Which recommendations should the nurse give to treat epistaxis? Select all that apply.

Intramuscular analgesic administration involves deposition of medication into skeletal muscle tissue allowing systemic absorption through capillary perfusion, producing onset dependent on drug class, lipid solubility, and circulation with expected analgesic effect occurring within defined pharmacokinetic time window requiring reassessment.

Rationale:

A. 10 minutes after intramuscular injection is too early for most analgesics to reach therapeutic plasma concentration. IM absorption requires vascular uptake and systemic distribution. Pain relief is usually not fully established at this time, making assessment premature and unreliable for efficacy evaluation.

B. 2 hours may be appropriate for some long-acting analgesics, but it exceeds the recommended initial reassessment window for most IM pain medications. Delayed evaluation risks prolonged untreated pain. Clinical guidelines emphasize earlier reassessment to ensure timely dose adjustment or additional intervention if needed.

C. Within 1 hour is the standard reassessment time for most IM analgesics as peak effect typically occurs within this period depending on drug type. This allows evaluation of analgesic efficacy and detection of inadequate pain control for timely clinical intervention or dose adjustment.

D. Once a shift is inappropriate for acute pain management following IM administration. Pain must be reassessed shortly after drug absorption begins, not at prolonged intervals. This approach risks uncontrolled pain, delayed response evaluation, and failure to meet effective pain management standards in clinical care.

End-stage heart failure is progressive myocardial pump failure causing systemic hypoperfusion, pulmonary congestion, hypoxia, dyspnea, palliative care, DNR directives prioritizing symptom relief, comfort-focused management, and avoidance of life-prolonging interventions therapies.

Rationale:

A. In a patient with comfort measures only and active DNR status, priority is symptom relief rather than resuscitation. The nurse should assess dyspnea severity and provide prescribed oxygen and morphine. This aligns with palliative goals and MRSA precautions protocol adherence.

B. Calling a Code Blue violates DNR orders and advance directive specifying comfort-only care. CPR initiation is inappropriate in end-stage disease. This action disregards end-of-life wishes and exposes patient to unwanted aggressive resuscitation contrary to ethical palliative care principles standards violated.

C. Documenting condition alone is incomplete during acute respiratory distress. Hypoxia requires immediate symptom management in comfort care settings. Failure to intervene with oxygen or opioids neglects palliative intervention priorities and does not address respiratory distress urgency per comfort protocol guidelines.

D. Contacting healthcare provider for ICU transfer conflicts with advance directive specifying comfort-only care. Escalation to intensive care contradicts palliative goals and DNR status. Focus should remain on symptom relief rather than invasive life-prolonging interventions in terminal heart failure clinical priority.