The nurse is caring for the terminally ill client.
Which interventions should the nurse implement to help minimize the stress and frustration experienced by the client and their family? Select all that apply.

The nurse must identify the client's highest risk factors for perioperative complications. While the client is currently in the preoperative area for a hip arthroplasty due to osteoarthritis, their specific medical history places them at an elevated priority for the development of a Deep vein thrombosis (DVT). Total hip arthroplasty is a high-risk procedure for venous thromboembolism (VTE), and this client's history of recurring clots significantly increases the likelihood of a repeat event during or after surgery.

Rationales:

Deep vein thrombosis: This is the priority condition for monitoring and prophylaxis in this scenario. The client has a documented history of DVT on two separate occasions. Surgery, particularly orthopedic surgery on the lower extremities, causes venous stasis and vessel injury, which combined with the client's history, creates a high-risk profile for VTE.

History of DVT: This is a direct indicator of the client's predisposition to venous clotting. Previous episodes of DVT are the strongest predictor for future occurrences, especially when undergoing a major surgery like a total hip arthroplasty that involves significant immobility.

History of multiple DVTs: The fact that the client has a history of two separate DVTs reinforces the priority of this condition. It suggests a chronic or recurring susceptibility to clotting that requires aggressive perioperative management, such as mechanical prophylaxis (sequential compression devices) and pharmacological anticoagulation.

Pulmonary embolus: While a pulmonary embolus is a life-threatening complication of DVT, there is no evidence in the notes (such as acute chest pain or shortness of breath) to suggest it is currently occurring. It is a potential consequence rather than a condition evidenced by the current preoperative notes.

Osteoarthritis flare: While the client has painful hip osteoarthritis, this is the reason for the surgery, not a priority complication to be identified from the medical history for perioperative safety.

GERD exacerbation: The client's GERD is controlled with an antacid PRN. While important for preoperative fasting (NPO) considerations, it is not a priority condition compared to the risk of vascular complications like DVT.

Chest pain and Dyspnea: These are symptoms of an active pulmonary embolism or cardiac event. Neither is mentioned in the 0630 nurses' notes, so they cannot serve as evidence for the client's current status.

Recent surgery: The client is currently preparing for surgery. While past surgeries are noted, "recent surgery" typically refers to the immediate postoperative period as a risk factor, rather than the historical hysterectomy or appendectomy.

Smoking history: While a 52-pack-year history is significant for respiratory and vascular health, the client quit 2 years ago. While it contributes to general risk, it is less specific to the immediate priority of DVT than the direct history of having had multiple clots.

Immobility risk: The client's BMI of 30.1 and the nature of hip surgery contribute to immobility, which is a risk factor. However, the history of previous DVTs is a more specific piece of "evidence" from the notes that points to the priority condition of recurrent DVT.

Anticoagulant use: The notes mention hypertension and cholesterol meds but do not explicitly list current anticoagulant use. If they were on them, it would be a management factor, but it is not listed as evidence in the provided note.

This scenario involves metabolic complications following chemotherapy for high-grade malignancies. Knowledge of intracellular electrolyte release, nucleic acid breakdown, and the resulting renal and systemic impacts is required to identify the specific oncological emergency occurring during rapid cell lysis.

Choice A rationale

Gastric ulcers cause abdominal pain and potential bleeding but do not account for a rapid increase in serum uric acid. Uric acid elevation is a systemic metabolic event related to DNA breakdown, whereas ulcers are localized mucosal erosions.

Choice B rationale

Tumor lysis syndrome occurs when chemotherapy causes rapid destruction of malignant cells, releasing intracellular contents. This leads to hyperuricemia, hyperkalemia, and hyperphosphatemia. High uric acid levels (above 6 mg/dL) can cause acute renal failure due to crystal formation.

Choice C rationale

While acute kidney injury may result from tumor lysis syndrome, it is a secondary consequence of the metabolic derangement. The primary diagnosis explaining the constellation of rapid uric acid rise and chemotherapy timing is the lysis syndrome.

Choice D rationale

Gastroenteritis causes nausea and abdominal pain but does not explain the significant metabolic shift of elevated uric acid. It is typically an infectious or inflammatory condition of the digestive tract, not a systemic response to cytotoxic therapy.