An older adult client with emphysema who continues to smoke cigarettes returns to the medical unit after a physical therapy session, and is short of breath. The nurse notes that the client is lying supine with the head of the bed elevated to 45 degrees. Oxygen is flowing via nasal cannula at 3L/minute. The client's pulse oximetry is 88%, respiratory rate is 14 breaths/minute, and vital signs are stable. Which intervention should the nurse implement?

Rationale for Correct Choices:

• Cortisol, epinephrine, and norepinephrine: These are key stress hormones activated during the fight-or-flight response. In PTSD, their persistent elevation is associated with symptoms like anxiety, agitation, and increased alertness, especially during perceived threats.
• Hypervigilance: Hypervigilance refers to an enhanced state of sensory sensitivity and constant scanning of the environment for threats. It is a hallmark of PTSD, evident in the client's easily startled behavior and environmental scanning.

Rationale for Incorrect Choices:

• Acetylcholine, epinephrine, and norepinephrine: Acetylcholine plays a greater role in attention and memory, not the stress response. Cortisol, not acetylcholine, is a more relevant hormone in PTSD-related hyperarousal and stress regulation.
• Dopamine, norepinephrine, and epinephrine: While dopamine influences motivation and pleasure, cortisol is more directly tied to the physiological stress response seen in PTSD. Omitting cortisol weakens the connection to stress-induced hyperalertness.
• Bradyphrenia: Bradyphrenia refers to slowed thinking, which is not typical in hyperaroused PTSD states. The client shows heightened awareness, not cognitive slowing.
• Hypoactivity: Hypoactivity implies reduced movement or response, which does not align with the client’s constant environmental scanning and heightened alertness. Hyperactivity, not hypoactivity, is more consistent with hypervigilance.

Rationale:
A. Encouraging the client to join a support group: While beneficial, referring the client to a support group does not immediately address the client's psychosocial need for acceptance in the nurse-client interaction. Acceptance should first be modeled directly by caregivers.

B. Allowing the client to ventilate feelings: This addresses emotional support but does not necessarily promote acceptance. The client may still feel socially isolated or judged if the nurse maintains physical distance or acts hesitantly.

C. Shaking the client's hand during an introduction: This action demonstrates respect, inclusion, and nonjudgmental care. It helps normalize the interaction and signals to the client that the nurse does not view their skin condition as repulsive or infectious. Such gestures reduce stigma and build trust.

D. Wearing gloves when interviewing the client: Gloving when unnecessary can send a message that the client is contaminated. For non-contact interviews, gloves are not required and may make the client feel rejected or judged. It contradicts acceptance goals.