Patient Data

Which question(s) should the nurse ask the client? Select all that apply.

Postoperative clients are at high risk for opioid-induced respiratory depression (OIRD) due to the administration of potent analgesics and anesthetics during surgery. Opioids act on mu-receptors in the brainstem respiratory centers, leading to a decreased sensitivity to carbon dioxide and a subsequent reduction in minute ventilation. Clinical indicators of toxicity include a respiratory rate below 10 breaths/minute, hemodynamic instability, and depressed levels of consciousness requiring immediate pharmacological reversal.

Rationale:

A. Milrinone is an inodilator used primarily for acute heart failure or to improve cardiac output by increasing contractility. While the client is hypotensive, the primary physiological threat is respiratory failure caused by central nervous system depression. Administering a cardiac stimulant does not address the underlying ventilatory insufficiency present in this client.

B. Acetaminophen is an antipyretic and non-opioid analgesic indicated for mild pain or febrile states. The client's temperature of 99.8 F is only slightly elevated and does not represent a clinical emergency. Prioritizing a minor temperature correction over severe bradypnea is a failure of basic life support prioritization.

C. Atropine is an anticholinergic medication used to treat symptomatic sinus bradycardia by blocking vagal stimulation of the sinoatrial node. Although the client's heart rate is 62, it remains within a relatively normal range and is not the primary cause of the low blood pressure. The priority must be restoring alveolar gas exchange to maintain systemic oxygenation.

D. Naloxone is the specific opioid antagonist required to reverse the life-threatening respiratory depression of 8 breaths/minute. It works by competitively displacing opioids from mu-receptors, rapidly restoring the drive to breathe and improving blood pressure. The nurse must monitor for rebound sedation as the half-life of naloxone is often shorter than the opioid.

Brief introduction:

Moderate anxiety involves a narrowed perceptual field where selective inattention occurs, yet individuals remain capable of learning. This physiological state triggers the sympathetic nervous system, increasing heart rate and muscle tension. Effective management requires neuromuscular intervention to reduce autonomic arousal and restore baseline homeostatic regulation during stressful episodes.

Rationale:

A. Increased social stimuli during moderate anxiety may cause sensory overload, further narrowing the focus. While social support is beneficial for long-term coping, it does not provide the immediate physiological stabilization required when anxiety levels rise or during acute perceived stress.

B. Music therapy is a supportive distraction, but it does not address the underlying somatic tension present. Upbeat tempos might inadvertently increase stimulation rather than promoting the necessary parasympathetic activation required to counteract the body's fight-or-flight response.

C. Progressive muscle relaxation directly targets physical tension and lowers autonomic arousal. By focusing on internal physical control, the client can widen their perceptual field, making this the most effective behavioral strategy for managing moderate anxiety levels.

D. Analyzing triggers is a cognitive task that is difficult during periods of moderate anxiety. Attempting deep introspection while the client is symptomatic can increase frustration and anxiety; such analysis is more appropriate during the mild anxiety or calm phase.