A nurse is assessing a client who has a new diagnosis of diabetes mellitus. The nurse should identify that which of the following findings is a manifestation of hyperglycemia?

Rationale:

• Client reports chest pain as 4 on a scale of 0 to 10: Chest pain, even when moderate, is a red flag symptom for possible myocardial ischemia, especially in a high-risk client. Prompt evaluation is essential to rule out unstable angina or early myocardial infarction.
• Client reports fatigue over the last several months: Chronic fatigue may be an early and often overlooked symptom of cardiovascular disease in women. In the context of other cardiac risk factors, this requires further cardiac workup.
• Client reports intermittent epigastric discomfort upon exertion: Epigastric discomfort on exertion may reflect angina equivalents, especially in women and diabetic patients. It may indicate myocardial ischemia and requires immediate attention.
• Client reports experiencing occasional nausea and heart palpitations: Nausea and palpitations may be atypical symptoms of cardiac ischemia or arrhythmias. These signs are concerning when paired with chest discomfort and cardiovascular history.
• History of smoking 1 pack per day for the past 30 years: Smoking is a major modifiable risk factor for coronary artery disease. Long-term tobacco use contributes to endothelial dysfunction and increases the risk of acute cardiac events.
• Past medical history of type 2 diabetes mellitus, systemic lupus erythematosus, hypertension, and hyperlipidemia: This cluster of comorbidities places the client at extremely high risk for cardiovascular complications. Each condition independently contributes to atherosclerosis and cardiac event risk.
• Father died at age 50 with coronary artery disease:A strong family history of premature CAD significantly elevates this client’s cardiac risk. It intensifies the concern for hereditary predisposition to cardiovascular events.

Rationale:

• Place the client on bedrest: Bedrest is necessary after PCI to reduce the risk of bleeding at the catheter insertion site, typically in the femoral artery. The client must remain flat with the leg extended for several hours to allow vessel healing.
• Administer vitamin K: Vitamin K is not routinely given after PCI. It is used to reverse warfarin-induced anticoagulation, not to manage post-procedure care in stable clients unless there is a specific bleeding disorder or elevated INR.
• Check pedal pulses: Assessing distal circulation is essential to monitor for complications like arterial occlusion or hematoma formation. Diminished pulses may indicate compromised blood flow due to thrombus or arterial damage.
• Apply pressure to the insertion site: Manual pressure is applied immediately after sheath removal to prevent bleeding. Continuous monitoring of the site for swelling, bleeding, or hematoma is a standard post-PCI nursing responsibility.
• Elevate the operative leg: Elevating the leg can increase the risk of bleeding by disturbing the clot at the insertion site. The leg should remain flat and immobilized to promote hemostasis and prevent complications.