The nurse is collecting data from the client following the transfusion of 2 units of packed RBCs.

Exhibits

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Laboratory Results:

1800:

WBC count 6,700/mm (5,000 to 10,000/mm3)

Hemoglobin 12 g/dL (14 to 18 g/dL)

Hematocrit 36% (40% to 52%)

Vital Signs:

1800:

Blood pressure 112/74 mm Hg

Heart rate 95/min

Respiratory rate 18/min

Temperature 37.5°  C (99.5°  F)

O2 saturation 100% 2 L/min O2 via nasal cannula

Assessment:

1800:

Physical Exam

General: no distress

Head, ears, eyes, nose, and throat (HEENT): oropharynx clear, mucous membranes moist and pink

Respiratory: bilateral breath sounds clear

Gastrointestinal: epigastric tenderness to palpation, no rebound tenderness or guarding

Neurologic: awake and alert

A. Take the medication and then lay down for 30 min. Doxycycline can cause esophageal irritation and ulceration if not taken properly. Clients should remain upright for at least 30 minutes after taking the medication to reduce the risk of esophagitis. Lying down immediately after ingestion increases this risk.
B. Take the medication with an antacid. Antacids containing aluminum, calcium, or magnesium can interfere with doxycycline absorption, reducing its effectiveness. Clients should avoid taking antacids within 1 to 2 hours of doxycycline administration.
C. Take the medication with calcium-fortified orange juice. Calcium interferes with the absorption of doxycycline, potentially decreasing its effectiveness. Clients should avoid dairy products and calcium-rich foods or beverages when taking this medication.
D. Take the medication with crackers. Taking doxycycline with food, such as crackers or a light snack, can help reduce gastrointestinal discomfort without significantly affecting its absorption. Although doxycycline is best absorbed on an empty stomach, taking it with a small amount of food can help minimize nausea and vomiting.

A. Provide the client with a glass of orange juice. While orange juice can provide a quick source of sugar and may help if the client is experiencing low blood sugar, the symptoms of dizziness, racing heart, and pallor while lying on their back are more indicative of supine hypotensive syndrome. Therefore, addressing the positioning is more critical.
B. Check the client's temperature. Checking the client's temperature may provide some information but is not the most immediate action to take in response to the symptoms presented. The symptoms described are more related to positional changes rather than an infection or fever.
C. Instruct the client to take a brisk walk. Encouraging physical activity, especially brisk walking, is not appropriate given the client's symptoms. Walking may exacerbate feelings of dizziness and discomfort.
D. Position the client on their left side. Positioning the client on their left side helps relieve pressure on the inferior vena cava, which can occur when a pregnant client lies supine. This action can improve blood flow to the heart and the fetus, alleviating symptoms of dizziness, racing heart, and pallor. It is a recommended intervention for clients experiencing these symptoms in the second trimester.