Twelve hours after a total hip replacement, a client complains of sudden chest pain and shortness of breath. What is the priority nursing action?
1. Reposition and elevate the head of bed.
2. Medicate with an analgesic.
3. Administer oxygen at 2 L/min via nasal cannula.
4. Notify the doctor regarding the pain status.
Answer: 3
Pain in the leg is expected but chest pain is not. The nurse should start oxygen and then notify the physician. There is possibility of a fat embolism, myocardial ischemia, or pulmonary emboli. The other measures of repositioning and medicating are not appropriate with the onset of sudden chest pain.
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