A nurse is caring for a client who has a tracheostomy and requires suctioning. Identify the sequence of steps the nurse should follow after applying sterile gloves. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Rationale:

A. Provide humidification of the room air: Xerostomia, or dry mouth, often results from radiation therapy to the head and neck region. Humidifying room air adds moisture to the environment, helping relieve oral dryness and improving comfort, especially during sleep.

B. Suggest rinsing his mouth with an alcohol-based mouth wash: Alcohol-based mouthwashes can worsen oral dryness and irritate mucosal tissues, making xerostomia more uncomfortable. Clients should instead use alcohol-free or moisturizing rinses.

C. Instruct the client on the use of esophageal speech: Esophageal speech is a communication method taught to clients after laryngectomy, not for xerostomia. It does not address dry mouth and is unrelated to the effects of mandibular radiation.

D. Offer the client saltine crackers between meals: Saltine crackers are dry and salty, which can exacerbate oral dryness and discomfort. Clients with xerostomia benefit more from moist, soft foods and frequent sips of water.

Rationale:

A. “I will eat fish for dinner at least twice per week.” Fish is a good source of lean protein and omega-3 fatty acids, which are heart-healthy and easier on the pancreas compared to fatty meats. This aligns with dietary recommendations for pancreatitis recovery.

B. “I will eat small, frequent meals.” Eating small, frequent meals reduces pancreatic stimulation and helps manage pain and nausea. It also supports better nutrient absorption and glucose control in clients with pancreatitis and hyperglycemia.

C. “I will notify my provider if my urine is dark.” Dark urine may indicate worsening liver dysfunction or bile obstruction, especially with elevated bilirubin levels. Prompt reporting can lead to early intervention.

D. “I should expect my bowel movements to be pale in color.” Pale stools may signal bile duct obstruction or malabsorption and are not a normal or expected finding. This should be reported rather than expected.

E. “I will limit my morning coffee to no more than two cups.” Caffeine can exacerbate gastrointestinal symptoms and may increase pancreatic irritation; it is usually recommended to limit or avoid coffee during pancreatitis recovery.