A client is wearing a Venturi mask to deliver oxygen and the dinner tray has arrived. What action by the nurse is best?

Choice A Reason:

Weigh the client daily: While monitoring weight is important for clients with Addison’s disease, it is not the primary action to prevent an Addisonian crisis. Daily weight monitoring helps track fluid balance and detect any sudden changes that might indicate complications, but it does not directly address the hormonal imbalance that characterizes Addisonian crisis.

Choice B Reason:

Restrict food intake: Restricting food intake is not recommended for clients with Addison’s disease. Proper nutrition is crucial for maintaining energy levels and overall health. Clients with Addison’s disease need a balanced diet to manage their condition effectively. Restricting food intake could lead to malnutrition and exacerbate symptoms.

Choice C Reason:

Administer oral corticosteroids: This is the correct action. Addison’s disease is characterized by insufficient production of cortisol and aldosterone by the adrenal glands. Administering oral corticosteroids helps replace the deficient hormones and manage the symptoms of Addison’s disease. During an Addisonian crisis, immediate administration of corticosteroids is critical to prevent severe complications such as shock, coma, or even death.

Choice D Reason:

Provide a low carbohydrate diet: A low carbohydrate diet is not specifically recommended for clients with Addison’s disease. Instead, a balanced diet that includes adequate carbohydrates, proteins, and fats is essential. Carbohydrates are important for maintaining energy levels, especially since clients with Addison’s disease may experience fatigue and weakness. Restricting carbohydrates could lead to low blood sugar levels, which can be dangerous for these clients.

Choice A Reason:

Documenting that the nasogastric tube is in the correct place is not appropriate in this scenario. A gastric pH of 7.35 is too high for stomach contents, which typically have a pH between 1.5 and 3.5. This high pH suggests that the tube may be misplaced, possibly in the respiratory tract or another non-gastric location. Therefore, documenting the tube as correctly placed could lead to serious complications if the tube is indeed misplaced.

Choice B Reason:

Notifying the health care provider is the most appropriate action. A pH of 7.35 is indicative of a potential misplacement of the nasogastric tube. The health care provider needs to be informed immediately to take corrective actions, such as ordering an X-ray to confirm the tube’s placement or re-evaluating the tube’s position. This step is crucial to ensure patient safety and prevent complications such as aspiration pneumonia or other adverse effects.

Choice C Reason:

Checking for placement by auscultating for air injected into the tube is an outdated and unreliable method. This technique can sometimes give false assurance of correct placement, as the sound of air can be heard even if the tube is in the respiratory tract. Current best practices recommend using pH testing and radiographic confirmation for accurate placement verification.

Choice D Reason:

Retesting the pH using another strip might seem like a reasonable step, but it is not the best immediate action. If the initial pH test shows a value of 7.35, it is unlikely that retesting will yield a significantly different result. The priority should be to notify the health care provider to address the potential misplacement promptly.

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