Exhibits

According to the client's vital signs, he is experiencing

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and

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Condition: The combination of severe abdominal pain, elevated inflammatory markers, and risk factors, along with the need for urgent care and surgical evaluation, suggests that GERD may be a significant underlying issue, especially in the context of potential complications.

Actions to Take

1. Prepare for surgery: Given the client's presentation of severe abdominal pain, elevated white blood cell count, and possible abdominal rigidity, surgical intervention may be necessary to rule out conditions like acute cholecystitis or perforation.
2. Transfer to high-risk level of care: Due to the client's elevated vital signs, including tachycardia and fever, along with the severe pain radiating to the shoulder, close monitoring in a high-risk area is warranted.

Parameters to Monitor

1. Pain: Regular assessment of the client's pain level is crucial to evaluate the effectiveness of interventions and to monitor any changes in the severity of the pain.
2. Signs and symptoms of abdominal perforation: Monitoring for indications such as increased abdominal tenderness, rigidity, fever, and changes in vital signs is essential to detect any complications promptly.

A. Determine the client's last dose of corticosteroids: This may be helpful later in understanding the client's MS management, but it is not the immediate priority in an acute neurological situation.
B. Determine neurological baseline prior to the fall: While important for comparison, establishing the client’s current status through assessment takes priority.
C. Administer a PRN IV antiemetic as prescribed: Vomiting may be a sign of increased intracranial pressure (ICP); treating the symptom without assessing for underlying neurological compromise could delay recognition of a critical condition.
D. Complete head-to-toe neurological assessment: This is the priority. The client’s confusion and projectile vomiting may indicate a traumatic brain injury with increased ICP. Immediate neurological assessment is necessary to identify life-threatening changes and guide urgent interventions.