A nurse is assisting with the care of a client who is requesting pain medication. The nurse returns to the bedside to administer the pain medication within the timeframe given to the client. Which of the following ethical principles did the nurse follow?

A. An infant who has respiratory syncytial virus and a respiratory rate of 70/min: This infant is experiencing tachypnea, which indicates respiratory distress. Discharging during a storm would place the infant at high risk for decompensation and inadequate access to emergency care.

B. An adolescent who has cystic fibrosis and is receiving their yearly tune-up: A routine annual check-up indicates the adolescent is stable and does not require acute care. This client is the safest candidate for discharge during a storm, as their condition is not immediately life-threatening.

C. A child who has a new diagnosis of type 1 diabetes mellitus and is receiving IV insulin: This child requires close monitoring and titration of insulin therapy, making discharge unsafe. Early management of new-onset diabetes involves frequent assessments that cannot be delayed.

D. A child who has leukemia and an absolute neutrophil count of 200/mm³: Severe neutropenia places the child at high risk for infection. Discharge during a storm could prevent timely access to emergency care if complications arise.

A. Difficulty swallowing: Difficulty swallowing is more commonly associated with cranial nerve involvement, neuromuscular disorders, or medication side effects rather than pain perception. It does not reliably reflect inadequate pain control following a spinal epidural. Difficulty swallowing would prompt evaluation of airway or neurologic status rather than pain relief.

B. Urinary retention: Urinary retention is a known effect of spinal or epidural anesthesia due to temporary blockade of sacral nerves. It reflects autonomic nervous system involvement rather than the client’s pain level. Retention can occur even when pain is adequately managed.

C. Restlessness: Restlessness is a common behavioral indicator of unrelieved pain, especially when pain persists despite treatment. Clients may appear unable to relax, frequently change positions, or seem agitated when discomfort is not controlled. This finding suggests the need for reassessment of pain management effectiveness.

D. Constipation: Constipation is associated with opioid use, reduced mobility, or decreased gastrointestinal motility rather than uncontrolled pain. It develops over time and is not an acute indicator of ineffective pain relief. It would prompt bowel management rather than pain reassessment.