An older aphasic client has severe osteoarthritis, bilateral contractures of the lower extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? (Select all that apply.)

Choice A reason: Crushing chest pain is the classic sign of an AMI, but it can be absent in some older men with an AMI. This is because older men may have a reduced pain perception due to aging, diabetes, or other conditions that affect the nerve endings. Older men may also have atypical or silent AMIs, which do not cause chest pain or other obvious symptoms.

Choice B reason: Epigastric burning is not a classic sign of an AMI, but it can be a symptom of an AMI in some older men. Epigastric burning may be mistaken for indigestion, heartburn, or gastritis, but it can also indicate ischemia or injury to the lower part of the heart.

Choice C reason: Dyspnea and fatigue are not classic signs of an AMI, but they can be symptoms of an AMI in some older men. Dyspnea and fatigue may be attributed to aging, deconditioning, or other chronic diseases, but they can also indicate reduced oxygen supply to the heart and the body.

Choice D reason: Vague complaints are not classic signs of an AMI, but they can be symptoms of an AMI in some older men. Vague complaints may include anxiety, restlessness, nausea, dizziness, or weakness, which may be overlooked or dismissed as minor ailments, but they can also indicate a serious cardiac event.

Choice E reason: None of the above is not the correct answer, as there is one choice that is the classic sign of an AMI that can be absent in an older man with an AMI.

Choice A: Pressure ulcers - Physical restraints can lead to immobility, which increases the risk of pressure ulcers due to prolonged pressure on the skin.

Choice B: Death - Restraints can cause fatal accidents. For example, a person might try to remove the restraint, fall, and suffer a fatal injury.

Choice C: Sepsis - While sepsis is a severe condition often caused by an infection, it's not a direct result of physical restraints. However, if a pressure ulcer (caused by restraints) becomes severely infected, it could potentially lead to sepsis.

Choice D: Decreased circulation/perfusion to the extremities - Restraints can restrict movement, leading to decreased blood flow to the extremities.

Choice E: Fractures - Struggling against restraints can lead to falls and subsequent fractures.