An older woman who was recently diagnosed with end stage metastatic breast cancer is admitted because she is experiencing shortness of breath and confusion. The client refuses to eat and continuously asks to go home. Arterial blood gas results indicate hypoxia. Which intervention is most important for the nurse to implement?

Rationale:

• Palpate and compare radial pulses: It is important to check radial pulses to assess circulation to the injured limb. Decreased pulse strength, especially in the left arm, could indicate vascular injury, which requires immediate attention.
• Administer ondansetron 4 mg IV: The client is feeling nauseated and worries about vomiting, likely due to postoperative effects, pain medication, or anesthesia. Ondansetron is an antiemetic, which is appropriate to administer to manage nausea and prevent vomiting.
• Check capillary refill on bilateral upper extremities: Checking capillary refill is essential to assess perfusion to both arms. The client’s left arm is experiencing coolness, and diminished pulses were noted earlier, so this is necessary to monitor blood flow and prevent complications like compartment syndrome.
• Inspect the bandage for drainage: After surgery, it is important to inspect the surgical site for any drainage, bleeding, or signs of infection. This helps ensure that there are no complications or issues with wound healing.

• Perform range of motion: Performing range of motion exercises is contraindicated immediately after trauma, especially with a fracture or suspected injury to the shoulder. The shoulder should be immobilized to prevent further damage and to facilitate proper healing. Early movement may worsen the injury or cause additional pain.
• Provide morphine 2 mg IV push (IVP): While he had a nerve block, its effectiveness will wane, and he will likely experience significant pain from the fracture and surgical manipulation. Administering prescribed analgesia like morphine is a priority for pain management.

A. Consult a dietitian to support nutrition and weight loss: Excess weight puts added stress on joints, particularly weight-bearing joints. A dietitian can help create a balanced, anti-inflammatory diet and assist with weight loss to reduce strain on the joints and control inflammation.

B. Perform fine motor activities for the client to decrease pain: Fine motor activities may increase joint strain and discomfort in RA patients, particularly if done in excess or without adequate rest. Focus should be on rest and controlled activity.

C. Avoid movement, as it will increase pain: Complete immobilization of joints can lead to stiffness and further deterioration. While rest is important during flare-ups, gentle movement and exercises, such as range-of-motion exercises, are essential to prevent joint stiffness and preserve function.

D. Eat a diet high in refined carbohydrates: A diet high in refined carbohydrates is not beneficial for RA patients. Refined carbohydrates can increase inflammation and contribute to weight gain, which may worsen the symptoms of RA. A well-balanced, anti-inflammatory diet is recommended instead.

E. Apply ice packs to inflamed joints: Applying ice packs to inflamed joints can reduce swelling and provide relief from acute pain and inflammation. Cold therapy can help to numb the area, providing short-term relief and decreasing inflammation in affected joints for pain management in RA.

F. Facilitate paraffin wax dips to help soothe joints: Paraffin wax dips used to relieve pain and stiffness in joints affected by rheumatoid arthritis. The warm wax helps to relax muscles, increase blood flow, and reduce stiffness in the hands and wrists, providing comfort and improving joint mobility.