A nurse is caring for a client who recently had a stroke and states, "I am having trouble swallowing my food." To which of the following members of the interprofessional team should the nurse initiate a referral?

A. "I will sleep on a soft mattress.": A soft mattress does not provide adequate joint support and may allow excessive joint flexion, increasing stiffness and discomfort in osteoarthritis. Firm or supportive surfaces help maintain proper spinal alignment and reduce mechanical stress on weight-bearing joints.

B. "I will apply a heating pad to make my hands feel better.": Heat therapy promotes vasodilation, increases blood flow, and relaxes periarticular muscles, which can reduce stiffness and improve joint mobility in osteoarthritis. Application of warm compresses or heating pads is particularly beneficial before activity to decrease morning stiffness and enhance range of motion.

C. "I will take aspirin on an empty stomach.": Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate the gastric mucosa by inhibiting prostaglandin synthesis, increasing the risk of gastritis and gastrointestinal bleeding. Taking these medications with food or milk reduces gastric irritation.

D. "I will exercise my joints as much as I can when they are inflamed.": During periods of acute inflammation, excessive joint use can worsen pain and tissue irritation. Low-impact, regular exercise is encouraged, but it should be balanced with rest during flare-ups to prevent additional joint stress and exacerbation of symptoms.

• Muscle guarding: Muscle guarding is a classic sign of peritoneal irritation, most commonly seen in acute appendicitis. Rebound tenderness and right lower quadrant pain strongly support inflammation of the appendix. Guarding occurs as the abdominal muscles contract to protect inflamed underlying tissue. It is not typically associated with celiac disease and is less characteristic of uncomplicated diverticulitis.
• Increased temperature: Fever reflects an inflammatory or infectious process and is commonly seen in appendicitis and diverticulitis. Both conditions involve localized infection that can progress if untreated. The client’s rising temperature supports acute abdominal inflammation. Celiac disease is an autoimmune condition and does not usually present with fever.
• Nausea and vomiting: Nausea and vomiting frequently accompany appendicitis due to visceral irritation and inflammation. These symptoms can also occur in diverticulitis as a result of bowel inflammation and decreased motility. In contrast, celiac disease more commonly presents with chronic diarrhea and malabsorption rather than acute vomiting.
• Abdominal pain: Abdominal pain is present in all three conditions but differs in character and location. Appendicitis typically causes right lower quadrant pain, while diverticulitis often presents with left lower quadrant pain. Celiac disease can cause diffuse abdominal discomfort related to gluten exposure and malabsorption.
• Elevated WBC count: An elevated white blood cell count indicates an acute inflammatory or infectious process, which is characteristic of appendicitis and diverticulitis. Leukocytosis reflects the body’s immune response to bacterial infection or tissue inflammation. Celiac disease does not typically cause leukocytosis because it is a chronic autoimmune condition rather than an acute infection.