A 2-year-old boy has an elevated lead level in his blood and urine. His treatment includes the administration of a chelating agent, edetate calcium disodium. Before the first dose of the chelating agent is given, which of these actions by the nurse is important?
• Chelating agents bind to heavy metals, making them non-toxic and letting them be eliminated in the urine.
• Measuring intake and output will ensure that kidney function is adequate to handle the lead being excreted. If kidney function is inadequate, using chelating agents could lead to nephrotoxicity or kidney damage.
• Lead interferes with red blood cell function by blocking the incorporation of iron into the protoporphyrin compound that makes up the heme portion of hemoglobin in red blood cells. Kidney destruction may also occur, causing excess excretion of amino acids, glucose, and phosphates.
• One effect of excessive lead levels is encephalopathy. The child has resulting symptoms of lethargy, impulsiveness, and learning difficulties.
• Weighing and isolating the patient are unnecessary. The nurse should always check the blood pressure as part of the normal nursing assessment, but this is not a priority before the administration of a chelating agent.