A nurse is providing teaching about foot care to a client who has diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply)

Rationale:

A. A newborn who has forceful vomiting with feedings: Forceful vomiting in a newborn may indicate pyloric stenosis, gastrointestinal obstruction, or other serious conditions that can quickly lead to dehydration and electrolyte imbalance. This is an urgent finding requiring immediate assessment to prevent rapid deterioration.

B. A newborn who has a heart rate of 160/min while crying: A heart rate of 160/min is within the expected range for a newborn (120–160/min) during activity or crying. While monitoring is necessary, this finding is not immediately concerning and does not require urgent intervention.

C. A newborn who is 24 hr of age and has blood-tinged vaginal discharge: A small amount of blood-tinged vaginal discharge (pseudomenstruation) is a normal hormonal response in female newborns due to maternal estrogen withdrawal. This is an expected finding and does not require urgent assessment.

D. A newborn who is 12 hr of age and has not voided: While monitoring urinary output is important, a newborn may normally not void within the first 12 hours of life. Assessment is needed, but it is not as urgent as forceful vomiting, which can quickly cause serious complications.

Rationale:

A. Administer a bronchodilator following meals: Bronchodilators should be administered before meals, not after, to help relieve shortness of breath and improve the client’s ability to eat without fatigue or dyspnea. Giving them afterward does not assist with eating difficulties.

B. Limit the client's food consumption between meals: Restricting food intake between meals would reduce overall caloric intake, which is counterproductive for a client who is underweight and experiencing nutritional deficits due to COPD. Frequent small meals are usually recommended.

C. Arrange for a low-protein diet: Clients with COPD who are underweight often need adequate protein to maintain muscle mass and respiratory function. A low-protein diet could worsen malnutrition and impair recovery.

D. Request non-gas-forming foods from the dietary department: Non-gas-forming foods reduce bloating and abdominal discomfort, which can make eating easier for clients with COPD who experience dyspnea. This intervention supports improved caloric intake and minimizes respiratory compromise during meals.