A client is admitted for observation with reports of progressively increasing fatigue over the past month and a brief episode of dizziness that occurred today. The client has a history of heartburn and indigestion that is self-treated with ibuprofen and antacids. Which assessment finding should the nurse report immediately to the healthcare provider?

Reference Range:

Guaiac stool [negative]

Hemoglobin (14 to 18 g/dl. (140 to 180 g/L)]

Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]

Gastric Acid pH (1.5 to 3.5)

A) Expresses that they cannot get enough air to breathe: While this statement suggests respiratory distress, it is not as objective an assessment finding as a respiratory rate of 7 breaths/minute. Objective measurements are typically more reliable indicators for initiating interventions.
B) Respiratory rate of 7 breaths/minute: A respiratory rate of 7 breaths/minute is indicative of respiratory depression, which is a potential side effect of opioid analgesics like morphine sulfate. Naloxone is an opioid antagonist used to reverse opioid-induced respiratory depression. Administering a prescribed PRN dose of naloxone is appropriate to counteract the respiratory depression and prevent further complications.
C) Bilateral wheezing on auscultation: Wheezing is more commonly associated with bronchoconstriction or airway obstruction rather than opioid-induced respiratory depression. Naloxone is not indicated for wheezing unless there is concurrent opioid-induced respiratory depression.
D) Pulse oximeter reading of 89% on room air: While a pulse oximeter reading of 89% indicates hypoxemia, it may not be solely due to opioid-induced respiratory depression. Other factors, such as hypoventilation, ventilation-perfusion (V/Q) mismatch, or lung disease, could contribute to decreased oxygen saturation. Administering naloxone solely based on pulse oximetry readings may not address the underlying cause adequately. It is essential to assess the client comprehensively, considering clinical signs and symptoms along with objective data.

A) Schedule both medications at bedtime:
Administering both medications at bedtime may not be the most appropriate schedule. PTU is typically administered multiple times a day to maintain consistent therapeutic levels in the bloodstream. Additionally, administering Lugol’s solution at bedtime may not provide sufficient time for the iodine to take effect before the PTU.

B) Administer iodine one hour before PTU:
This option is correct. Lugol’s solution, a strong iodine solution, is often given before antithyroid medications such as PTU or methimazole to temporarily block thyroid hormone production. Administering iodine about one hour before PTU allows the iodine to be taken up by the thyroid gland, effectively reducing thyroid hormone synthesis before the PTU starts to inhibit the conversion of T4 to T3.

C) Give parental dose once every 24 hours:
This option does not address the timing of administration between PTU and Lugol’s solution. While it may be correct for the dosing frequency of PTU, it does not specify when to administer Lugol’s solution in relation to PTU.

D) Offer both drugs together with a meal:
Administering both drugs together with a meal may not be appropriate, especially considering that Lugol’s solution needs to be absorbed into the bloodstream to exert its effect on the thyroid gland. Administering Lugol’s solution and PTU together may not allow adequate time for the iodine to take effect before the PTU starts to inhibit thyroid hormone production.