The nurse assesses a client with uncontrolled hyperthyroidism and infection. Which findings require immediate follow-up? Highlight the findings that indicate possible thyroid storm with systemic decompensation.

Nurses' Notes 0730: The client with Graves disease is admitted for pneumonia after missing antithyroid medication for several days. The history notes that a fine hand tremor has been present for several months and is unchanged since clinic. The chart also shows that body weight decreased 4 kg over the previous 3 months according to clinic records. At 0740, the nurse records that oral temperature is 40.2 °C despite removal of heavy bedding. The prior laboratory report shows that thyroid-stimulating hormone remains below the reportable range on the current panel. The client says that mild heat intolerance usually occurs during household activity and improves with rest. At 0745, telemetry shows that atrial fibrillation continues at an extremely rapid ventricular rate. The neck assessment confirms that a diffuse goiter was documented previously and remains unchanged in the handoff. The nurse observes that new disorientation and severe agitation develop during the assessment. The medication record shows that the first prescribed antibiotic dose was administered as scheduled for pneumonia. At 0750, the monitor shows that blood pressure decreases to 82/46 with cool distal extremities. The nurse activates rapid evaluation for suspected thyroid storm and prepares ordered emergency measures. Continuous cardiac, temperature, respiratory, and neurologic monitoring is started.