165. A nurse is collecting a specimen for an aerobic culture from a client who has a draining pressure injury. Identify the sequence of actions the nurse should follow. (Move the Steps into the box on the right. placing them in the order of performance. use all the steps.)

A. Abdominal aortic aneurysm: While this condition is serious, it does not directly affect the safety of applying localized heat therapy to a distal site like the foot, unless systemic complications are present.
B. Osteoarthritis: Heat therapy is often beneficial in osteoarthritis, as it helps reduce joint stiffness and improve circulation to the affected area, making it a common and safe intervention.
C. Phlebitis: Warm compresses are sometimes used in phlebitis to reduce inflammation and promote comfort, provided there are no signs of infection or severe vascular compromise.
D. Peripheral neuropathy: Clients with peripheral neuropathy have impaired sensation and may not feel excessive heat, increasing the risk of burns or tissue injury. This makes heat therapy unsafe for these individuals.

Rationale for Correct Findings:

• Spontaneous abortion: The client is at 10 weeks gestation with moderate, bright red vaginal bleeding, abdominal cramping, and an open cervix. These findings are classic indicators of an inevitable spontaneous abortion, where pregnancy loss is imminent and cannot be prevented.
• Cervical dilation: Cervical dilation during early pregnancy, especially in the presence of bleeding and cramping, indicates that the pregnancy is not viable. The open cervix confirms the uterus is preparing to expel its contents, consistent with spontaneous abortion.

Rationale for Incorrect Findings:

• Ectopic pregnancy: Ectopic pregnancies typically present with unilateral pelvic pain and are usually associated with lower hCG levels than expected for gestational age. A confirmed intrauterine pregnancy with an open cervix and high hCG makes ectopic pregnancy unlikely.
• Molar pregnancy: Molar pregnancies are characterized by markedly elevated hCG levels, larger-than-expected uterine size, and sometimes passage of grape-like vesicles. The client's symptoms do not fit this profile, making this diagnosis less likely.
• hCG levels: The hCG level of 30,000 IU/L is within the normal range for 10 weeks gestation and does not indicate any problem. It supports a pregnancy of appropriate dating, not necessarily a spontaneous abortion.
• History of chlamydia infections: A history of recurrent chlamydia is a risk factor for ectopic pregnancy due to potential fallopian tube scarring. However, it does not directly support a current diagnosis of spontaneous abortion without additional findings.