A nurse in an emergency department is planning care for a client who has abdominal trauma from a motor-vehicle crash. Which of the following provider prescriptions should the nurse implement first?

Miosis : Pinpoint pupils are a hallmark of opioid overdose due to stimulation of the parasympathetic nervous system. This finding helps distinguish opioid toxicity from other types of substance use, which often cause pupil dilation instead.

Respiratory depression : Opioids depress the medullary respiratory centers in the brainstem, leading to slowed breathing. A respiratory rate of 10/min is significantly reduced and signals impaired ventilation, making it a critical diagnostic clue.

Opioid overdose: The clinical signs—needle marks, sedation, pinpoint pupils, bradypnea, and a positive response to naloxone—all strongly point to an opioid overdose. A similar prior episode adds to the likelihood of chronic opioid misuse.

Alcohol intoxication: While alcohol can depress the central nervous system, it does not typically cause miosis or respond to naloxone. Also, the pattern of rapid reversal with naloxone suggests opioid involvement rather than alcohol alone.

Benzodiazepine overdose: Though it shares features like sedation and respiratory depression with opioid overdose, benzodiazepine toxicity does not cause miosis, and naloxone has limited or no effectiveness as a reversal agent.

Cocaine intoxication : Typically causes stimulant effects including mydriasis (dilated pupils), increased heart rate, hypertension, and agitation. These are not consistent with the symptoms in this case, which reflect CNS depression.

A. Discuss the client's preferences for determining a repositioning schedule. While it's important to consider the client's comfort, repositioning must follow clinical guidelines (typically every 2 hours) to prevent pressure injuries, especially in clients with limited mobility post-stroke.
B. Raise the side rails on both sides of the client's bed during repositioning. Raising both side rails can be considered a form of restraint if not medically justified. Only one rail should be raised for safety and support unless otherwise indicated by facility policy.
C. Reposition the client without the use of assistive devices. Repositioning a client post-stroke without proper equipment increases the risk of injury to both the client and the nurse. Assistive devices promote safety and proper body mechanics.
D. Evaluate the client's ability to help with repositioning. This is the first and most important step. Assessing the client’s physical capability and level of consciousness ensures that the nurse uses the appropriate technique and equipment for safe repositioning.