A nurse is developing a care plan for a client who is in Buck's traction and is scheduled for surgery for a fractured femur of the right leg. Which of the following interventions should the nurse delegate to an assistive personnel?

A. Dextrose 10% in water is commonly used to prevent hypoglycemia in patients receiving TPN if the TPN infusion is running low and a new bag isn't available immediately.
B. Discontinuing the infusion could lead to nutritional deficiencies or glucose instability.
C. Slowing the infusion rate does not solve the issue of a soon-to-be-depleted TPN bag and may cause fluid imbalance.
D. Lactated Ringer's solution is not a substitute for the nutritional requirements provided by TPN.

Condition: Osteoarthritis

• The client reports pain in the right knee and left wrist over the last two years. OA typically presents with chronic, localized joint pain, particularly in weight-bearing joints (e.g., knees) and joints that experience repetitive use (e.g., wrists).
• Crepitus (a crackling or grating sound when the joint moves) is noted in both the right knee and left wrist, which is a characteristic finding in osteoarthritis due to cartilage breakdown and joint space narrowing.
• The absence of systemic symptoms such as rashes or other joint pain, as well as normal laboratory values (e.g., normal ESR, normal ANA), further supports a diagnosis of osteoarthritis rather than conditions like systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), which are associated with systemic inflammation.

Actions to Take for Osteoarthritis:

• Instruct the client to apply heat and cold:

Heat and cold therapy can help manage the pain and stiffness associated with osteoarthritis. Cold therapy can reduce inflammation, while heat therapy can improve blood flow and relax the muscles around the joint.

• Instruct the client to apply topical analgesics:

Topical analgesics (such as menthol or capsaicin creams) can provide localized pain relief for osteoarthritis. They are commonly used as part of the non-pharmacological treatment approach for joint pain.

Parameters to Monitor for Osteoarthritis:

• ESR (Erythrocyte Sedimentation Rate):

While osteoarthritis is generally not associated with systemic inflammation, monitoring the ESR can help ensure that there are no signs of additional inflammatory processes (such as rheumatoid arthritis) that might be missed. In this case, the client's ESR is within the normal range (20 mm/hr), which supports the diagnosis of osteoarthritis.

• Joint deformities:

Monitoring for joint deformities over time is essential in osteoarthritis to assess disease progression. OA can lead to the formation of osteophytes (bone spurs) and other joint deformities that might impair function.

Explanation for incorrect choices; Systemic Lupus Erythematosus (SLE):

SLE typically presents with a variety of symptoms, including a characteristic butterfly-shaped rash on the face, photosensitivity, and systemic involvement such as kidney or neurological issues. The client does not exhibit any skin rashes, systemic symptoms, or abnormal ANA (antinuclear antibody), which would be elevated in SLE.

Gout:

Gout involves the deposition of uric acid crystals in joints, leading to sudden, severe pain, usually in the big toe (but other joints can be involved). While the client has a mildly elevated uric acid level (7.2 mg/dL, which is within the upper limit), there are no signs of an acute gout flare (such as intense joint pain, redness, and swelling). Additionally, the client’s symptoms are chronic, which is more consistent with OA.

Rheumatoid Arthritis (RA):

RA is an autoimmune disease that causes inflammation and deformities in the joints, usually in a symmetrical pattern (e.g., both wrists or knees). The client’s presentation does not fit this pattern, and laboratory results (normal ANA, ESR) do not suggest an autoimmune inflammatory condition like RA.