A nurse is providing teaching for a client diagnosed with gastroesophageal reflux disease (GERD) about ways to manage the condition. Which of the following instructions should the nurse include?

A. Increase physical activity and daily exercise.

Regular physical activity helps improve insulin sensitivity, manage blood glucose levels, and lower the risk of cardiovascular complications associated with diabetes.

B. Reduce cholesterol and saturated fat intake.

Managing cholesterol levels and reducing saturated fat intake can help lower the risk of cardiovascular disease, which is a common complication of diabetes.

C. Maintain optimal blood pressure to prevent kidney damage.

Controlling and maintaining blood pressure within optimal ranges is crucial in preventing kidney damage, a common complication of diabetes.

D. Enroll in a smoking-cessation program.

Smoking increases the risk of cardiovascular complications and can exacerbate other diabetes-related health issues. Quitting smoking is important in reducing the risk of complications.

E. Sustain hyperglycemia to reduce deterioration of nerve cells.

Sustaining hyperglycemia (high blood sugar levels) is detrimental and contributes to the progression of diabetic complications, including nerve damage (neuropathy). Lowering and controlling blood glucose levels are essential in preventing complications rather than sustaining hyperglycemia.

A. Encourage weight lifting during physical therapy:

Encouraging weight lifting or strenuous physical activities might not be advisable for individuals with advanced cirrhosis. Engaging in intense physical activity could potentially strain the liver or increase the risk of injury or bleeding, which is already heightened in individuals with cirrhosis.

B. Measure the client's abdominal girth:

Monitoring the client's abdominal girth is essential because cirrhosis can lead to the accumulation of fluid in the abdomen, known as ascites. Changes in abdominal girth can indicate the progression or resolution of ascites, guiding treatment and interventions.

C. Administer warfarin:

Administering warfarin, an anticoagulant, might not be ideal in cirrhosis due to the increased risk of bleeding. Liver dysfunction in cirrhosis can impair the production of clotting factors, increasing the risk of bleeding complications.

D. Administer furosemide:

Furosemide, a diuretic, can be utilized in managing ascites by promoting the elimination of excess fluid. However, its use requires careful monitoring, considering the electrolyte balance and potential adverse effects, especially in individuals with liver impairment.

E. Implement a low-sodium diet:

A low-sodium diet is crucial in managing cirrhosis-related complications, particularly ascites and edema. Sodium restriction helps reduce fluid retention, lessening the burden on the liver and alleviating symptoms associated with fluid accumulation.