A charge nurse is teaching a newly licensed nurse about health care-associated infections (HAIs). Which of the following should the nurse include in the teaching as examples of HAIS?

A. Oral hypoglycemic medications are often prescribed to lower blood glucose levels in individuals with type 2 diabetes mellitus. They work by either increasing insulin production, improving insulin sensitivity, or reducing glucose production by the liver. These medications are typically considered when lifestyle modifications alone are insufficient to achieve target blood glucose levels.
B. Insulin therapy is considered in type 2 diabetes who cannot achieve adequate glucose control with oral medications alone.
C. Peritoneal dialysis is not typically indicated as a secondary prevention measure for diabetes mellitus. Peritoneal dialysis is a treatment for end-stage renal disease (ESRD) when the kidneys can no longer function effectively.
D. Fluid restrictions may be necessary in clients with advanced kidney disease (nephropathy) resulting from diabetes. However, fluid restrictions alone do not constitute a secondary prevention action for diabetes mellitus itself.

A. A decrease in systolic blood pressure from 140 mm Hg to 120 mm Hg could indicate hypotension. Postoperatively, especially after receiving a spinal anesthetic, hypotension can occur due to vasodilation or decreased sympathetic tone. This change in blood pressure warrants notification of the provider because significant hypotension can lead to inadequate perfusion to vital organs and tissues.
B. A slight increase in temperature from 37.2°C to 37.5°C (99.0°F to 99.5°F) is a mild elevation and may not necessarily require immediate notification unless accompanied by other signs of infection or instability. It could be related to the stress response post-surgery. However, if there are other concerning signs (e.g., increased heart rate, worsening pain), the nurse should reassess and consider further action.

C. A decrease in pulse oximetry from 98% to 96% indicates a mild decrease in oxygen saturation. While this change alone may not be alarming, the nurse should assess the client's respiratory status and potential causes (e.g., positioning, respiratory depression from anesthesia). Oxygen saturation levels below 95% generally require intervention, but 96% is still within a normal range for most clients.
D. An increase in pain from 4/10 to 6/10 indicates worsening pain. Postoperatively, increasing pain may indicate inadequate pain management, worsening condition at the surgical site, or other complications such as hematoma or infection.