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Manually ventilate the client using the ambu bag: Manual ventilation can increase intrathoracic pressure and inadvertently worsen intracranial pressure if performed without a clear indication or synchronized settings. It should only be done if the ventilator or airway is malfunctioning, not as an initial response to rising ICP.

Administer the prescribed PRN dose of morphine sulfate IV: Morphine can cause respiratory depression, CO₂ retention, and cerebral vasodilation, which can further elevate intracranial pressure. Analgesics may be given later for comfort, but they are not the priority.

Draw a stat arterial blood gas to assess for hypercapnia: Although evaluating CO₂ levels helps determine the cause of increased ICP, obtaining and processing the blood sample takes time. The nurse should first ensure the airway is clear and ventilation adequate before proceeding with diagnostic measures.

Hyperglycemia: Mannitol is not metabolized like glucose and therefore does not affect blood glucose levels significantly. Any elevation in glucose would likely be related to stress or steroid therapy rather than the direct effect of mannitol.

Hyponatremia: Mannitol promotes osmotic diuresis, leading to the excretion of water and electrolytes; however, it can sometimes cause hypernatremia if excessive water loss occurs. Hyponatremia is not the typical outcome of mannitol administration.

Oliguria: Mannitol increases urine output by enhancing renal perfusion and promoting osmotic diuresis. The expected response is polyuria, not oliguria, unless renal failure develops or the drug accumulates due to poor renal function.

Thick green mucus is important because it indicates infection and airway secretion buildup. However, while it signals the presence of pneumonia, it is not the most urgent finding to prioritize over immediate respiratory assessment. The nurse should monitor secretions and provide interventions like suctioning or hydration to help mobilize them.

The tracheostomy state is important for airway patency. While it must be monitored to ensure it remains patent and functional, the current notes indicate it is in place and functioning normally. Immediate intervention is not indicated unless changes occur.

Fraction of inspired oxygen (FiO2) is relevant to oxygen delivery. The client is currently on her usual 30% FiO2, which is appropriate for her baseline oxygenation needs. No adjustment is required unless hypoxia or respiratory distress is noted.

Administer epinephrine IV: Epinephrine is given after the first unsuccessful defibrillation attempt during cardiac arrest management. It enhances coronary and cerebral perfusion pressures, but it is not the initial intervention when ventricular fibrillation is first identified.

Prepare for synchronized cardioversion: Synchronized cardioversion is used for organized tachyarrhythmias such as supraventricular tachycardia or atrial fibrillation with a pulse. It is inappropriate for ventricular fibrillation because there is no coordinated electrical activity to synchronize with.

Give an IV bolus of amiodarone: Amiodarone is administered after defibrillation and epinephrine if VF persists. It stabilizes the cardiac membrane and reduces recurrent dysrhythmias, but drug therapy follows defibrillation in the resuscitation sequence.

Primary cardiomyopathy: Cardiomyopathy involves chronic structural and functional heart muscle changes, often leading to heart failure symptoms like dyspnea and fatigue. It does not present acutely with pulsus paradoxus or a rapid rise in central venous pressure.

Acute pericarditis: Pericarditis causes chest pain and pericardial friction rub but rarely results in hemodynamic collapse. While inflammation may lead to fluid accumulation, cardiac tamponade is the condition that produces the severe pressure and pulsus paradoxus described.

Infective endocarditis: Endocarditis involves infection of heart valves and presents with fever, murmurs, and embolic phenomena. It does not cause acute pressure changes, distant heart sounds, or pulsus paradoxus immediately after cardiac surgery.

Apply external pacing pads: Transcutaneous pacing is appropriate for symptomatic bradycardia with a pulse, not for pulseless electrical activity (PEA). In this case, the client has no pulse, so pacing will not generate effective cardiac output and should not be the first intervention.

Obtain blood pressure reading: During cardiac arrest, the client has no palpable pulse or measurable blood pressure. Attempting to obtain a blood pressure reading wastes valuable time that should be spent on life-saving interventions such as medication administration and high-quality CPR.

Insert second peripheral IV: While establishing additional IV access can be useful for administering fluids or medications, it is not the immediate priority during a pulseless event. The focus should remain on pharmacologic support and maintaining perfusion through CPR.