A nurse is teaching a client who has multiple sclerosis. Which of the following instructions should the nurse include in the teaching?

Rationale:
A. Select a vein on the back of the hand: Veins on the dorsum of the hand are more fragile in older adults and have less subcutaneous tissue, increasing the risk of infiltration or phlebitis. Larger veins on the forearm are preferred for safer and more stable IV access.

B. Apply a tourniquet firmly above the insertion site: Excessive tourniquet pressure can damage fragile veins and impair circulation in older adults. The tourniquet should be applied gently enough to distend the vein without causing bruising or discomfort.

C. Clean the site using vigorous friction: Vigorous scrubbing can irritate or damage delicate skin in older adults. The site should be cleansed using gentle, circular motions with appropriate antiseptic solution to reduce infection risk without causing trauma.

D. Use a 22-gauge catheter for insertion: A 22-gauge catheter provides an appropriate balance between ease of insertion and adequate flow rate for older adult clients. Smaller-gauge catheters minimize trauma to fragile veins while still allowing effective IV therapy.

Rationale:

• Stool: The presence of blood and mucus in the stool (“currant jelly” stool) is classic for intussusception, caused by ischemia and mucosal sloughing of the affected bowel segment.

• Abdominal findings: A distended abdomen with a small, palpable, oblong mass in the right upper quadrant is characteristic of the telescoping bowel seen in intussusception.

• Pain rating: Severe, intermittent, colicky abdominal pain causing the child to draw knees to chest is hallmark of intussusception due to periodic intestinal obstruction and ischemia. Children with Crohn’s may report chronic mild to moderate pain, often intermittent. Pain in appendicitis is usually steady, localized and worsens over time.

• Vomiting : Vomiting is common in intussusception due to partial bowel obstruction, often light-colored and non-bilious in early stages. In appendicitis, nausea and vomiting are common early symptoms.

•Temperature: In Crohn's disease low-grade fever is common due to the chronic inflammatory process, while in appendicitis, low-grade fever is common due to inflammation or early infection.