The nurse provides discharge teaching to a client who had a myocardial infarction.
Which statements by the client indicate an understanding? Select all that apply.

Evaluating post-operative recovery for a total hip arthroplasty requires distinguishing between expected healing milestones and potential complications related to anticoagulation or nutritional status. Knowledge of surgical recovery timelines, respiratory stability following a pulmonary embolism, and signs of therapeutic drug toxicity is essential for accurate assessment.

Choice A rationale: Being able to perform activities of daily living independently indicates successful functional rehabilitation and improved mobility. This progress demonstrates that the surgical hip is stabilizing and that the client is regaining the muscle strength and coordination required for self-care.

Choice B rationale: A weight loss of 27 pounds in a short period since hospitalization is excessive and concerning rather than a sign of progress. Rapid weight loss in a post-surgical geriatric client can impair wound healing and suggest poor nutritional intake or underlying systemic issues.

Choice C rationale: Walking independently with a cane while maintaining full weight-bearing status is a key indicator of orthopedic recovery. It reflects adequate stability of the prosthetic joint and successful integration of physical therapy goals following the right total hip arthroplasty.

Choice D rationale: Reports of severe bruising on the arm while taking warfarin are signs of potential anticoagulant toxicity or an elevated international normalized ratio. This finding requires investigation of bleeding risk rather than being considered a positive sign of healing or progress.

Choice E rationale: Increased pain in the non-surgical left hip indicates the progression of degenerative joint disease in another area. While it identifies a future surgical need, it represents a decline in musculoskeletal health rather than an improvement in the current recovery.

Choice F rationale: The absence of new shortness of breath or chest pain suggests that the previously diagnosed pulmonary embolism is resolving and that no new thrombotic events have occurred. This respiratory stability is a primary indicator of successful medical management and recovery.

Choice G rationale: An oxygen saturation of 95% on room air is within the normal range and indicates that the client is maintaining adequate gas exchange without supplemental support. This finding confirms the resolution of the respiratory compromise associated with the earlier pulmonary embolism.

Choice H rationale: An incision that is healed with a hairline scar indicates excellent primary intention healing and a lack of infection. The resolution of the surgical wound is a fundamental requirement for the overall success of the total hip arthroplasty procedure.

Assessment of respiratory patterns in terminal patients involves identifying neurological and metabolic shifts. This scenario requires knowledge of breathing cycles, specifically the crescendo-decrescendo pattern and apnea associated with brainstem dysfunction or advanced heart failure during end-of-life care.

Choice A rationale

Kussmaul respirations involve deep, rapid breathing typically seen in metabolic acidosis. This pattern is a compensatory mechanism to expel excess carbon dioxide, lowering arterial acidity, and is distinct from the cyclic apnea seen in terminal brain injury.

Choice B rationale

Cheyne-Stokes is characterized by rhythmic waxing and waning of breathing depth followed by apnea. It occurs due to delayed feedback in the respiratory center, often seen in stroke, traumatic brain injury, or profound heart failure.

Choice C rationale

Biot respirations involve clusters of shallow breaths followed by irregular periods of apnea. This occurs with damage to the medulla oblongata and lacks the rhythmic, gradual increase and decrease in depth seen in the Cheyne-Stokes pattern.

Choice D rationale

Orthopnea is the physical inability to breathe comfortably while lying flat. It is common in congestive heart failure and pulmonary edema, requiring the patient to sit upright to decrease venous return and improve diaphragmatic excursion.