A nurse is assisting with the plan of care for10-month-old infant who has HIV. Which of the following interventions should the nurse include in the plan?

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.

A) "I will get you information about some head-covering options."
This response acknowledges the client's concern about hair loss and provides a supportive and proactive solution. Many chemotherapy clients experience hair loss, and offering resources for head coverings shows empathy while helping them cope with the anticipated changes in appearance. It demonstrates the nurse's willingness to assist the client with emotional and physical challenges related to treatment.

B) "Let’s discuss this when we have more time."
Delaying the discussion about hair loss is not ideal. It dismisses the client’s current concern and may make the client feel like their feelings are not a priority. Hair loss can be a significant emotional challenge, and the nurse should address it in a timely and compassionate manner rather than postponing the conversation.

C) "I can’t imagine how difficult it would be to lose my hair."
While this response is empathetic, it focuses on the nurse's feelings instead of addressing the client's concern. It is important to maintain a client-centered approach and focus on the client's needs. The nurse should offer concrete support or information, such as head-covering options, rather than expressing personal emotions that may not be helpful to the client.

D) "I wouldn’t worry about this right now. Let's focus on your chemotherapy."
This response dismisses the client's concern about hair loss, which can be a significant issue for many clients starting chemotherapy. Minimizing the concern or suggesting it is not worth discussing at this time may make the client feel unheard or undervalued. It’s important to acknowledge the client’s worries and provide support for them to manage the emotional impacts of chemotherapy.