Patient data

The nurse has mixed the formula with enteral nutritional formula powder to increase the caloric content to 24 calories per ounce (24 cal/30 mL).

Which nursing intervention(s) should the nurse include from the plan of care (POC) to help meet the client's nutritional needs? Select all that apply.

Amlodipine → Calcium channel blocker → Relaxes vascular smooth muscle, causing vasodilation and decreased blood pressure
Aspirin → Antiplatelet → Inhibits cyclooxygenase (COX-1), preventing thromboxane A₂ formation and reducing platelet aggregation
Lisinopril → Angiotensin-converting enzyme (ACE) inhibitor → Blocks conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased aldosterone secretion
Nitroglycerin → Nitrate → Causes vasodilation (primarily venous), reducing preload and myocardial oxygen demand

Rationale:

Amlodipine is a calcium channel blocker that inhibits calcium ion influx into vascular smooth muscle and myocardial cells. This leads to arterial vasodilation, decreasing systemic vascular resistance and lowering blood pressure. By reducing afterload, amlodipine decreases cardiac workload, which is particularly helpful in patients with hypertension and chest pain from myocardial ischemia.

Aspirin is an antiplatelet medication that irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of thromboxane A₂, a substance that promotes platelet aggregation. This reduces the risk of thrombus formation, which is critical in acute coronary syndrome (ACS) and in patients presenting with chest pain suggestive of myocardial infarction.

Lisinopril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II. This leads to vasodilation and decreased secretion of aldosterone, which reduces blood pressure and decreases fluid retention. By lowering afterload and preload, lisinopril reduces myocardial oxygen demand, protecting the heart during episodes of ischemia.

Nitroglycerin is a nitrate that primarily causes venous vasodilation, decreasing preload and myocardial oxygen demand. This improves coronary blood flow and relieves ischemic chest pain. Nitroglycerin is commonly used in the management of angina and acute chest pain associated with myocardial ischemia.

A. Finding out if the client can lie prone is not the most critical consideration. While some imaging procedures require specific positioning, most IV pyelograms can be performed with the client in a supine position, and the radiology team can adjust as needed. Inability to lie prone would not prevent the procedure, so this is a lower priority.

B. Asking about an allergy to shellfish is the most important action. IV pyelogram uses iodine-based contrast media, and clients with allergies to iodine or shellfish are at risk for hypersensitivity reactions, which can range from mild rash to life-threatening anaphylaxis. Screening for allergies is essential for client safety and takes priority over positioning, bowel prep, or medication considerations.

C. Determining the last bowel movement is helpful because bowel contents can interfere with visualization of the urinary tract during the x-ray. Sometimes bowel preparation is needed to improve imaging quality. However, this is secondary to the immediate safety concern of an allergic reaction.

D. Inquiring about regularly scheduled medications is important because some medications, such as metformin, may interact with contrast dye and need to be held before the procedure. Despite this, medication history is less urgent than identifying potential allergies that could lead to severe reactions.