an adequate salt intake to prevent lithium
toxicity.
E. Lithium toxicity
1. Description
a. Occurs when ingested lithium cannot
be detoxified and excreted by the
kidneys
b. Symptoms of toxicity begin to appear
when the serum lithium level is at 1.5
mEq/L (1.5 mmol/L).
2. Mild toxicity
a. Serum lithium level of 1.5 mEq/L (1.5
mmol/L)
b. Apathy
c. Lethargy
d. Diminished concentration
e. Mild ataxia
f. Coarse hand tremors
g. Slight muscle weakness
3. Moderate toxicity

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