A nurse is caring for a client who is newly diagnosed with type 1 diabetes mellitus. The nurse should recognize that the client needs a referral for diabetic education when the client does which of the following?

Restlessness is a common sign that a client's pain is not adequately relieved. When a client experience unrelieved pain, they may find it difficult to get comfortable and may exhibit restlessness, such as frequently changing positions, fidgeting, or appearing agitated. It is important for the nurse to assess the client's pain level and address any concerns regarding pain management.

While difficulty swallowing (dysphagia), constipation, and urinary retention can be potential side effects or complications associated with spinal epidural anesthesia, they are not specific indicators of unrelieved pain. These findings may be related to the effects of the anesthesia itself or other factors, and they should still be assessed and addressed by the nurse. However, restlessness is more directly linked to the experience of pain and should be recognized as an important sign that the client's pain relief measures may need adjustment.

b. Perform passive range-of-motion exercises.

During a vaso-occlusive crisis in sickle-cell disease, blood flow to certain areas of the body may be restricted, leading to pain and tissue damage. Passive range-of-motion exercises can help promote blood circulation and prevent joint stiffness and further complications. These exercises involve gently moving the child's joints through their full range of motion without active participation from the child.

Explanation for the other options:

a. Limit fluid intake during the evening: Fluid intake is important in sickle-cell disease to prevent dehydration and maintain adequate blood flow. Restricting fluid intake during a vaso-occlusive crisis can further contribute to dehydration and may worsen the crisis. It is important to encourage fluid intake unless otherwise instructed by the healthcare provider.

c. Apply cold compresses to painful areas: Cold compresses are not recommended during a vaso-occlusive crisis in sickle-cell disease. Cold temperatures can cause vasoconstriction and further worsen the blood flow to affected areas, leading to increased pain and tissue damage. Warm compresses or warm packs may be used to promote vasodilation and provide pain relief.

d. Provide a low-protein diet: A low-protein diet is not specifically indicated in the plan of care for a vaso- occlusive crisis in sickle-cell disease. Adequate protein intake is important for overall nutritional needs and tissue repair. The focus of nutritional management in sickle-cell disease is usually on a well-balanced diet that includes adequate hydration and appropriate nutrient intake.

In summary, performing passive range-of-motion exercises is an appropriate intervention to include in the

plan of care for a school-age child experiencing a vaso-occlusive crisis in sickle-cell disease.