A nurse is reinforcing discharge teaching with a client who has heart failure. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A. "Sarcoptes scabiei." Sarcoptes scabiei is the parasitic mite that causes scabies, a contagious skin condition. While scabies is highly transmissible through direct contact, it is not a nationally notifiable disease and does not require mandatory reporting to the state health department.
B. "Impetigo contagiosa." Impetigo is a bacterial skin infection commonly caused by Staphylococcus aureus or Streptococcus pyogenes. Although it is contagious, it is not classified as a reportable disease at the national level, though some local jurisdictions may require reporting in outbreak situations.
C. "Neisseria gonorrhoeae." Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae and is a nationally notifiable disease. Healthcare providers are required to report cases to public health authorities for surveillance, tracking, and prevention efforts, as untreated gonorrhea can lead to serious complications such as pelvic inflammatory disease, infertility, and neonatal infections.
D. "Human papillomavirus." Human papillomavirus (HPV) is the most common sexually transmitted infection, with multiple strains that can cause genital warts and cervical cancer. Although HPV is a significant public health concern, individual cases are not typically required to be reported to state health departments unless part of a specific surveillance program.

A. Current medications. The client is taking ibuprofen 800 mg three times daily, which is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can cause gastric mucosal injury, leading to peptic ulcers and gastrointestinal bleeding. Given the client's symptoms and history of dark, tarry stools, the use of NSAIDs requires immediate follow-up to prevent further complications.
B. Respiratory rate. The client’s respiratory rate is 18/min, which is within the normal range (12 to 20/min). This finding does not require immediate follow-up.
C. WBC count. The WBC count is 6,700/mm³, which falls within the normal range (5,000 to 10,000/mm³). There is no indication of an active infection or leukocytosis requiring urgent intervention.
D. Heart rate. The heart rate is 118/min, which is elevated and suggests tachycardia. This could be a compensatory response to hypovolemia from gastrointestinal bleeding. Immediate follow-up is necessary to prevent hemodynamic instability.
E. Stool results. The stool test is positive for occult blood, indicating gastrointestinal bleeding. This finding requires immediate follow-up to determine the severity of bleeding and prevent further blood loss.
F. Temperature. The client’s temperature is 37.5°C (99.5°F), which is within the normal range. There is no indication of fever or infection, so this does not require immediate intervention.
G. Blood pressure. The blood pressure is 90/50 mm Hg, which is low and may indicate hypovolemia due to gastrointestinal blood loss. Hypotension combined with tachycardia is a concerning sign that requires urgent intervention.
H. Hemoglobin and hematocrit. The hemoglobin (9.1 g/dL) and hematocrit (27%) are low, suggesting anemia likely due to chronic blood loss. This requires immediate follow-up to assess for continued bleeding and the need for interventions such as fluid resuscitation or blood transfusion.