A nurse is reviewing the electronic health record (EHR) of a client who has type 2 diabetes mellitus. Which of the following findings in the client EHR should the nurse identify as a risk factor for type 2 diabetes mellitus?

• Pneumonia: The preschooler is showing signs of shallow breathing, refusal to use the incentive spirometer, and slightly diminished breath sounds in the bilateral lower lobes, all of which increase the risk of developing pneumonia. Postoperative patients, especially young children, are vulnerable to pneumonia due to pain-limited deep breathing and poor pulmonary expansion.
• Wound infection: Although there is some serosanguinous drainage at the incision site, the dressing remains dry overall, and there is no mention of redness, warmth, or purulent discharge typically associated with wound infection. Therefore, wound infection is not the primary concern at this point.
• Ileus: Hypoactive bowel sounds are present, but they have been stable throughout the day without worsening abdominal distension or absence of bowel function. While ileus is a postoperative risk, the more pressing concern given the respiratory findings is pneumonia.
• Shallow breathing: The child consistently shows shallow, unlabored respirations throughout assessments, which indicate limited lung expansion. Without effective use of the incentive spirometer and adequate deep breathing, shallow breathing places the child at high risk for pulmonary complications such as pneumonia.
• Increasing temperature: Although the child's temperature rose slightly by 1600, it remains below 38° C (100.4° F), which is not typically classified as a fever. The minor temperature elevation could be related to inflammation rather than an infectious process at this stage.
• Hypoactive bowel sounds: Hypoactive bowel sounds are expected in the early postoperative period, particularly following abdominal surgery due to the effects of anesthesia and manipulation of the bowel during surgery. While they should be monitored, they are not the primary finding indicating the most urgent complication in this situation.

A. "I will empty the pouch every 2 to 3 hours.": While it is important to empty the pouch when it is about one-third to half full, emptying it every 2 to 3 hours is unnecessary unless output is extremely high. Frequent emptying is based on the volume of stool, not strict timing.

B. "I will no longer be able to eat nuts.": Clients with a sigmoid colostomy typically resume a normal diet after healing, including nuts, unless otherwise instructed. Nuts are more commonly restricted after ileostomies due to the risk of obstruction, not sigmoid colostomies.

C. "I should expect my stool to be unformed.": Stool from a sigmoid colostomy is usually formed or semi-formed because it comes from the end of the colon where water absorption has mostly occurred. Unformed stool is more characteristic of ileostomies.

D. "I will notify my doctor if the stoma starts to look purple.": A healthy stoma should appear pink to red and moist. A purple, dark, or dusky stoma indicates impaired blood flow or ischemia and requires immediate medical evaluation to prevent serious complications.