A client is admitted to the hospital with a diagnosis of suspected pulmonary embolism. Physician prescriptions include the following: oxygen 2 to 4 L/min per nasal cannula, oximetry at all times, and IV administration of 5% dextrose in water at 100 mL/h. The client has increasing dyspnea and has a respiratory rate of 32 breaths/min. The nurse should first:
1. Increase the oxygen flow rate from 2 to 4 L/min.
2. Call the physician immediately.
3. Provide reassurance to the client.
4. Obtain a sample for arterial blood gas analysis.
The first action is to increase the oxygen flow rate from 2 to 4 L/min to help ensure adequate oxygenation for the client. Although it is important to notify the physician for additional prescriptions and to obtain further assessment data, such as arterial blood gas measurements, it is a priority to support the client’s cardiopulmonary system. It would be appropriate to reassure the client while these other interventions are occurring.
CN: Reduction of risk potential; CL: Synthesize
小编寄语：Troubles in the world, half from survival, half from care.世间的烦恼，一半源于生存，一半源于计较。