A female client is admitted with abdominal pain, possibly due to a gastric ulcer. Two days after admission, the client reports feeling nervous and tremulous. Further assessment reveals that the client's family is bringing a gin and tonic each night to help her relax. Which action(s) should the nurse take? Select all that apply.

A. Glucose and calcium levels: During thyrotoxic crisis, the body’s metabolism is increased, which can lead to hyperglycemia. Additionally, calcium levels may fluctuate due to the impact of thyroid hormones on bone metabolism, making these values critical to monitor.

B. Electrolytes and hemoglobin: While monitoring electrolytes is important, they are not the most critical values in a thyrotoxic crisis. Hemoglobin levels are not directly impacted by thyroid storm and are less likely to provide essential insights for managing this condition.

C. Renal and liver function tests: While important for general health monitoring, renal and liver function tests are not the most critical in the immediate management of a thyrotoxic crisis. The focus should be on metabolic and electrolyte imbalances rather than organ function tests.

D. Blood and urine cultures: Blood and urine cultures are used to detect infections, they are not a priority during a thyrotoxic crisis unless there is a concern about infection. The primary focus should be on managing thyroid hormone levels and associated metabolic effects.

Rationale:

• Pain: The client is reporting intense pain (10 on a 0 to 10 scale) in his left arm, and he is unable to move it. This suggests a possible fracture or significant soft tissue injury. Managing this pain is the priority to ensure the client’s comfort and prevent further complications.
• Compartment syndrome: Given the swelling, bruising, and coolness to the touch in the left arm, compartment syndrome is a serious risk. This occurs when swelling or bleeding in a muscle compartment increases pressure, potentially compromising blood flow to muscles and nerves. Immediate interventions are required to prevent tissue damage.

Rationale for Incorrect Options:

• Swelling: While swelling is present, it is a natural part of the healing process and not the primary concern in this case. The risk of compartment syndrome is much more urgent than managing swelling.
• Mobility: The client’s mobility is impaired due to pain, but pain management must be prioritized before focusing on restoring mobility. Only once pain is controlled should mobility be addressed.
• Fat embolism syndrome: Although fat embolism syndrome is a risk in traumatic fractures, especially with long bone injuries, the symptoms of this client (swelling, bruising, cool arm) point more directly to the risk of compartment syndrome rather than fat embolism syndrome.
• Venous thromboembolism (VTE): VTE is a concern in immobilized patients, but in the acute phase, compartment syndrome poses a more immediate threat. The priority is to manage the current trauma and risk for compartment syndrome before considering VTE prevention.