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 for correct choices

• The statement "Why don't you just leave me? I am of no use" reflects hopelessness, a high‑risk indicator for self‑harm in older adults. Expressions of worthlessness or being a burden require immediate follow‑up because they signal severe depression or suicidal ideation. The priority is ensuring safety and initiating urgent mental health evaluation.

• The report of cognitive decline accompanied by worsening memory, disordered thought process, and impaired self‑care indicates a significant functional deterioration. These symptoms can reflect rapidly progressing depression, delirium, or early dementia. Any acute decline in cognition or functional ability in an older adult warrants prompt assessment to identify reversible causes.

• Loss of appetite with an 8‑lb weight loss in one month suggests clinically significant unintentional weight loss. Combined with decreased interest in eating, this is a red flag for major depressive disorder, frailty progression, or underlying illness. Sudden nutritional decline increases morbidity risk and requires timely intervention.

• Poor eye contact, monotone speech, and flat facial expression are key affective indicators of depression. These signs, when combined with statements of worthlessness, suggest severe depressive symptoms that require urgent assessment and intervention to prevent further decline.

Rationale for incorrect choices

• Sleeping 7 hours per night with 1–2 awakenings to urinate can be normal for older adults. This finding does not indicate acute risk and is not a priority compared with weight loss, cognitive decline, or suicidal statements. It can be evaluated during routine assessment rather than requiring urgent follow‑up.

• Heart rate 68/min is within normal limits for an older adult and does not signal instability or deterioration. It does not require immediate intervention and can be monitored routinely while priority concerns related to mood, cognition, and safety are addressed.

Rationale:

A. A liaison negotiates with service providers to obtain accessible cost-effective care: One of the primary roles of a nurse case manager as a liaison is to connect clients with necessary healthcare services. This includes coordinating with service providers, negotiating costs, and ensuring that clients have access to appropriate, cost-effective care to meet their needs.

B. A liaison promotes interprofessional communication: While promoting communication among healthcare team members is an important function of case management, it is more closely aligned with the role of a coordinator rather than the liaison function, which focuses on external connections and access.

C. A liaison monitors the use of clinical practice guidelines for delivery of care: Monitoring adherence to clinical guidelines is part of quality assurance and clinical oversight, which falls under the role of a case manager or quality improvement nurse, not specifically the liaison role.

D. A liaison measures the quality of services being provided: Measuring service quality is a responsibility related to quality management or evaluation within case management, not the primary function of a liaison. The liaison role emphasizes connecting clients to resources rather than evaluating service performance.