A nurse is assisting with the initiation of epidural analgesia for a client who is in the second stage of labor. Which of the following actions should the nurse take?

Rationale for Correct Choices:

• Decreased cardiac output: The client is post–myocardial infarction and experiences chest pain with minimal exertion, tachycardia (HR 112/min), and signs of anxiety and fear. These findings suggest that myocardial function may be compromised. Decreased cardiac output is a significant risk in post-MI clients due to potential for reinfarction, ischemia, or left ventricular dysfunction.
• Respiratory failure: The client has COPD, an elevated respiratory rate (32/min), and oxygen saturation of 87% on room air, which indicates significant hypoxemia. The productive cough, fatigue, and shortness of breath increase the risk for decompensation into respiratory failure without prompt oxygen therapy and pulmonary support.

Rationale for Incorrect Choices:

• Pancytopenia: This condition involves a reduction in red blood cells, white blood cells, and platelets. There is no evidence of bone marrow suppression, recent chemotherapy, or hematologic disorder in this client’s history.
• Neurogenic shock: Neurogenic shock results from spinal cord injury or disruption of sympathetic nervous system control. The client has no evidence of trauma or spinal pathology, and the elevated heart rate contradicts the expected bradycardia of neurogenic shock.
• Hepatic encephalopathy: This is caused by liver dysfunction, typically in clients with advanced liver disease. There are no signs of altered mental status, liver disease, or elevated ammonia levels in this case.

Rationale:

A. Email the client's health information to the facility in an unencrypted file: Sending unencrypted emails violates HIPAA standards, as it risks unauthorized access to protected health information. All electronic transmissions must be secured to ensure client confidentiality.

B. Fax the client's name and identifiable information to the rehabilitation: Faxing identifiable information can be permissible if proper safeguards are used, but without assurance of security or a cover sheet, this could breach confidentiality. It’s not the best initial action without those protections.

C. Discuss the client's response to the transfer with another staff nurse: Unless the other nurse is directly involved in the client’s care, this discussion is unnecessary and breaches confidentiality. Health information should only be shared on a need-to-know basis.

D. Provide a verbal report of the client's condition to the paramedic: Providing a verbal handoff to the paramedic is appropriate and necessary for continuity of care during transfer. It is a secure, direct communication method that supports both confidentiality and patient safety.