A nurse assisting with the care of a client who is admitted to the medical-surgical unit.

The nurse is reviewing the client's laboratory findings and vital signs.

Select the 5 findings that require immediate follow-up.

A) *Once you have completed a living will, it cannot be changed: This statement is inaccurate. A living will can be revised or updated at any time while the client is still capable of making decisions. The client can amend or revoke their living will if they change their mind about their wishes regarding end-of-life care or other medical decisions.

B) "You will need an attorney to appoint a health care surrogate": This statement is incorrect. While legal assistance might be beneficial in some cases, it is not required to appoint a health care surrogate. The appointment can typically be done through a simple form provided by the facility, and it is not necessary to hire an attorney for this process.



C) "You should appoint a family member as your health care surrogate": While appointing a family member as a health care surrogate is common, it is not a requirement. The person appointed should be someone who understands the client’s wishes and will act in the client's best interest. It is important to select someone who can make tough decisions, but it
doesn’t have to be a family member.

D) "Your health care surrogate will make decisions on your behalf if you are unable": This statement is correct. A health care surrogate is a person appointed to make medical decisions on behalf of the client if they are unable to do so themselves due to incapacity. This role is critical when the client cannot communicate their wishes due to illness or injury.

The client reports joint pain in the knee and wrist with a history of gout in the family. The elevated uric acid level (7.2 mg/dL) supports a diagnosis of gout, a condition caused by uric acid crystal deposition in the joints. The negative ANA and normal ESR make inflammatory autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus unlikely.

Actions to Take:

Instruct the client to avoid foods high in purines.

Purine-rich foods (e.g., red meat, shellfish, organ meats) contribute to increased uric acid production, exacerbating gout symptoms. Dietary modifications can help reduce flare-ups and long-term complications.

Instruct the client to apply topical analgesics.

Topical analgesics can provide localized pain relief and reduce discomfort in affected joints. They serve as an adjunct to systemic medications in managing acute symptoms.

Parameters to Monitor:

Uric acid levels.

Monitoring uric acid levels helps assess the effectiveness of dietary changes and medications in preventing flare-ups and reducing joint damage.

Joint deformities.

Chronic gout can lead to joint destruction and tophi formation, so assessing for deformities helps track disease progression and the need for further interventions.