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Difficulty: HardHigh Risk Behaviors

A 28-year-old client is brought to the emergency department after heavily using cocaine at a party. The client is profoundly agitated, diaphoretic, and reporting severe, crushing chest pain. Place the following nursing interventions in the correct order of priority.

  1. 1Apply continuous cardiac monitoring and assess vital signs.
  2. 2Establish peripheral intravenous (IV) access.
  3. 3Administer a prescribed intravenous benzodiazepine.
  4. 4Obtain a 12-lead electrocardiogram (ECG).
  5. 5Dim the room lights and minimize environmental noise.

Answer

The correct sequence prioritizes immediate cardiovascular assessment and circulatory access, followed by targeted pharmacological de-escalation of the hyperadrenergic state, diagnostic evaluation of the chest pain, and environmental modification.
In the setting of acute cocaine intoxication with severe agitation and chest pain, the priority is to assess the cardiovascular status and establish a route for medication. The immediate pharmacological treatment of choice is intravenous benzodiazepines to control the hyperadrenergic state. Once the client is calmed and hemodynamically stabilized, a 12-lead ECG can be accurately obtained to evaluate for myocardial ischemia. Finally, environmental modifications support continued stabilization.

Step-by-Step Solution

1
Prioritize immediate assessment.
Applying continuous cardiac monitoring and assessing vital signs.
Cocaine is a potent sympathomimetic that causes severe vasoconstriction, tachycardia, and hypertension. Immediate cardiovascular assessment is critical.
2
Prepare for pharmacological intervention.
Establishing peripheral IV access.
Rapid administration of emergency medications is required to stabilize the client's vital signs and control agitation.
3
Administer targeted therapy.
Administering an intravenous benzodiazepine.
Benzodiazepines are the treatment of choice for cocaine-induced agitation and cardiovascular toxicity, as they blunt the excessive sympathetic outflow and prevent seizures.
4
Perform diagnostic evaluation.
Obtaining a 12-lead ECG.
An ECG is necessary to evaluate the chest pain, but the client must be chemically calmed first to obtain an accurate, artifact-free tracing.
5
Modify the environment.
Dimming the lights and minimizing noise.
Reducing sensory input prevents further escalation of agitation and sympathetic response after acute medical stabilization.

Key Concept

Prioritization in Acute Stimulant Intoxication
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Topics

High Risk Behaviors

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