A 70-year-old female client with type 2 diabetes mellitus comes to the emergency department with diaphoresis, nausea, generalized weakness, and epigastric burning pain. Which intervention should the nurse implement first?

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11ecbb05_c963_e40e_b433_41210e2e0224_MD0009_00 Female, elderly, and diabetic clients tend to present with atypical symptoms of myocardial infarction (MI), such as diaphoresis, nausea, fatigue, or dyspnea, but may not always experience chest discomfort. Pain may be absent or atypical or may radiate to unusual locations (eg, jaw, back). Some clients may report pain as "indigestion" (epigastric burning or gas). The nurse should obtain a 12-lead electrocardiogram (ECG) on any client with atypical MI symptoms to assess for evidence of ischemia, injury, or infarction (Option D). ST-segment elevation MI is life-threatening and requires rapid coronary intervention. (Option A) Morphine is administered to relieve pain and anxiety. A 12-lead ECG must be obtained to verify that the symptoms are cardiac in nature before giving medications. (Option B) In clients with diabetes, diaphoresis may indicate hypoglycemia, but other symptoms, such as epigastric pain, in this client make MI more likely. (Option C) Nausea and generalized weakness may result from some electrolyte imbalances, and the nurse should send blood for routine studies (eg, basic metabolic panel, complete blood count). However, a 12-lead ECG will give more immediate assessment information, allowing for quicker intervention if MI is present. Educational objective: Female, elderly, and diabetic clients tend to present with atypical symptoms of myocardial infarction. The nurse should obtain a 12-lead electrocardiogram immediately for any client with atypical symptoms before assessing for other causes.

A 70-Year-Old Female Client with Type 2 Diabetes Mellitus Comes