The nurse is preparing the client for discharge.

Exhibits

Which of the following statements indicate the client understands the discharge teaching?

Select the 3 client statements that indicate an understanding of the teaching.

• Rheumatoid arthritis is the most likely condition given the client’s bilateral wrist and shoulder stiffness lasting for several hours in the morning, fatigue, and loss of appetite. The elevated ESR and anemia further support chronic inflammation. Positive ANA, while not specific, can be present in RA and other autoimmune disorders.
• Osteoarthritis is incorrect because it typically presents with stiffness that improves within 30 minutes of activity, not lasting for several hours. It is also a non-inflammatory condition, whereas the client has elevated ESR and anemia, suggesting an inflammatory process.
• Gout is unlikely as it usually causes acute, severe joint pain with redness and swelling, often affecting the big toe. The client’s uric acid level is within normal range, making gout less probable.
• Carpal tunnel syndrome primarily causes numbness, tingling, and weakness in the hands due to median nerve compression. It does not typically cause prolonged morning stiffness, fatigue, or systemic inflammation.
• Positive ANA is not the best choice because while it is seen in rheumatoid arthritis, it is also present in other autoimmune diseases such as lupus. It does not specifically confirm RA.
• Normal WBC count does not support an inflammatory condition, as RA can lead to mild leukopenia, which is seen in the follow-up labs.
• Low blood pressure is not a defining feature of RA and does not correlate with the client’s symptoms or disease progression

A. Remove the tape by pulling from the center of the dressing. Tape should be removed by pulling toward the wound rather than from the center to avoid skin trauma and unnecessary disruption to the healing tissue. Pulling from the center can increase discomfort and damage surrounding skin.
B. Clean the wound from the center to the outer edges. Cleaning from the center outward prevents the introduction of microorganisms from the surrounding skin into the wound, reducing the risk of further infection. This technique follows the principle of working from the cleanest area to the least clean.
C. Moisten the dressing before removal. A wet-to-dry dressing is meant to adhere to necrotic tissue and debris, which is then removed when the dry dressing is taken off. Moistening it before removal defeats this purpose by softening the dressing, reducing its effectiveness in debriding the wound.
D. Wear sterile gloves to remove the dressing. Clean gloves are appropriate for removing a contaminated dressing. Sterile gloves are necessary for applying the new dressing to maintain an aseptic environment. Using sterile gloves for removal is unnecessary and does not improve infection control.