A nurse is developing home care instructions for a client with peripheral artery disease (PAD). Which intervention should the nurse include?

Choice A reason: Polyuria and excessive thirst are classic symptoms of diabetes insipidus and indicate the body's inability to retain water due to a lack of antidiuretic hormone (ADH). While these symptoms need to be managed, they are not immediately life-threatening compared to severe hypernatremia.

Choice B reason: A serum sodium level of 185 mEq/L (185 mmol/L) indicates severe hypernatremia, which is an immediate medical emergency. Severe hypernatremia can lead to neurological symptoms such as confusion, seizures, and even coma due to the osmotic shift of water out of brain cells. Immediate intervention is required to correct the sodium imbalance and prevent serious complications.

Choice C reason: An apical heart rate of 110 beats per minute is indicative of tachycardia, which can be associated with dehydration and the body's response to maintain cardiac output. While it is a concern, it does not take precedence over the need to address severe hypernatremia.

Choice D reason: Dry skin with inelastic turgor is a sign of dehydration, which is a common issue in diabetes insipidus due to excessive fluid loss. While this requires attention, it is not as immediately critical as addressing severe hypernatremia, which poses a direct and urgent threat to the client's neurological and overall health.

Choice A reason: Replacing dietary table salt with salt substitutes is not specifically related to managing gout. Gout is caused by the accumulation of uric acid crystals in the joints, leading to inflammation and pain. The primary dietary factor influencing gout is purine intake, not sodium. While reducing sodium intake is generally beneficial for overall cardiovascular health, it does not directly impact uric acid levels or the management of gout. Therefore, recommending salt substitutes does not address the underlying cause or prevention of gout attacks. Moreover, some salt substitutes contain potassium chloride, which can have its own health implications, particularly for individuals with kidney issues.

Choice B reason: Encouraging active range of motion to limit stiffness is important for maintaining joint function in many conditions, but during an acute gout attack, the primary focus should be on reducing inflammation and pain. Gout attacks cause severe pain and swelling, particularly in the affected joint, and encouraging active movement during an acute phase can exacerbate the pain and inflammation. It is more appropriate to rest the affected joint and manage pain and inflammation with medications and other supportive measures. Once the acute phase has resolved, gradual reintroduction of movement and exercise can help maintain joint function and prevent long-term stiffness.

Choice C reason: Taking prescribed pain medication after exercising joints is not appropriate advice for managing gout. Pain medication, such as NSAIDs (nonsteroidal anti-inflammatory drugs), should be taken as prescribed by the healthcare provider to effectively manage pain and inflammation. It is crucial to follow the prescribed regimen for pain management, regardless of exercise or activity. Furthermore, during an acute gout attack, it is advisable to avoid activities that may aggravate the affected joint. Pain management should be proactive, and medications should be taken at regular intervals to maintain pain relief rather than in response to specific activities like exercise.

Choice D reason: Avoiding the consumption of wine, beer, and coffee is crucial for managing gout. Alcohol, particularly beer and wine, contains high levels of purines, which can increase uric acid production and exacerbate gout symptoms. Alcohol also promotes dehydration, which can lead to higher uric acid concentrations in the blood. Both of these factors can trigger gout attacks. Coffee has mixed effects on gout; while some studies suggest that moderate coffee consumption may not significantly impact uric acid levels, it is generally advised to be cautious with its intake. Educating the client to avoid or limit these beverages can help prevent future gout attacks and manage symptoms more effectively. Dietary modifications are a key component of gout management, and avoiding high-purine foods and beverages is essential in reducing the frequency and severity of gout attacks.