A nurse is caring for a client whose partner has a terminal diagnosis. Which of the following statements made by the client indicates effective coping?

• Open wound on right foot with purulent drainage: A non-healing wound with purulent drainage suggests infection, which is a major concern in clients with hyperglycemia. Poor wound healing is common in diabetes due to impaired circulation and immune function.
• Frequent urination, increased thirst, and unexplained 4.5 kg (10 lb) weight loss: Classic symptoms of hyperglycemia and possible diabetes mellitus. Polyuria and polydipsia result from osmotic diuresis due to high blood glucose levels, while unexplained weight loss may indicate the body breaking down fat and muscle for energy.
• Temperature 38.3° C (100.9° F): Fever indicates a possible systemic infection. In diabetic clients, infections can progress rapidly and lead to complications such as cellulitis, osteomyelitis, or sepsis.
• Heart rate 104/min: Tachycardia may be a response to fever, dehydration, or underlying infection. Persistent tachycardia could indicate worsening sepsis or hemodynamic instability.
• Blood pressure 98/74 mm Hg: While not critically low, this blood pressure is on the lower end and could indicate early signs of dehydration from polyuria or systemic infection.
• Blood glucose 250 mg/dL: Significantly elevated blood glucose suggests poor glycemic control, increasing the risk of infection, delayed wound healing, and diabetic ketoacidosis (DKA) if it continues to rise.:

• Respiratory rate 18/min: A normal respiratory rate does not indicate respiratory distress or metabolic compensation.
• Oxygen saturation 97% on room air: Oxygenation is within the normal range, suggesting no immediate hypoxia.
• WBC count 9,500/mm³: Within the normal range, although an infection may still be present given the fever and purulent wound drainage.
• Triiodothyronine (T3) 200 mg/dL: Within normal limits, ruling out thyroid dysfunction as a cause of symptoms.
• BMI 27: Slightly overweight but not directly contributing to the acute condition.

Sickle Cell Disease:
• Fatigue

Iron Deficiency Anemia:
• Ferritin level
• Fatigue
• Orthostatic hypotension

Pernicious Anemia:
• Vitamin B12 level
• Fatigue

Rationale:

• Vitamin B12 level: A decreased vitamin B12 level is characteristic of pernicious anemia, which results from impaired absorption of vitamin B12 due to intrinsic factor deficiency.

• Orthostatic hypotension: A drop in blood pressure upon standing is commonly seen in iron deficiency anemia due to reduced oxygen-carrying capacity and inadequate perfusion.

• Ferritin level: A low ferritin level indicates depleted iron stores, which is a hallmark of iron deficiency anemia.

• Fatigue: Fatigue is a common symptom in all three conditions due to reduced oxygen delivery to tissues. In sickle cell disease, fatigue results from chronic hemolysis and vaso-occlusive episodes. In iron deficiency anemia, it is caused by insufficient hemoglobin production. In pernicious anemia, fatigue results from ineffective erythropoiesis due to vitamin B12 deficiency.