The nurse is teaching a client with cancer about skin care for the portal site receiving external beam radiation. Which client action regarding skin care indicates a need for further teaching?

a) Denies cramps, weakness, or nausea

This finding indicates that the actions taken were effective in relieving the patient's symptoms of fatigue, weakness, muscle cramps, and nausea. These symptoms may have been caused by electrolyte imbalances, dehydration, or infection related to her ESRD and missed dialysis sessions.

b) BP 116/68 mm Hg, HR 75 bpm

This finding indicates that the actions taken were effective in lowering the patient's blood pressure and heart rate. The patient had a history of HTN and CAD and presented with elevated BP and HR in the ED. The orders for EKG, cardiac monitor, chest X-ray, and echocardiogram may have helped to assess and manage her cardiac status. The patient may have also received antihypertensive medications or fluids as part of her treatment.

c) Potassium level 3.6 mEq/L (3.6 mmol/L)

This finding indicates that the actions taken were effective in normalizing the patient's potassium level. The patient had ESRD and missed dialysis sessions, which could have resulted in hyperkalemia or hypokalemia. The orders for basic metabolic panel and blood cultures may have helped to monitor and correct her electrolyte levels. The patient may have also received potassium supplements or binders as part of her treatment.

d) Verbalizes commitment to dialysis appointments

This finding indicates that the actions taken were effective in educating and motivating the patient to adhere to her dialysis schedule. The patient had ESRD and missed dialysis sessions, which could have worsened her condition and increased her risk of complications. The orders for CT scan of abdomen and echocardiogram may have helped to evaluate her renal function and cardiac function. The patient may have also received counseling or support from the health care team as part of her treatment.

e) Client states that she will need to resume her Lisinopril to control blood pressure

This finding indicates that the actions taken were ineffective in teaching the patient about her medication regimen. The patient had a history of HTN and CAD and was prescribed Lisinopril as an antihypertensive medication. However, Lisinopril is contraindicated in patients with ESRD as it can cause hyperkalemia or worsen renal function. The patient should be informed about the potential risks of taking Lisinopril and advised to consult with her nephrologist or primary care provider before resuming it.

f) Client is eager to add dark green vegetables and potatoes to her diet

This finding indicates that the actions taken were ineffective in educating the patient about her dietary restrictions. The patient had ESRD and required hemodialysis three times a week. She should follow a renal diet that limits the intake of potassium, phosphorus, sodium, and fluid. Dark green vegetables and potatoes are high in potassium and phosphorus and should be avoided or consumed in moderation by patients with ESRD. The patient should be provided with a list of foods that are suitable for her condition and referred to a dietitian for further guidance.

Choice A reason: Jogging or running are not excellent aerobic exercises for an older adult client with osteoarthritis. These activities can put a lot of stress and impact on the joints, especially the knees, hips, and ankles, which can worsen the pain and inflammation of osteoarthritis. The nurse should advise the client to avoid high-impact exercises that can damage the cartilage and bones.

Choice B reason: Tennis or racquetball are not ideal exercises for an older adult client with osteoarthritis. These activities involve sudden movements, twists, and turns that can strain the joints, especially the elbows, wrists, and shoulders, which can aggravate the symptoms of osteoarthritis. The nurse should advise the client to avoid exercises that can cause joint instability and injury.

Choice C reason: Limiting the exercise to just the daily activities is not a good advice for an older adult client with osteoarthritis. Exercise is important for maintaining joint health, mobility, and function, as well as preventing muscle loss, obesity, and cardiovascular diseases. The nurse should encourage the client to engage in regular moderate exercise that can improve the quality of life and reduce the complications of osteoarthritis.

Choice D reason: Swimming is an excellent exercise for an older adult client with osteoarthritis. Swimming is a low-impact aerobic exercise that can strengthen the muscles, improve the cardiovascular fitness, and enhance the flexibility of the joints without putting too much pressure or stress on them. Swimming can also reduce the pain and stiffness of osteoarthritis by providing a soothing and relaxing effect on the body. The nurse should recommend swimming as a safe and effective exercise for the client.