A nurse in the emergency department is caring for female client. Exhibits After reviewing the assessment findings, which of the following findings require follow-up? (Select All that Apply.)
Explanation & Rationale
A. Breath sounds: Clear breath sounds are a normal finding and do not require follow-up. B. Total T4: The client's Total T4 is 20 mcg/dL, which is significantly above the normal range (5 to 12 mcg/dL). This confirms the diagnosis of hyperthyroidism and is the root cause of the client's hypermetabolic symptoms. C. Oxygen saturation: A saturation of 97% is within the normal range. D. Blood pressure: The blood pressure of 168/70 mm Hg indicates systolic hypertension with a widened pulse pressure, which is characteristic of hyperthyroidism due to increased cardiac output. This requires follow-up to prevent cardiovascular complications like heart failure or stroke. E. Bowel pattern: While 2-3 bowel movements per day is a symptom of increased gastric motility associated with the disease, it is not an immediate life-threatening finding compared to the T4 level and severe hypertension. F. Potassium level: A level of 3.6 mEq/L is within the normal reference range (3.5 to 5 mEq/L).