A nurse is discharging a patient with newly diagnosed type 2 diabetes.
During teaching, the patient states, "I don't have a refrigerator at home, and I sometimes skip meals because I can't afford groceries.”. Which actions by the nurse best address social determinants of health while promoting quality and safety? Select all that apply.

Choice A rationale

Administering an antiemetic is an appropriate pharmacological intervention for a patient experiencing nausea and vomiting secondary to opioid use via PCA. However, the nursing process requires assessment before intervention. The nurse must first determine the underlying cause of the vomiting, such as a postoperative ileus or slowed gastric motility, before giving medication. Providing a drug without a prior assessment could mask a more serious complication resulting from the surgery or the morphine sulfate administration.

Choice B rationale

Encouraging the use of an incentive spirometer is a standard postoperative intervention to prevent atelectasis and pneumonia, particularly when a patient is receiving opioids like morphine which can suppress the cough reflex and decrease tidal volume. While important for respiratory health, it does not directly address the current complaint of nausea and vomiting. Assessment of the gastrointestinal system is a higher priority in this specific context to ensure the patients physical safety and comfort are maintained.

Choice C rationale

Inserting a nasogastric tube is an invasive procedure used to decompress the stomach in cases of severe gastric distention or a confirmed bowel obstruction. This action is usually performed only after an assessment and a specific providers order. It is not an initial nursing action for a report of nausea. The nurse must first perform a non-invasive assessment of the abdomen to determine the presence of bowel sounds and the severity of the nausea before considering such measures.

Choice D rationale

Assessment is always the first step of the nursing process. In a postoperative patient receiving morphine, nausea and vomiting could indicate a paralytic ileus, which is a common side effect of both anesthesia and opioid analgesics. By auscultating bowel sounds, the nurse can determine the presence of peristalsis. Normal bowel sounds occur every 5 to 15 seconds. This data is essential to differentiate between simple opioid-induced nausea and a more significant gastrointestinal complication requiring medical intervention.

Choice A rationale

Pain management is a high priority for patient comfort and can influence physiological stability, but it falls under the category of psychosocial or secondary physiological needs in Maslows hierarchy compared to immediate life threats. While an 8/10 pain level is significant and requires intervention, it does not supersede an active airway or breathing crisis. The nurse should address the patients pain after ensuring the stability of patients with compromised ABC parameters or critical physiological imbalances.

Choice B rationale

A blood glucose of 210 mg/dL is elevated above the normal fasting range of 70 to 99 mg/dL or postprandial range under 140 mg/dL. However, for a diabetic patient awaiting discharge, this level is not an acute, life-threatening emergency like a respiratory or circulatory collapse. Discharge instructions are a low priority when compared to patients experiencing acute physiological distress. The nurse can address this teaching and glucose management once more unstable patients are properly assessed and stabilized.

Choice C rationale

This patient is the highest priority because they demonstrate signs of respiratory distress and potential hypoxia. A respiratory rate of 32 breaths/min is significantly higher than the normal range of 12 to 20 breaths/min. Confusion in a patient with pneumonia often indicates inadequate cerebral oxygenation. Following the ABC framework, breathing takes precedence over pain or routine discharge. Failure to assess this patient immediately could lead to respiratory failure, making them the most critical individual to see first.

Choice D rationale

A potassium level of 3.4 mEq/L is slightly below the normal range of 3.5 to 5.0 mEq/L. While hypokalemia can eventually cause cardiac dysrhythmias, a level of 3.4 is usually considered mild and does not represent an immediate threat to life compared to a patient with a respiratory rate of 32. Assisting a patient to the bathroom is a safety and mobility need that can be delegated or delayed until the nurse assesses the most unstable patient.