During a routine prenatal visit at the antepartal clinic, a multipara at 35 weeks gestation presents with 2+ edema of the ankles and feet. Which additional information should the practical nurse (PN) report to the registered nurse?

Based on the provided audio clip, the sound heard is a high-pitched, continuous, musical sound. This sound is characteristic of wheezing, which is caused by the narrowing of the airways due to inflammation, bronchoconstriction, or the presence of mucus. Wheezing is commonly associated with conditions such as asthma, chronic obstructive pulmonary disease (COPD), or bronchitis.

Let's evaluate the other options:

b) Rhonchi: Rhonchi are low-pitched, coarse, ratling sounds that typically indicate the presence of mucus or fluid in the larger airways. Rhonchi are often heard in conditions such as pneumonia or bronchitis, but they are different from the high-pitched wheezing sound heard in the audio clip.

c) Stridor: Stridor is a high-pitched, harsh, and crowing sound that is heard during inspiration. It is often associated with upper airway obstruction, such as in cases of croup, epiglottitis, or a foreign body obstruction. The sound in the audio clip does not match the characteristics of stridor.

d) Fine crackles: Fine crackles are discontinuous, high-pitched, and brief sounds that are typically heard during inspiration. They are often described as "velcro-like" or "rice crispies" and are associated with conditions such as pulmonary fibrosis or congestive heart failure. The sound in the audio clip does not resemble fine crackles.

In summary, the sound in the provided audio clip is best described as wheezing, characterized by a high- pitched, continuous, musical sound. Therefore, the practical nurse (PN) should document this sound as "wheeze."

Based on the provided information, the following components should be included in the treatment regimen for this client:

• Oral anti-diabetic:

  While oral medications are common in managing type 2 diabetes, the current information does not suggest immediate initiation of pharmacotherapy based solely on the random blood sugar result without further evaluation.

• Weight-reduction treatment: With a BMI of 28, the client is considered overweight. Weight reduction is an important aspect of managing diabetes and improving overall health. The treatment regimen should include strategies to promote weight loss, such as dietary modifications and increased physical activity.
• Exercise planning: Regular exercise is beneficial for managing diabetes and promoting overall health. The treatment regimen should include an exercise plan tailored to the client's abilities and preferences. This may involve aerobic exercises, strength training, and flexibility exercises.
• Nutrition education: Nutrition plays a crucial role in diabetes management. The client should receive education on healthy eating habits, portion control, carbohydrate counting, and the importance of a balanced diet. The treatment regimen should include ongoing nutrition education and support.

The following options should not be included in the treatment regimen for this client:

• Short-acting insulin: Based on the information provided, there is no indication for the immediate use of short-acting insulin in this client.
• Long-acting insulin: Similar to short-acting insulin, there is no indication for the immediate use of long-acting insulin in this client.
• Extra carbohydrates: Extra carbohydrates may not be necessary for this client unless prescribed by a healthcare professional to manage hypoglycemia or specific dietary needs.