What does the nurse identify as INDIRECT cause of acute respiratory distress syndrome (ARDS) SELECT ALL THAT APPLY

A) Respiratory compromise
A spinal cord injury (SCI) at the level of C-3 (cervical spine) results in the loss of function of the diaphragm, which is innervated by the phrenic nerve originating from C-3 to C-5. As a result, the patient is at high risk for respiratory compromise and may require mechanical ventilation. Respiratory failure is a leading cause of death and complications in individuals with high cervical spinal cord injuries, particularly when the injury is at or above C-4.

B) Hypertension
Although spinal cord injuries can cause autonomic dysreflexia (a condition where the body’s autonomic nervous system overreacts to stimuli, leading to dangerously high blood pressure), this condition is more common in individuals with injuries above T6. At C-3, respiratory issues are the primary concern, and hypertension is not the leading cause of complications.

C) Septic shock
Septic shock can occur after any significant injury, especially if the individual develops infections (e.g., from urinary retention, pressure ulcers, or pneumonia). However, septic shock is not the main cause of complications or death related to a C-3 spinal cord injury.

D) Bradycardia
Bradycardia (a slow heart rate) can indeed be a concern in patients with SCI, especially those with injuries at or above the T1 level. However, at the level of C-3, the main cause of complications is respiratory failure, not bradycardia. While bradycardia can occur due to disruption of sympathetic nervous system control, respiratory compromise is the most critical immediate concern.

A) "I agree. Sometimes the adverse effects can be worse than the disease":
While it's important for the nurse to acknowledge the client's concerns, making this statement may not be helpful in this situation. It could unintentionally reinforce fear and anxiety, implying that the chemotherapy's side effects may be worse than the disease itself, which is not always the case. Instead, the nurse should engage the client in a discussion to explore the specific concerns, allowing for tailored support and information.

B) "Someone from the American Cancer Society will be here soon to answer your questions":
While the American Cancer Society can provide valuable support and resources, referring the client to someone else to answer their questions can feel dismissive. The nurse should take the opportunity to listen to the client’s concerns and provide immediate reassurance or information. Direct involvement in the discussion builds trust and allows for more immediate emotional and psychological support.

C) "What is it about the adverse effects that concern you?":
This response is the most appropriate as it encourages the client to express their specific concerns. By asking the client to clarify their worries, the nurse can provide more accurate information, address misunderstandings, and offer reassurance. This open-ended question helps the nurse understand the client's emotions and individual needs, which allows for a more personalized approach in managing anxiety and providing education about the chemotherapy treatment.
D) "I will have your provider discuss the adverse effects with you before the treatment begins":
While it is important for the healthcare provider to discuss the treatment plan and potential side effects, the nurse should not defer the conversation entirely. The nurse plays an essential role in providing ongoing support, educating the client, and answering questions. The nurse can start the conversation and provide information about the common side effects of chemotherapy, offering the opportunity for further discussion with the provider as needed. Deferring the conversation might leave the client feeling unsupported.