A nurse assisting with the care of a client who is admitted to the medical-surgical unit.

The nurse is reviewing the client's laboratory findings and vital signs.

Select the 5 findings that require immediate follow-up.

A) Sit in a hot tub for 30 min every evening:
While a warm bath or hot tub may provide temporary relief for some types of pain, it is not generally recommended during pregnancy, especially in the later stages, because prolonged exposure to hot water can raise the body's core temperature. This could pose a risk to both the mother and fetus, especially at 34 weeks of gestation. It is safer to use warm compresses or baths for shorter durations.

B) Raise chairs to keep knees lower than hips:
This recommendation is incorrect. For relieving lower back pain, it is better for the knees to be slightly higher than the hips when sitting. This posture helps to alleviate strain on the lower back by reducing pressure on the spine. Sitting with the knees lower than the hips can actually exacerbate lower back pain.

C) Perform pelvic rocking exercises several times per day:
Pelvic rocking exercises are an excellent recommendation for relieving lower back pain during pregnancy. These exercises involve gently rocking the pelvis forward and backward, which can help to strengthen the lower back muscles, relieve tension, and improve posture. They are specifically beneficial in alleviating discomfort during pregnancy, particularly at 34 weeks of gestation.

D) Use the arms to pick up heavy items:
While using the arms instead of the back is generally a good practice for avoiding strain, this advice does not directly address the specific issue of lower back pain during pregnancy. Pregnant clients should be advised to avoid lifting heavy objects whenever possible, as the added weight can exacerbate back pain. Safe body mechanics, such as squatting down to pick up objects and using leg muscles rather than back muscles, are also important.

A) Tonic-clonic seizures: Tonic-clonic seizures are typically the result of a seizure disorder, but during electroconvulsive therapy (ECT), a controlled seizure is intentionally induced to facilitate the therapeutic effects. After the procedure, there should not be uncontrolled tonic-clonic seizures. The goal is to induce a seizure under controlled conditions during the procedure itself, so this is not an expected finding 15 minutes post-ECT.

B) Paresthesias: Paresthesias (tingling or numbness) are not a common immediate side effect following ECT. While ECT can have some neurological effects, paresthesias are more commonly associated with other neurological conditions or nerve injuries, rather than as a direct result of the procedure itself.

C) Sleep apnea: Sleep apnea is not a typical immediate consequence of ECT. While ECT can have a range of physical and psychological side effects, sleep apnea, which involves breathing interruptions during sleep, is not an expected finding following the procedure.

D) Disorientation: Disorientation is a common and expected finding following ECT. It typically occurs due to the temporary effects of anesthesia, the brain’s response to the electrical stimulation, and the stress of the procedure. Clients often experience confusion, memory loss, and disorientation for a short period, particularly in the first 15 minutes after the procedure, as the anesthesia wears off and they recover from the induced seizure. This is a normal part of the recovery process.