A diabetic client states he feels depressed, is complaining of chest pain, and has an open wound. Which of these complaints would require an immediate focused assessment?

Choice A reason: Tachycardia is a physiological response to fear and anxiety. Tachycardia is a condition where the heart rate is faster than normal, usually above 100 beats per minute. Fear and anxiety can trigger the release of stress hormones, such as adrenaline and cortisol, that stimulate the sympathetic nervous system. This causes the heart to beat faster and stronger, increasing the blood flow and oxygen delivery to the muscles and organs. This prepares the body for the fight-or-flight response, which is a survival mechanism that helps the person to cope with a perceived threat or danger.

Choice B reason: Bronchial constriction is not a physiological response to fear and anxiety. Bronchial constriction is a condition where the airways in the lungs become narrow and inflamed, reducing the airflow and causing difficulty breathing. Bronchial constriction can be caused by various factors, such as asthma, allergies, infections, or irritants. Fear and anxiety can worsen the symptoms of bronchial constriction, but they are not the primary cause of it.

Choice C reason: Bradypnea is not a physiological response to fear and anxiety. Bradypnea is a condition where the breathing rate is slower than normal, usually below 12 breaths per minute. Bradypnea can be caused by various factors, such as brain injury, drug overdose, sleep apnea, or metabolic disorders. Fear and anxiety can increase the breathing rate, not decrease it, as the body needs more oxygen to cope with the stress.

Choice D reason: Pupillary constriction is not a physiological response to fear and anxiety. Pupillary constriction is a condition where the pupils in the eyes become smaller and less responsive to light. Pupillary constriction can be caused by various factors, such as eye injury, medication, aging, or neurological disorders. Fear and anxiety can cause pupillary dilation, not constriction, as the pupils widen to allow more light and improve the vision. This helps the person to see better and react faster to the situation.

Choice A reason: I try to walk in the hallway each day with assistance is a correct statement. Walking is a form of physical activity that can stimulate bowel movements and prevent constipation. Walking also has other benefits such as improving circulation, muscle strength, and mood. The patient should be encouraged to walk as much as possible with assistance to prevent falls and injuries.

Choice B reason: I need to increase fiber in my diet and drink more water is a correct statement. Fiber is a type of carbohydrate that is not digested by the body and helps to form soft and bulky stools. Fiber can be found in foods such as fruits, vegetables, whole grains, nuts, and seeds. Water is essential for hydration and helps to soften the stools and ease their passage. The patient should be advised to consume at least 25 grams of fiber and 8 glasses of water per day to prevent constipation.

Choice C reason: I take my laxative every morning and an enema every night is an incorrect statement that requires follow-up teaching by the nurse. Laxatives and enemas are medications that are used to treat constipation by stimulating or lubricating the bowel. However, they should not be used routinely or excessively, as they can cause side effects such as dehydration, electrolyte imbalance, abdominal cramps, diarrhea, or dependence. The patient should be instructed to use laxatives and enemas only as prescribed by the doctor and for a short period of time. The patient should also be informed of the potential risks and complications of overusing laxatives and enemas.

Choice D reason: The pain medication I take tends to make my constipation worse is a correct statement. Pain medications, especially opioids, can slow down the movement of the bowel and cause constipation. This is a common and expected side effect of pain medications. The patient should be educated on how to manage constipation caused by pain medications, such as increasing fiber and water intake, exercising regularly, and using stool softeners or laxatives as needed. The patient should also be reassured that constipation does not mean that the pain medication is not working or that they are addicted to it.