A 68-year-old male patient, who had bilateral total hip arthroplasty two years ago, arrived at the emergency department by ambulance.
He reports that he slipped while putting away groceries at home.
He did not feel dizzy or lightheaded before the fall.
He fell face-forward, hitting his head on the wall and his left shoulder on the floor.
He reports pain mainly in his left shoulder.
As a nurse, what interventions should you plan to reduce further complications?

Based on the provided information, the following assessment findings require immediate follow-up by the nurse:

• Difficulty breathing on a hike: This is a significant symptom of asthma exacerbation and needs immediate attention.
• Symptoms did not resolve after taking albuterol: Albuterol is a quick-relief medication for asthma symptoms. If symptoms do not improve after its use, it indicates that the asthma exacerbation is severe.
• Mild subcostal retractions: This is a sign of respiratory distress and indicates that the client is using accessory muscles to breathe.
• Wheezes noted throughout the lung fields: Wheezing is a common sign of asthma and indicates airway obstruction.
• The client is pale: Paleness can be a sign of decreased oxygenation.
• Heart rate of 122 beats/minute: A high heart rate can be a sign of distress or could be due to the body’s attempt to compensate for decreased oxygenation.
• Oxygen saturation of 91% on room air: Normal oxygen saturation is typically 95% or higher. A saturation of 91% indicates that the client is not getting enough oxygen.

Choice A rationale

While monitoring the respiratory rate is important in a patient receiving opioids like hydromorphone, it does not directly indicate whether the patient is receiving an equianalgesic dose of the medication.

Choice B rationale

Pain scale assessment is the most direct way to evaluate if the patient is receiving an equianalgesic dose of hydromorphone. Equianalgesic refers to a dose of one opioid that would provide the same level of pain relief as a given dose of another opioid. If the patient’s pain is well-controlled, it suggests that the dose of hydromorphone is equianalgesic to the dose of the previous opioid.

Choice C rationale

Monitoring blood pressure is important in a patient receiving opioids as these medications can cause hypotension. However, blood pressure does not directly indicate whether the patient is receiving an equianalgesic dose of hydromorphone.

Choice D rationale

While it’s important to monitor the level of consciousness in a patient receiving opioids as these medications can cause sedation, it does not directly indicate whether the patient is receiving an equianalgesic dose of hydromorphone.