A nurse is teaching the parents of a school-age child who is newly diagnosed with juvenile idiopathic arthritis. Which of the following interventions should the nurse include in the teaching?

Rationale for correct choices

• Preeclampsia: The client is at 30 weeks gestation with new-onset hypertension, right upper quadrant pain, headache, nausea, and facial edema, which are hallmark signs of preeclampsia. Laboratory findings, including thrombocytopenia (platelet count 98,000/mm³), elevated liver enzymes (AST 38, ALT 40), elevated uric acid (8.5 mg/dL), and proteinuria, further support this diagnosis.

• Blood pressure: The client’s blood pressure readings are elevated (148/94 mm Hg initially, 156/96 mm Hg an hour later), which is a key diagnostic criterion for preeclampsia. Hypertension directly contributes to maternal and fetal risk, making blood pressure monitoring critical in risk assessment and management.

• Urinalysis: Proteinuria (25 mg/dL) on urinalysis confirms renal involvement, a defining feature of preeclampsia. Detecting protein in the urine alongside elevated blood pressure strengthens the diagnosis and guides the nurse to monitor for worsening renal function or progression to severe preeclampsia.

Rationale for incorrect choices

• Urinary tract infection: The client has a normal WBC count in urine (2/low power field) and no significant bacteriuria or pyuria. Abdominal pain and nausea are better explained by preeclampsia rather than a urinary tract infection.

• Hyperemesis gravidarum: Although the client reports nausea and vomiting, hyperemesis gravidarum typically presents in the first trimester and involves severe dehydration, weight loss greater than 5% of pre-pregnancy weight, and ketonuria. This client is 30 weeks gestation with minimal weight gain and no ketones detected, making hyperemesis unlikely.

• Fetal heart rate: The fetal heart rate is within normal limits (140/min) and does not indicate maternal or fetal pathology at this time. While fetal monitoring is important, it is not a primary indicator of preeclampsia.

• Fundal height: The fundal height is consistent with gestational age (29 cm at 30 weeks) and does not provide evidence of preeclampsia. It is useful for general fetal growth assessment but is not a key diagnostic criterion in this context.

• Pain assessment: While right upper quadrant pain is present, pain alone cannot confirm preeclampsia without supporting evidence from blood pressure and urinalysis. Pain assessment is supplementary rather than definitive for risk evaluation.

A. Fold the top of the stocking over neatly: Folding the top of antiembolic stockings can create a tourniquet effect, restricting venous return and increasing the risk of skin injury or deep vein thrombosis. Stockings should lie flat without folds to maintain proper circulation.

B. Massage the client's legs once every 8 hr while the stockings are in place: Massaging the legs while antiembolic stockings are on is contraindicated because it can dislodge a thrombus if present, potentially causing a pulmonary embolism. Leg massage should be avoided in clients at risk for thromboembolic events.

C. Determine if the stockings are binding: Assessing whether the stockings are binding or causing constriction is essential. Improperly fitted stockings can impair circulation, lead to skin breakdown, and reduce the prophylactic effect against venous thromboembolism.

D. Apply the stockings after the client is in a chair: Antiembolic stockings should be applied while the client is supine with legs elevated to prevent edema and ensure even pressure distribution. Applying them while seated can reduce effectiveness and increase the risk of skin injury.