The nurse is managing the care for a client with hyperparathyroidism, and is reviewing the client's list of prescribed and over-the-counter medications. Which medication(s) on the client's current medication record should the nurse discuss further with the healthcare provider? Select all that apply.

Potential Condition - Tension pneumothorax:

The client presents with sudden decreased oxygen saturation (56%) after being intubated, along with absent breath sounds on the left side and a tracheal deviation to the right. These are classic signs of a tension pneumothorax, which occurs when air enters the pleural space and is trapped, leading to increased pressure on the lung and mediastinum, resulting in tracheal deviation and respiratory compromise. The low PaO2 and high PaCO2 in the ABG further support the diagnosis of respiratory failure due to this condition.

Actions to Take:

Collect equipment for a needle aspiration: Tension pneumothorax is treated emergently by needle decompression to release the trapped air and relieve the pressure on the lung and heart. The nurse should prepare for this procedure by gathering the necessary equipment.

Increase the fraction of inspired oxygen on the ventilator: Increasing the oxygen delivery can help improve the client's oxygenation while preparing for further intervention, such as needle aspiration.

Parameters to Monitor:

Blood gas: The ABG results show acid-base imbalance (low pH, elevated PaCO2, low PaO2), which need continuous monitoring to assess the effectiveness of interventions, such as needle decompression and oxygenation support.

Breath sounds: The nurse should continue auscultating for changes in breath sounds as the tension pneumothorax is treated. The resolution of the absent breath sounds on the left side would indicate the success of the intervention.

Rationale for incorrect choices:

Endotracheal tube obstruction: The absence of breath sounds on one side and the tracheal deviation suggest a pneumothorax, not an obstruction. Obstruction would typically cause wheezing or decreased breath sounds on both sides, but it wouldn’t cause tracheal deviation.

Pulmonary hypertension: Pulmonary hypertension might cause hypoxia and respiratory distress, but it would not cause the sudden and severe signs of a tension pneumothorax, such as tracheal deviation and unilateral absent breath sounds

Ventilator malfunction: While a ventilator malfunction could affect oxygenation, it would not cause the physical signs of tension pneumothorax (tracheal deviation and absent breath sounds on one side). A malfunction would likely affect the entire chest and wouldn’t cause localized changes as seen in this client.

Potential Condition - Delirium:

The client exhibits confusion, difficulty with memory, and disorientation (e.g., not knowing what happened, asking about her husband, inability to recall medications), which are typical signs of delirium. Delirium is an acute change in mental status and is common in older adults post-surgery, particularly after trauma or hospitalization.

Actions to Take:

Reorient to environment: Reorientation helps to reduce confusion and anxiety. The client is unsure of her surroundings and what is happening, so gently reminding her of the situation can improve awareness and reduce distress.

Institute fall precautions: Delirium increases the risk of falls due to impaired cognitive function. Given that the client is ambulating with assistance and has difficulty understanding instructions (e.g., unsure of the call light), instituting fall precautions is essential to prevent injury.

Parameters to Monitor:

Nutritional intake/intake and output: The client had difficulty feeding herself and consumed only a small portion of the meal. Monitoring her nutritional intake is important for overall recovery and to prevent dehydration, particularly given her dry mucosa and skin tenting.

Intracranial pressure: Given the client's age, recent surgery, and possible trauma from the motor vehicle accident, monitoring intracranial pressure (via MRI order) is necessary to rule out any traumatic brain injury or worsening of symptoms, especially since she has periods of confusion and disorientation.