Toxicity from which of the following medications may cause a patient to see a green-yellow halo around lights?

correct answer is Choice B.

Choice B rationale:

Orthostatic hypotension is a significant drop in blood pressure that occurs when a person stands up from a lying or sitting position. It's characterized by a decrease in systolic blood pressure of at least 20 mmHg or a decrease in diastolic blood pressure of at least 10 mmHg within 3 minutes of standing.

The client's assessment data clearly demonstrates orthostatic hypotension, with a systolic blood pressure drop of 23 mmHg and a diastolic drop of 13 mmHg upon standing.

Orthostatic hypotension is a major risk factor for falls, especially in older adults. This is because the sudden decrease in blood pressure can lead to lightheadedness, dizziness, blurred vision, weakness, and even fainting.

Falls in older adults can result in serious injuries, such as fractures, head trauma, and even death. Therefore, it's crucial to identify and address orthostatic hypotension to prevent falls and their associated complications.

Rationales for other choices:

Choice A: Ineffective breathing pattern is not directly related to orthostatic hypotension. While hypotension can cause shortness of breath in some cases, it's not the primary concern in this scenario.

Choice C: Ineffective role performance can be a consequence of frequent falls, but it's not the most immediate or pressing nursing diagnosis in this case.

Choice D: Risk for imbalanced fluid balance is a potential concern in some cases of orthostatic hypotension, but it's not the most likely diagnosis based on the client's assessment data.

A rationale:

While a shellfish allergy is important information for the healthcare team to be aware of, it is not directly relevant to the cardiac angiogram procedure itself. Shellfish allergies typically involve reactions to iodine-containing contrast dyes, which are not commonly used in cardiac angiograms. The contrast dye used in cardiac angiograms is usually a gadolinium-based contrast agent, which has a different allergy profile.

It's essential to communicate any allergies to the healthcare team, but this information would not necessarily prompt an immediate notification to the physician in the context of a cardiac angiogram.

Choice B rationale:

The patient's last meal time is relevant for some procedures that require sedation or anesthesia, but it's not typically a major concern for a cardiac angiogram.

Patients are often instructed to have a light meal or snack several hours before the procedure, but an exact fasting time is not always necessary. Unless the physician has specifically ordered a strict fasting period for this patient, the nurse would not need to notify the physician immediately about a meal consumed the previous evening.

Choice C rationale:

This statement is the most concerning and would require immediate notification of the physician. Aspirin is a common antiplatelet medication that helps prevent blood clots. It's often prescribed to patients with heart disease to reduce the risk of heart attack and stroke.

Discontinuing aspirin therapy without medical guidance can increase the risk of blood clots, which could be dangerous during a cardiac angiogram. The procedure involves inserting a catheter into the heart's arteries, and there's a risk of clot formation during this process.

If a patient has not taken their aspirin as prescribed, the physician needs to be aware of this to assess the risks and benefits of proceeding with the angiogram and potentially consider alternative medications or interventions to manage the patient's clotting risk.

Choice D rationale:

Metformin is a medication used to treat type 2 diabetes. While it's important for patients to take their medications as prescribed, missing a single dose of metformin is not typically a major concern in the context of a cardiac angiogram.

The nurse would likely remind the patient to take their metformin as soon as possible, but this would not require immediate notification of the physician.