An older client is 1 day post-esophagectomy. The nurse finds the client short of breath with a heart rate of 120 beats/min. Which action by the nurse takes priority?
a. Assess the client's lungs and oxygen sa-turation.
b. Ask the client to rate pain, and treat if needed.
c. Help the client change to a side-lying po-sition.
d. Increase the client's supplemental oxygen.
A
Clients can have many complications from this operation, and older clients are especially vul-nerable to fluid overload. The nurse should first assess lung sounds and oxygen saturation. Al-though pain can cause tachycardia, it usually does not cause shortness of breath. If the client has pain, it should be treated, but it is not the priority. The nurse needs to know the client's oxygen saturation before turning up the oxygen. Changing the client's position will not help.
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