A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.
The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?

Choice A rationale:

Seizure precautions are necessary because:

The patient has ingested multiple drugs, some of which can lower the seizure threshold, such as benzodiazepines. Naloxone, while reversing opioid overdose, can also precipitate seizures in some individuals.

Flumazenil, used to reverse benzodiazepine overdose, can also induce seizures, especially in patients with a history of epilepsy or benzodiazepine dependence.

The potential for drug interactions and unpredictable effects of multiple drug ingestion further increases the risk of seizures. Specific seizure precautions include:

Placing the patient in a bed with padded side rails. Having oxygen and suction equipment readily available.

Keeping intravenous access open for potential administration of anticonvulsant medications. Closely monitoring the patient's neurological status for any signs of seizure activity.

Choice B rationale:

Aspiration precautions are crucial due to:

The patient's unconscious state, which impairs their ability to protect their airway.

The possibility of vomiting, which can occur as a side effect of naloxone or flumazenil administration.

The potential for aspiration of gastric contents, which can lead to serious respiratory complications, such as pneumonia. Specific aspiration precautions include:

Positioning the patient on their side in the recovery position. Continuously monitoring the patient's respiratory status.

Having suction equipment ready to clear the airway if necessary.

Considering intubation and mechanical ventilation if the patient's airway is compromised.

Choice D rationale:

Fall precautions are essential because:

The patient is unconscious and may be disoriented or uncoordinated upon regaining consciousness.

The effects of the ingested drugs, as well as the medications administered, can impair balance and coordination. Falls can result in serious injuries, such as head trauma or fractures.

Specific fall precautions include:

Keeping the bed in a low position with side rails up.

Assisting the patient with ambulation when they are able to move. Ensuring the patient's environment is free of tripping hazards.

Providing close supervision and assistance as needed.

Choice C rationale:

Suicide precautions are not routinely implemented in this scenario because:

The patient's primary presentation is drug overdose, not active suicidal ideation or attempts.

The focus of care is on addressing the immediate medical complications of the overdose and stabilization.

However, a thorough suicide risk assessment should be conducted once the patient is medically stable to determine if ongoing suicide precautions are necessary.

Choice A rationale:

Mixing insulins in a vial is generally not recommended unless specifically instructed by the healthcare provider. It can alter the effectiveness of the insulins and increase the risk of dosage errors.

Premixed insulins, which are already combined in a specific ratio, are available if a combination of insulins is needed.

However, in this case, the patient is instructed to administer regular and NPH insulin separately, indicating that they should not be mixed in a vial.

Choice B rationale:

Insulin can be injected into various subcutaneous sites, including the abdomen, thighs, upper arms, and buttocks.

There is no specific requirement to inject mixed insulin into the buttocks only.

The choice of injection site can be based on individual preferences, absorption rates, and the presence of lipohypertrophy (thickening of the subcutaneous tissue due to repeated injections).

Choice C rationale:

Drawing up NPH insulin first could lead to contamination of the regular insulin vial with NPH insulin.

NPH insulin is a suspension, and drawing it up first could introduce some of its particles into the regular insulin vial, potentially altering its absorption and action profile.

Choice D rationale:

It's crucial to draw up the regular insulin first to prevent contamination of the regular insulin vial with NPH insulin. The following steps outline the correct procedure:

Wash hands thoroughly with soap and water.

Inspect the insulin vials for clarity, expiration date, and any damage.

Roll the NPH insulin vial gently between the palms to resuspend the insulin particles (if applicable). Wipe the rubber stoppers of both vials with an alcohol swab.

Using a sterile syringe, withdraw air into the syringe equal to the amount of regular insulin to be drawn.

Inject the air into the regular insulin vial, keeping the needle tip above the fluid level to avoid creating bubbles. Invert the regular insulin vial and withdraw the prescribed dose of regular insulin.

Without injecting air into the NPH insulin vial, withdraw the prescribed dose of NPH insulin. Administer the insulin as directed, using proper injection technique.