A nurse is caring for a client at the endocrinologist's office.

Exhibits

The client sees the diabetic nurse educator. Click to highlight the findings that indicate an understanding of the diabetic foot care education the client received. To deselect a finding, click on the finding again.

"I understand that I need to inspect my feet daily. I will dry my feet thoroughly when I get out of the shower. It is important to apply lotion to my feet and especially my toes to keep my skin in good health. That will prevent any sores on my feet. I will be very careful when I cut my toenails and will be sure to cut them straight across and then file the edges with an emery board. I will wear closed toed shoes. I am glad I can still go barefoot in the house because I never wear shoes at home. If I have any foot sores or corns come up, I will see my doctor or go to a podiatrist instead of treating it myself."

Rationale:

A. Administer morphine 4 mg IV bolus: Morphine is appropriate for severe chest pain unrelieved by nitrates. It decreases preload, pain, and anxiety, reducing myocardial oxygen demand. This intervention helps improve comfort and may lower sympathetic nervous system activation during an acute MI.

B. Prepare client for an exercise tolerance test: This is contraindicated during active chest pain and elevated troponin levels. Stress testing would increase cardiac workload and worsen ischemia. It is only done when a patient is stable and MI has been ruled out.

C. Administer an intermittent IV fluid bolus: Fluid boluses are not indicated unless hypotension or hypovolemia is present. Extra fluid can increase cardiac workload and worsen outcomes in MI. In a normotensive patient with chest pain, it offers no benefit and may increase risk of pulmonary congestion.

D. Administer nitroglycerin sublingual: Nitroglycerin is a first-line medication for ischemic chest pain. It improves blood flow by dilating coronary arteries and reducing cardiac preload. It can rapidly relieve angina and should be administered as soon as possible in acute chest pain.

E. Place the client in the supine position: Supine positioning may worsen breathing difficulty and is not ideal during acute chest pain. A semi-Fowler's position is better to support oxygenation. Keeping the head elevated helps reduce venous return and cardiac workload.

F. Apply oxygen at 2 L/min via nasal cannula: Oxygen is appropriate with labored respirations and signs of hypoxia. It improves oxygen delivery to the myocardium during ischemic events. Supplemental oxygen can help stabilize oxygen saturation while definitive interventions are underway.

G. Prepare client for percutaneous coronary intervention: PCI is a key treatment for myocardial infarction and should be anticipated given the client’s chest pain, elevated troponin, and high risk profile. It restores perfusion to the affected coronary artery and reduces infarct size and mortality when performed promptly.

Rationale:
A. "You will drink a contrast solution 30 minutes prior to the procedure.": Contrast solutions are used for imaging studies like CT scans, not for bronchoscopies. Bronchoscopy is a visual examination of the airways and does not require contrast ingestion beforehand.

B. "You will not be able to eat or drink after the procedure until you are able to cough.": After a bronchoscopy, the gag and cough reflexes are temporarily suppressed due to local anesthesia. Eating or drinking before these reflexes return increases the risk of aspiration, so this is an essential safety measure.

C. "The purpose of this procedure is to remove excess fluid from your lungs.": Bronchoscopy is primarily used for visualizing the airways, obtaining tissue samples, or removing obstructions. Thoracentesis, not bronchoscopy, is the procedure used to remove fluid from the pleural space.

D. "You will need to lie on your back for 4 to 6 hours following the procedure.": Prolonged supine positioning is not necessary after bronchoscopy. Clients are typically monitored in a semi-Fowler’s position until sedation wears off and airway protective reflexes return.