The nurse is caring for a client in the postanesthesia care unit (PACU) who underwent a thoracotomy two hours ago. The nurse observes the vital signs as a heart rate of 140 beats/minute, respirations 26 breaths/minute, and a blood pressure 140/90 mm Hg. Which intervention is most important for the nurse to implement?

Decreased hemoglobin and hematocrit levels:

• Folic acid deficiency anemia: Yes, folic acid deficiency can result in low hemoglobin and hematocrit levels as folate is necessary for red blood cell (RBC) production.
• Iron deficiency anemia: Yes, iron deficiency leads to decreased hemoglobin and hematocrit levels because iron is crucial for hemoglobin synthesis.
• Vitamin B12 deficiency anemia: Yes, B12 deficiency can cause decreased hemoglobin and hematocrit levels due to impaired RBC production.
  Rationale: All three forms of anemia can result in low hemoglobin and hematocrit levels due to impaired red blood cell production.

Uptake often impeded by medications:

• Folic acid deficiency anemia: Yes, certain medications, like anticonvulsants or methotrexate, can interfere with folic acid absorption and utilization.
• Iron deficiency anemia: Yes, some medications like proton pump inhibitors (PPIs) or antacids can interfere with iron absorption.
• Vitamin B12 deficiency anemia: Yes, medications such as proton pump inhibitors, H2 blockers, and metformin can interfere with B12 absorption.
  Rationale: Medications can affect the absorption of all three nutrients—folic acid, iron, and B12—and lead to deficiencies, especially in individuals taking these medications long-term.

Result of dietary deficiency:

• Folic acid deficiency anemia: Yes, inadequate dietary intake of folate can lead to deficiency and anemia. Common in those with poor diets or increased demand (e.g., pregnancy).
• Iron deficiency anemia: Yes, iron deficiency is commonly caused by inadequate dietary intake of iron-rich foods (e.g., red meat, leafy greens).
• Vitamin B12 deficiency anemia: Yes, insufficient dietary intake, particularly in vegetarians or vegans who avoid animal products, can lead to B12 deficiency.
  Rationale: All three anemias can be caused by inadequate dietary intake of the respective nutrients.

Often associated with chronic alcoholism:

• Folic acid deficiency anemia: Yes, chronic alcohol use can impair folic acid absorption and utilization, contributing to deficiency.
• Iron deficiency anemia: Less commonly associated with alcoholism, though heavy drinking can affect iron absorption and cause gastrointestinal bleeding, leading to iron loss.
• Vitamin B12 deficiency anemia: Yes, alcohol use can interfere with vitamin B12 absorption and contribute to deficiency.
  Rationale: Chronic alcohol use is often associated with folic acid and B12 deficiencies due to impaired absorption, while its association with iron deficiency is less direct but can occur due to GI bleeding or poor nutrition.

Can be caused by malabsorption syndrome:

• Folic acid deficiency anemia: Yes, conditions like celiac disease or Crohn's disease can impair folate absorption.
• Iron deficiency anemia: Yes, malabsorption syndromes (e.g., celiac disease, Crohn's) can prevent proper iron absorption.
• Vitamin B12 deficiency anemia: Yes, malabsorption syndromes like pernicious anemia or celiac disease can impair B12 absorption in the intestines.
  Rationale: All three types of anemia can result from malabsorption syndromes due to difficulty absorbing nutrients from the digestive tract.

Rescue inhaler three times: The fact that the client used his rescue inhaler three times without relief indicates that his asthma symptoms are not adequately controlled, and he may need further medical intervention or adjustments in his asthma management plan.

Symptoms seem worse when outdoors and when exercising: This suggests that environmental triggers and physical activity exacerbate his asthma, indicating a need for tailored management strategies, possibly including preventive measures or medications before exposure to these triggers