The nurse is providing care to a client admitted with a diagnosis of bacterial pneumonia. On assessment, the client has dry mucous membranes and coarse rhonchi. What nursing interventions would the nurse include in the plan of care?

A. Recent intake of sildenafil:
While there is a potential drug interaction between atenolol (a beta-blocker) and sildenafil (a phosphodiesterase inhibitor used for erectile dysfunction), this alone would not necessarily be an indication to hold atenolol. Sildenafil can cause hypotension, which might be exacerbated by atenolol, especially in older adults or those with cardiovascular issues. However, this interaction usually requires monitoring rather than immediate discontinuation of atenolol, unless the client is symptomatic (e.g., feeling faint, dizziness). If symptoms of hypotension occur after taking both medications, the nurse would assess the client's condition but would not automatically hold atenolol based solely on this information.

B. Heart rate 52 and blood pressure 90/56: The most concerning finding in a client receiving atenolol (a beta-blocker) for angina is a heart rate of 52 beats per minute (bradycardia) and a blood pressure of 90/56 mmHg (hypotension). Beta-blockers, such as atenolol, work by reducing the heart rate and lowering blood pressure. A heart rate of 52 beats per minute is below the typical threshold of 60 beats per minute and indicates bradycardia, which could worsen due to the medication's effects. Additionally, hypotension (blood pressure 90/56) can be dangerous, especially when combined with bradycardia. Both of these findings suggest that the client may be experiencing excessive beta-blockade, which could lead to severe complications such as cardiogenic shock or arrhythmias. Therefore, the nurse should hold the medication and contact the provider for further assessment and possible adjustment of the treatment plan.

C. Restlessness and mild confusion:
Restlessness and mild confusion could indicate several possible issues, such as hypoxia, electrolyte imbalances, or medication side effects. While beta-blockers can cause side effects like fatigue or depression, restlessness and confusion are not common acute reactions to atenolol. However, if these symptoms are due to hypotension or bradycardia from the atenolol, then holding the medication and notifying the provider may be warranted. Nonetheless, these symptoms alone are not a clear cause to immediately hold atenolol without further assessment.

D. Positional vertigo and wheezing:
Positional vertigo can occur due to a variety of causes, including inner ear issues, hypotension, or even medication side effects. Wheezing, however, raises concerns about potential bronchospasm, which is a known side effect of non-cardioselective beta-blockers. Atenolol is a cardioselective beta-blocker, meaning it is less likely to cause bronchospasm compared to non-cardioselective agents like propranolol. While wheezing could indicate a reaction to the medication, it is not a primary concern with atenolol, unless the client has a history of asthma or chronic obstructive pulmonary disease (COPD). If wheezing occurs, the nurse should still monitor the client but would not necessarily hold atenolol immediately unless the symptoms are severe.

A) Encouraging the client to cough and deep breathe every two hours:
Encouraging the client to cough and deep breathe is an important nursing intervention for clients with a chest tube. This helps promote lung expansion, prevent atelectasis, and improve respiratory function. It also helps to clear secretions that may accumulate in the lungs. Therefore, this practice is appropriate and beneficial for the client.

B) Stripping the chest tube to dislodge any blood clots:
Stripping the chest tube, which involves forcibly pulling or pinching the tubing to remove clots, is an unsafe and outdated practice. It can create a dangerous increase in intrathoracic pressure, which may lead to tension pneumothorax, as well as injury to the lung tissue. Instead, the nurse should focus on gently milking the chest tube if necessary (if prescribed by the healthcare provider) or ensure that any blood clots are properly managed by the physician. Stripping or clamping the tube without proper indications is contraindicated.

C) Assessing the client's respiratory status frequently:
Frequent assessment of the client's respiratory status is crucial when managing a patient with a chest tube. The nurse should monitor for signs of respiratory distress, changes in breath sounds, oxygen saturation, and any signs of complications such as pneumothorax or hemothorax. Regular respiratory assessment helps in early detection of issues and provides the data necessary to manage the client's care effectively.

D) Monitoring skin for subcutaneous emphysema:
Monitoring for subcutaneous emphysema is a vital part of nursing care for a client with a chest tube. Subcutaneous emphysema occurs when air escapes from the pleural space into the tissues under the skin, and can be a sign of a pneumothorax or a complication related to the chest tube. It is important to detect this early so appropriate intervention can be made to prevent further complications.