A 38-year-old female client was diagnosed with a right lower extremity deep vein thrombosis (DVT) after surgery 2 days ago. This morning the nurse reviews the client's electronic health record to complete a shift assessment. Data from the health record include a prescription from the primary health care provider for warfarin 5 mg orally every day, and the following laboratory results:

• Hemoglobin: 17 g/dL
• Hematocrit: 44.9%
• WBC count: 5500/mm³
• Platelets: 160,000/mm³
• aPTT: 40 sec
• PT: 12 sec
• INR: 0.9
• BUN: 16 mg/dL
• Creatinine: 0.6 mg/dL

The nurse assesses the client for which signs and symptoms of a DVT?

Choice A reason: Addison's Disease is characterized by insufficient production of adrenal hormones, leading to symptoms like weight loss, hyperpigmentation, low blood pressure, and severe fatigue. The lab findings would typically show low sodium, high potassium, and low cortisol levels. RM's lab results and symptoms are not consistent with Addison's Disease, making this an unlikely diagnosis.
Choice B reason: Cushing syndrome results from excess cortisol production, often causing weight gain, particularly around the abdomen and face, thinning skin, and hypertension. RM's symptoms of fatigue, dry skin, hair loss, and weight gain without dietary changes do not align with Cushing syndrome, and her lab results do not indicate elevated cortisol levels.
Choice C reason: Hyperthyroidism is characterized by excessive thyroid hormone production, leading to symptoms like weight loss, anxiety, palpitations, and heat intolerance. RM's symptoms of weight gain, fatigue, and cold intolerance, along with her lab results showing low T4 and T3 and elevated TSH, are not consistent with hyperthyroidism.
Choice D reason: Hypothyroidism occurs due to an underactive thyroid gland producing insufficient thyroid hormones. This leads to symptoms such as fatigue, weight gain, cold intolerance, dry skin, hair loss, and constipation. RM's lab results showing low T4 and T3 levels and elevated TSH align with the diagnosis of hypothyroidism. The body's response to low thyroid hormone levels is to increase TSH production in an attempt to stimulate the thyroid gland. The clinical presentation and lab findings point towards hypothyroidism as the correct diagnosis.

Choice A reason: Suggesting the use of adult incontinence briefs for nighttime only may help manage incontinence during the night, but it does not address the primary issue of urinary retention caused by a flaccid bladder. Incontinence briefs are a passive approach and do not prevent urinary retention or the complications associated with it, such as urinary tract infections and kidney damage. Additionally, it does not empower the patient to actively manage their urinary retention.
Choice B reason: Assisting the patient to the commode every 2 hours during the day can help to some extent in managing urinary retention. However, this approach requires constant assistance and is not practical for long-term management, especially when the patient is alone or in settings where frequent assistance is not available. This method also does not ensure complete bladder emptying, which is crucial for preventing urinary tract infections and other complications.
Choice C reason: Teaching the patient how to self-catheterize is the most appropriate and effective action for managing urinary retention caused by a flaccid bladder. Self-catheterization allows the patient to empty the bladder regularly and completely, reducing the risk of urinary tract infections, bladder distention, and kidney damage. It also provides the patient with a sense of control and independence in managing their condition. Self-catheterization is a standard and recommended practice for individuals with neurogenic bladder dysfunction due to multiple sclerosis.
Choice D reason: Encouraging decreased evening intake of fluid can help reduce nighttime urination, but it does not address the issue of urinary retention caused by a flaccid bladder. Decreasing fluid intake is not a comprehensive solution and does not prevent complications associated with incomplete bladder emptying. It is important to manage fluid intake appropriately, but this should be part of a broader strategy that includes effective bladder emptying techniques like self-catheterization.