What is the immediate step for a client with hyperthyroidism who has visual changes and pressure behind her eyes?

In a client with hyperthyroidism experiencing visual changes and pressure behind the eyes, the immediate priority is to manage potential complications related to thyroid eye disease, also known as Graves' ophthalmopathy. This condition can lead to severe visual impairment if not addressed promptly.

Referring the client for an immediate evaluation by an ophthalmologist is the appropriate step because they can assess the severity of the visual changes and determine if there is risk of damage to the optic nerve or other critical structures in the eye. Timely intervention by an eye specialist can prevent further deterioration of vision and manage symptoms like eye pain, double vision, and proptosis (bulging eyes).

While options such as ordering a thyroid ultrasound or total thyroxine (T4) could provide additional information about thyroid function and structural abnormalities, they are not immediate interventions for the acute changes the client is experiencing. Prescribing a beta-adrenergic blocker, while it may address symptoms like increased heart rate associated with hyperthyroidism, does not directly address the ophthalmic concerns that need urgent evaluation. Immediate referral to an ophthalmologist allows for focused assessment and intervention specific to the eye-related symptoms, making it the most critical and immediate step.