A nurse in the Emergency Department (ED) is caring for a client who is having acute asthma attack. Which of the following assessments indicates that the respiratory status is declining?(Select all that apply)

A. This statement indicates a good understanding of nutritional needs. High-protein foods are essential for maintaining muscle mass and supporting immune function, particularly for individuals with HIV. Finger foods can also help if the client has a reduced appetite or difficulty with larger meals.
B. While hydration is important, 1 liter may not be sufficient for overall health, especially if the client is experiencing weight loss or other symptoms of dehydration. The nurse would typically recommend a higher intake, considering fluid needs can vary based on activity level and overall health.
C. This statement may not be optimal for weight gain. For someone struggling with weight maintenance, smaller, more frequent meals may be more beneficial than three large meals. Large meals might lead to fullness and decrease overall caloric intake, which can hinder weight gain efforts.
D. While fats can provide a high caloric density, a diet excessively high in unhealthy fats is not ideal. It’s important to focus on healthy fats (like avocados, nuts, and olive oil) rather than just increasing fat intake indiscriminately.

A. Gouty arthritis, or gout, is characterized by the accumulation of uric acid crystals in the joints, leading to sudden and severe pain, especially in the big toe (podagra). The presence of tophi (deposits of uric acid crystals under the skin) on the left toe is a classic sign of chronic gout. The patient's high BMI and frequent beer consumption also increase the risk for elevated uric acid levels, contributing to gout.
B. Rheumatoid arthritis is an autoimmune condition that typically causes symmetric joint pain and stiffness, often involving the small joints of the hands and feet. It is less likely to present with tophi and is usually not linked to a history of beer consumption or a specific joint (like the big toe) in isolation.
C. Systemic lupus erythematosus (SLE) can cause joint pain, but it usually involves multiple joints in a symmetrical pattern and is associated with a range of other systemic symptoms. The presence of tophi and the specific pain in the big toe point more toward gout.
D. Osteoarthritis is a degenerative joint disease that commonly affects weight-bearing joints and can cause pain, especially with movement. However, it does not typically cause the acute attacks or the presence of tophi that are characteristic of gout.