The nurse working in a critical care unit (CCU) is assigned the care of two clients, one with pneumonia who is being mechanically ventilated, and the other who had a thoracotomy yesterday and is reporting incisional pain. Which action(s) should the nurse perform first?

A. Polydipsia and polyuria: These symptoms are more commonly associated with uncontrolled diabetes mellitus rather than hypertension. They are not direct complications of elevated blood pressure.

B. Elevated blood urea nitrogen: Hypertension can damage renal blood vessels, leading to impaired kidney function and elevated BUN levels. This is a significant complication that indicates progressive end-organ damage.

C. Dry and irritated skin: This is a nonspecific symptom that may result from dermatologic conditions, dehydration, or environmental factors. It is not typically associated with hypertension complications.

D. New onset of bradycardia: Bradycardia is not a usual complication of hypertension itself, though it may occur as a side effect of certain antihypertensive medications such as beta-blockers. It is not a primary complication to anticipate.

Rationale for correct choices:

• Respirations: Morphine is an opioid analgesic that can depress the respiratory center in the brainstem, leading to slowed breathing and hypoventilation. Monitoring respirations after administration is critical to detect early signs of opioid-induced respiratory depression.

• Ice application to the shoulder: Applying ice reduces swelling, pain, and inflammation by causing vasoconstriction and limiting fluid accumulation at the injury site. For an acute humeral fracture with significant swelling and bruising, cold therapy is the appropriate intervention.

Rationale for incorrect choices:

• Nausea: While morphine can cause nausea and vomiting as side effects, they are not the most life-threatening concerns compared to respiratory depression. Monitoring nausea is appropriate but not the priority when evaluating opioid safety.

• Blood pressure: Morphine can cause hypotension, but this effect is less common and typically secondary to respiratory depression and vasodilation. Continuous monitoring of blood pressure is helpful, but respiratory monitoring takes priority in detecting opioid complications.

• Early active range of motion: Active movement of the injured arm is not recommended immediately after a displaced humeral fracture, as it can worsen displacement and interfere with healing. Immobilization and stabilization are required before introducing range-of-motion exercises.

• Heat application to the shoulder: Heat increases blood flow to tissues, which can worsen swelling and bleeding in the acute phase of injury. Applying heat too soon after a fracture increases the risk of complications rather than reducing them.