A nurse is teaching a client who has burns to the upper body about positioning to prevent contractures. Which of the following information should the nurse include?

Rationale for Correct Choices:

• Hyperthyroidism: The client's symptoms—including a high fever, chest pain, palpitations, tremors, tachycardia, weight loss, diarrhea, and hyperactive bowel sounds—are indicative of hyperthyroidism. The lab results showing elevated T3 and T4 with suppressed TSH further support this diagnosis..
• Place client on telemetry: Given the client's tachycardia (heart rate of 125/min), chest pain, and potential for arrhythmias (a common complication of hyperthyroidism), placing the client on telemetry is essential to monitor for any cardiac dysrhythmias.
• Initiate hydration therapy: Hyperthyroidism can lead to dehydration due to increased metabolic activity and diarrhea. The client has reported weight loss and diarrhea, indicating the need for fluid replacement.
• Cardiac dysrhythmias: Hyperthyroidism often causes tachycardia and increases the risk of arrhythmias, especially atrial fibrillation. Monitoring for cardiac dysrhythmias is crucial in this case to ensure the client’s heart rhythm is stable and to prevent complications.
• Neurological Status: The client is oriented x 3 but appears nervous, agitated, and has tremors. In thyroid storm, severe agitation, delirium, psychosis, and even coma can develop. Close monitoring of neurological status is essential to assess the severity of encephalopathy.

Rationale for Incorrect Choices:

• Hypoparathyroidism: Hypoparathyroidism typically causes symptoms such as muscle spasms, tetany, and hypocalcemia, which do not match the client’s presentation. The client has symptoms more consistent with hyperthyroidism.
• Hypothyroidism: Hypothyroidism is characterized by fatigue, weight gain, bradycardia, and cold intolerance, which is the opposite of what the client is presenting with. The lab results (elevated T3 and T4 levels) also exclude hypothyroidism as a possibility.
• Hyperparathyroidism: Hyperparathyroidism typically presents with hypercalcemia, muscle weakness, and fatigue. The client’s calcium levels are normal (9.5 mg/dL) and the clinical symptoms are more indicative of hyperthyroidism, not hyperparathyroidism.
• Provide nutritional support: While nutritional support may be needed for managing hyperthyroidism long-term, it is not the priority action in this acute setting. Immediate interventions should focus on stabilizing the patient’s heart rate and fluid balance.
• Check for Chvostek and Trousseau signs: Chvostek and Trousseau signs are used to assess for hypocalcemia, which is more relevant to conditions like hypoparathyroidism. In this case, hyperthyroidism is more likely, and these signs would not be helpful in this scenario.
• Monitor for hypoglycemia: While endocrine disorders can sometimes have overlapping symptoms or comorbidities, there's no specific indication or direct risk for hypoglycemia from hyperthyroidism in this presentation.
• Phosphorus levels: Phosphorus levels are typically monitored in cases involving kidney function, bone metabolism, or certain endocrine disorders like hypoparathyroidism or hyperparathyroidism, not hyperthyroidism.
• Weight gain: Weight gain is not relevant in the context of hyperthyroidism, where the typical presentation includes weight loss despite an increased appetite. Monitoring weight gain would be more appropriate in cases of hypothyroidism.
• Calcium levels: The client's calcium level is currently normal. While thyroid conditions can sometimes affect calcium, it's not the primary or most dynamic parameter to monitor for the acute phase and progress of thyroid storm compared to vital signs and mental status

Rationale for correct findings:

• Client is urinating 100 mL/hour: This indicates improved kidney perfusion and rehydration. At 0900, the client reported frequent urination, which was likely osmotic diuresis leading to dehydration. A consistent urine output of 100 mL/hour suggests effective fluid resuscitation and that the kidneys are now functioning more optimally.
• Client is tolerating soft diet and oral fluids: The ability to tolerate a soft diet and oral fluids suggests that the client is recovering from nausea and dehydration. This is an important indicator of improvement in gastrointestinal function and overall metabolic status.
• Pulse rate decreased to 84/min: The pulse rate has decreased from 110/min to 84/min, indicating that the client’s cardiovascular status is improving, likely due to improved hydration and metabolic control.
• Blood pressure increased to 106/76 mm Hg: The client’s blood pressure has improved from 96/65 mm Hg to 106/76 mm Hg, reflecting a more stable circulatory volume and better perfusion. This improvement suggests that fluid resuscitation is helping to stabilize the client’s hemodynamic status.
• Blood glucose decreased to 310 mg/dL: A decrease in blood glucose from 468 mg/dL to 310 mg/dL shows that insulin therapy is having a positive effect on reducing hyperglycemia. The blood glucose level is still high but moving in the right direction, indicating recovery from the acute phase of hyperglycemia.

Rationale for Incorrect Finding:

• Bowel sounds are hyperactive in all 4 quadrants: Hyperactive bowel sounds remain unchanged from the initial assessment. It is not a sign of improvement, and could be related to the stress response, medications, or ongoing issues with the gastrointestinal system.