A 25-year-old patient is admitted to the ambulatory surgery unit to receive two units of whole blood.

The patient has anemia, systemic lupus erythematosus, hypertension, schizophrenia, and primary hypothyroidism.

The patient’s vital signs are BP 100/68, P 110, R 24, T 99.1 °F, O2-97%. The patient reports experiencing shortness of breath with exertion, fatigue, dizziness when standing, and an intolerance to cold temperatures.

Initial labs indicate an Hgb of 6.8, an Hct of 21.2, a CRP of 38, an albumin of 14, and an iron level of 9. The patient’s current medications include hydroxychloroquine 200 mg one BID, amlodipine 10 mg one PO daily, Citalopram 20 mg one PO daily, Lisinopril 20 mg one PO daily, sertraline 50 mg one daily, levothyroxine 75 mg one PO daily, Ferrous sulfate 30 mg one PO TID, and quetiapine 100 mg one PO HS. Which patient assessment findings require immediate follow-up by the nurse at this time? (Select all that apply)

Choice A rationale:
It is crucial to prioritize the patient's spouse's emotional needs and preferences during this highly stressful and sensitive situation. Offering the choice to be present during resuscitation demonstrates respect for their autonomy, promotes family- centered care, and facilitates coping mechanisms.
Key considerations supporting this approach:
Respect for Autonomy:
Patients and their loved ones have the right to make informed decisions about their care, including being present during resuscitation efforts.
Respecting this right fosters trust, empowers the spouse, and aligns with ethical principles of patient autonomy. Family-Centered Care:
Family-centered care recognizes the importance of family members in the patient's care and decision-making.
Inviting the spouse to be present demonstrates a commitment to including them in the care process and supporting their emotional needs.
Facilitating Coping Mechanisms:
Witnessing resuscitation efforts can be distressing, but it can also provide closure, acceptance, and the opportunity to say goodbye.
Some individuals find comfort in being present and actively involved, even in difficult circumstances. The nurse can provide emotional support and guidance throughout the process.
Potential Benefits of Presence:
Studies have shown that family presence during resuscitation can have positive outcomes, such as decreased anxiety and post- traumatic stress disorder (PTSD) symptoms in family members.
It may also contribute to greater satisfaction with care and a sense of peace for those who choose to be present.
Rationales for other choices:
Choice B: Requesting that the spouse sit in the waiting room may isolate them and increase their anxiety. It deprives them of the opportunity to be involved in decision-making and potentially delays their grieving process.
Choice C: While the hospital's crisis team can provide valuable support, immediate referral may not align with the spouse's immediate needs or preferences. It's essential to first assess their emotional state and offer the choice of being present.
Choice D: Suggesting prayer may be appropriate for some individuals, but it should not be the first or only option presented. It's important to respect the spouse's spiritual beliefs and offer a range of support options.

Choice A rationale:
Metabolic alkalosis is a condition characterized by an increase in the pH of the blood due to an excess of bicarbonate (HCO3-) in the body. It is not typically caused by severe diarrhea. In fact, diarrhea can often lead to a loss of bicarbonate, which can contribute to metabolic acidosis.
Causes of metabolic alkalosis include: excessive vomiting, use of diuretics, and excessive intake of alkali such as antacids. Clinical manifestations of metabolic alkalosis include: muscle twitching, paresthesias, seizures, confusion, and lethargy.
Choice B rationale:
Respiratory alkalosis is a condition characterized by a decrease in the partial pressure of carbon dioxide (PaCO2) in the blood, leading to an increase in blood pH. It is caused by hyperventilation, which removes excess CO2 from the body. Severe diarrhea does not typically cause hyperventilation.
Causes of respiratory alkalosis include: anxiety, hyperventilation syndrome, high altitude sickness, and pulmonary embolism. Clinical manifestations of respiratory alkalosis include: lightheadedness, dizziness, paresthesias, palpitations, and tetany.
Choice C rationale:
Respiratory acidosis is a condition characterized by an increase in the partial pressure of carbon dioxide (PaCO2) in the blood, leading to a decrease in blood pH. It is caused by hypoventilation, which prevents the body from removing enough CO2. Severe diarrhea does not typically cause hypoventilation.
Causes of respiratory acidosis include: chronic obstructive pulmonary disease (COPD), pneumonia, asthma, and neuromuscular disorders.
Clinical manifestations of respiratory acidosis include: headache, confusion, somnolence, and coma.
Choice D rationale:
Metabolic acidosis is a condition characterized by a decrease in the pH of the blood due to an excess of acid in the body or a loss of bicarbonate. Severe diarrhea can lead to metabolic acidosis through several mechanisms:
Loss of bicarbonate in the stool: Diarrhea often contains a significant amount of bicarbonate, which can be lost from the body in large amounts during severe diarrheal episodes. This loss of bicarbonate can lead to a decrease in the blood's pH, resulting in metabolic acidosis.
Dehydration: Severe diarrhea can also lead to dehydration, which can concentrate acids in the blood and contribute to metabolic acidosis.
Lactic acidosis: In some cases, severe diarrhea can also cause lactic acidosis, a type of metabolic acidosis that occurs when there is a buildup of lactic acid in the body. This can happen due to impaired circulation or tissue hypoxia, which can occur as a complication of severe diarrhea.