When conducting a home safety/hazard assessment, it is crucial to evaluate all rooms, entrances, and outdoor areas, tailoring the assessment to the specific needs of the client, such as hearing impairment. Key principles of home safety involve addressing various hazards. For instance, for clients with decreased mobility, installing a shower with grab bars or a walk-in bathtub is preferable to reduce the risk of falls compared to traditional bathtubs. Rugs and floor runners should be minimized, as they can increase the risk of falls, particularly for those with decreased sensory perception and mobility impairment, especially when using mobility aids. Additionally, space heaters should be avoided due to the fire hazard they pose. Clients with hearing impairment are especially vulnerable, as they may miss important environmental sounds, such as fire alarms. Therefore, visual fire alarms, which include flashing lights, are recommended. Lastly, safe food handling practices should be followed to mitigate the risk of consuming spoiled foods due to improper storage.

When assigning clients to specific nursing staff, it’s essential to align the client’s needs with the expertise and skills of the available nursing staff. Telemetry units are designed to provide care for clients who require cardiac monitoring without invasive interventions, such as intubation or hemodynamic monitoring (e.g., pulmonary artery catheter). Nurses working in telemetry units possess specialized knowledge concerning cardiac conditions and the interpretation of cardiac rhythms. For clients with dysrhythmias who are receiving vasoactive IV medications, continuous telemetry monitoring is necessary. As an example, a client with atrial fibrillation who requires a calcium-channel blocker (e.g., diltiazem) would be appropriately admitted to a telemetry unit.

Sickle cell disease results in the production of rigid, sickle-shaped red blood cells, which can lead to the aggregation and blockage of blood vessels. This blockage, known as a sickle cell disease crisis, leads to reduced perfusion and tissue damage. During a crisis, most body systems can be affected, and symptoms can vary depending on the location of the blockage. Common symptoms include pain in the legs, hands, back, and chest due to ischemia and inflammation. Additionally, itching is a sign of elevated bilirubin resulting from the destruction of red blood cells. Due to the risk of life-threatening complications arising from impaired circulation, such as blood clots and organ damage, immediate assessment is necessary for this client. The nurse should be prepared to anticipate the need for interventions such as IV fluids, oxygen, and analgesics.

Atypical angina, which can manifest as symptoms like indigestion or shoulder pain, may indicate a possible myocardial infarction (MI), particularly in populations such as females and individuals with diabetes. Clients with diabetes are also at risk of presenting with asymptomatic (silent) MIs due to cardiac neuropathy. Therefore, immediate intervention is essential to prevent cardiac damage or cardiac arrest. Priority follow-up actions include promptly reporting symptoms to the healthcare provider, assessing for additional MI symptoms, such as chest pain, shortness of breath, diaphoresis, altered mental status, and fatigue, and conducting diagnostic testing, such as an electrocardiogram (ECG) and measuring troponin levels, to confirm the diagnosis.

Vasoconstriction resulting from preeclampsia can lead to poor organ perfusion, affecting vital organs such as the liver and kidneys. This hypoperfusion can cause liver inflammation and ischemia, which may manifest as continuous heartburn (e.g., epigastric pain). It’s crucial for the client to promptly notify the healthcare provider when experiencing continuous heartburn, as it could indicate severe disease or disease progression, such as the development of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).

Vasoconstriction resulting from preeclampsia can lead to poor organ perfusion, affecting vital organs such as the liver and kidneys. This hypoperfusion can cause liver inflammation and ischemia, which may manifest as continuous heartburn (e.g., epigastric pain). It’s crucial for the client to promptly notify the healthcare provider when experiencing continuous heartburn, as it could indicate severe disease or disease progression, such as the development of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).

Digoxin, a cardiac glycoside utilized for heart failure and atrial arrhythmias, operates by inhibiting the sodium-potassium pump, leading to an accumulation of intracellular calcium and sodium. This elevated intracellular calcium enhances myocardial contractility (positive inotropy) and increases parasympathetic (vagal) activity, thereby reducing heart rate (negative chronotropy). Notably, both digoxin and potassium compete for binding sites on the sodium-potassium pump. In the presence of hypokalemia, digoxin can more readily bind to these sites, heightening the risk of digoxin toxicity. Therefore, it is crucial to ensure the client has a normal potassium level before administering digoxin. Signs of digoxin toxicity encompass gastrointestinal symptoms (nausea, vomiting, diarrhea), central nervous system effects (confusion, visual disturbances like yellow-green halos), and cardiac disturbances (arrhythmias, bradycardia).

Myasthenia gravis (MG) is a chronic autoimmune condition characterized by the destruction of acetylcholine receptors, leading to muscle weakness, dysphagia, double vision, and ptosis. Antimyasthenic medications such as pyridostigmine and neostigmine work by inhibiting acetylcholinesterase, thereby increasing the availability of acetylcholine in the neuromuscular junction, ultimately enhancing muscle strength. However, this can lead to cholinergic toxicity, marked by an overstimulation of the parasympathetic nervous system, resulting in “wet” symptoms opposite to those of anticholinergic toxicity. Signs of cholinergic toxicity can be recalled using the mnemonic SLUDGE (salivation, lacrimation, urination, diaphoresis, gastrointestinal distress [diarrhea], emesis). Clients experiencing cholinergic toxicity are at risk for severe bradycardia and bronchoconstriction and should promptly notify their healthcare provider.

After experiencing a myocardial infarction (MI), individuals are advised to implement several lifestyle adjustments to aid recovery and prevent future cardiac events. These changes include engaging in regular physical activity, with the American Heart Association (AHA) recommending a gradual buildup to at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity weekly. Additionally, post-MI medication adherence is crucial and typically involves taking a statin to prevent coronary thrombosis, as well as 6-12 months of dual-antiplatelet therapy with aspirin and a P2Y12 inhibitor such as clopidogrel or ticagrelor. It is also imperative to avoid non-steroidal anti-inflammatory drugs (NSAIDs) other than aspirin, as they heighten the risk of MI, kidney damage, and bleeding, particularly for individuals with cardiovascular or renal disease, or those taking anticoagulants or antiplatelet medications such as clopidogrel and aspirin.

Clients with extremity injuries, such as crush injuries or fractures, are susceptible to acute compartment syndrome, a condition in which swelling elevates pressure within the affected limb, impeding arterial blood flow and posing a risk of tissue necrosis and limb loss. Early signs of compartment syndrome include a decrease in pedal pulse strength, making it crucial for nurses to prioritize the assessment of pedal pulse strength. Continuous monitoring for the “6 Ps” is essential to identify signs of compartment syndrome: pain out of proportion to the injury, paresthesia, pallor, pulselessness, pressure, and paralysis. Treatment typically involves a fasciotomy to alleviate pressure and restore adequate perfusion.