A client with a history of angina is being admitted to the emergency department with a suspected myocardial infarction (MI). Which of the following findings will help the nurse distinguish stable angina from an MI?

Choice A: Lactated Ringer’s

Lactated Ringer’s solution is an isotonic crystalloid that contains electrolytes similar to those found in blood plasma. While it is commonly used for fluid resuscitation, it does not provide a significant source of calories and therefore is not the best option to temporarily replace TPN.

Choice B: 0.9% sodium chloride

0.9% sodium chloride, also known as normal saline, is an isotonic solution that is used to expand volume and correct electrolyte imbalances. Like Lactated Ringer’s, it does not contain a significant amount of calories and is not suitable as a temporary replacement for TPN.

Choice C: 3% sodium chloride

3% sodium chloride is a hypertonic saline solution used in controlled settings to treat specific conditions such as hyponatremia. Due to its high concentration of sodium, it is not appropriate for routine fluid replacement and does not provide calories.

Choice D: Dextrose 10% in water

D10W is the preferred choice in this scenario because it provides a source of glucose, which can help maintain blood glucose levels when TPN is not available. It is important to monitor the patient’s blood glucose levels while infusing D10W to ensure they remain within a safe range. When a TPN container is delayed, Dextrose 10% in water is the most appropriate temporary solution to infuse until the next container becomes available, as it provides necessary calories in the form of glucose to the patient.

Choice A: Bradycardia Bradycardia, or a slower than normal heart rate, is not typically a direct symptom of flail chest. While traumatic injuries can lead to various cardiac responses, bradycardia is not commonly associated with the respiratory distress seen in flail chest. Flail chest is a serious condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. This can severely affect breathing and lead to other complications.

Choice B: Anxiety Anxiety is a common response in patients with flail chest due to the pain and difficulty in breathing associated with the condition. The stress of the injury and the body’s response to the trauma can lead to feelings of anxiety and panic.

Choice C: Dyspnea Dyspnea, or difficulty breathing, is one of the primary symptoms of flail chest. The instability of the chest wall and the paradoxical movement of the flail segment impair the normal mechanics of breathing, leading to shortness of breath.

Choice D: Unequal chest expansion Unequal chest expansion is a hallmark sign of flail chest. The affected area of the chest wall moves in the opposite direction to the rest of the chest during the respiratory cycle, which can be observed as an abnormal movement during inhalation and exhalation.

Choice E: Hypotension Hypotension, or low blood pressure, can occur in flail chest cases, especially if there is associated trauma such as bleeding or if the patient is in shock. The body’s response to the injury and the potential for compromised venous return due to the chest wall’s dysfunction can lead to hypotension.

Choice F: Paradoxical chest movement Paradoxical chest movement is a definitive sign of flail chest. It occurs when the broken section of the rib cage moves inward during inhalation and outward during exhalation, opposite to the normal chest movement. This is due to the loss of stability in the chest wall and is easily observable during a physical examination. Flail chest is a critical condition that requires immediate medical attention. The signs and symptoms associated with this condition include anxiety, dyspnea, unequal chest expansion, hypotension, and paradoxical chest movement. These symptoms reflect the underlying pathophysiology of the condition, which is the instability of the chest wall and the resulting impairment of normal respiratory function.