What is the best action to perform fourth of the six actions identified as part of planned client care for this particular client?

 

The fourth best action to perform as part of the planned patient care is to decrease O2 to 2L Nasal Cannula and continue Sp02 monitoring. However, this first requires the reevaluation of the patient’s SpO2. The 2L Nasal Cannula can provide the needed oxygen flow rate and maintain the recommended physician SpO2 of 92% or greater. The 2L per minute flow is also average and can reduce the risks associated with high SpO2. Monitoring the patient will help them identify any extra oxygen needs and respond accordingly.
What is the incorrect action?
The incorrect action during the management of the client was to call the physician to get an order for Nicotine Patch, and report decreased urinary output with amber urine. Firstly, the decreased urinary output with amber urine may be due to dehydration. Providing the client with fluids can help resolve the problem. On the other hand, ordering a nicotine patch for a patient managing pain is not the correct action to take at the moment for various reasons. Firstly, nicotine is a ganglionic cholinergic-receptor agonist that can regulate cardiovascular (CV) and heart oxygen demands as well as body temperature, leading to vasoconstriction and restricted blood flow and risk for increased heart rate, high blood pressure, and related CV problems (Deng & Jiang, 2020). Additionally, nicotine regulates pain perception. Animal models have proven the increased effects of chronic nicotine on increased pain perception during withdrawal (Zhang et al., 2020). Additionally, prolonged nicotine exposure leads to decreased α7-nAChR expression, leading to increased experiences of chronic pain (Zhang et al., 2021). This means providing the client with nicotine can limit the analgesic efficacy of administered drugs, risking overdosing and dependency.
References
Akyüz, E., & Tunçbilek, Z. (2021). Anti-embolism stocking care protocol to prevent associated skin problems: A quasi-experimental study. Journal of Tissue Viability, 30(1), 89–94. https://doi.org/10.1016/J.JTV.2020.07.001

Awadallah, M., Gurusamy, K., Easey, S., & Parker, M. (2021). SHOULD WE CONTINUE TO USE ANTI-EMBOLISM GRADUATED COMPRESSION STOCKINGS? Orthopaedic Proceedings, 103-B(SUPP_13), 56–56. https://doi.org/10.1302/1358-992X.2021.13.056