43. A nurse is reinforcing teaching about use of a metered-dose inhaler (MDI) with a client who has a new diagnosis of asthma. Identify the sequence the client should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all steps.)

D. Obesity and weight loss are more directly linked to type 2 diabetes but they are not primary factors in the management of type 1 diabetes. Type 1 diabetes is characterized by the autoimmune destruction of beta cells, leading to an absolute deficiency of insulin. Weight loss can improve insulin sensitivity, which might be relevant for type 2 diabetes or insulin resistance, but type 1 diabetes patients will always require exogenous insulin regardless of weight changes.
A. Patients with type 1 diabetes are at risk for diabetic ketoacidosis (DKA), a serious condition caused by high blood glucose levels and ketone buildup due to insufficient insulin. Monitoring blood glucose levels is crucial in preventing DKA.
B. Type 1 diabetes is an autoimmune disease where the immune system attacks the insulin- producing beta cells in the pancreas. A viral infection can sometimes trigger this autoimmune response in genetically susceptible individuals.
C. There is a genetic component to type 1 diabetes, and having a family history of the disease can increase the risk, although environmental factors also play a role.

B. Maintaining a healthy weight is important for managing a hiatal hernia. Excess body weight can increase abdominal pressure and exacerbate symptoms. Weight loss, if necessary, can help reduce the frequency and severity of symptoms.
C. Elevating the head of the bed helps prevent the reflux of stomach contents into the esophagus while sleeping. Gravity helps keep the stomach contents down, reducing the risk of acid reflux and associated symptoms.
D. Caffeine and spicy foods can irritate the stomach lining and exacerbate symptoms of hiatal hernia, such as heartburn and acid reflux. Reducing the intake of these foods can help manage symptoms.
A. This is not typically a recommendation for managing a hiatal hernia. Drinking fluids is important for overall health and digestion. However, it is advisable to avoid drinking large amounts of fluids quickly, especially with meals, as this can increase intra-abdominal pressure and worsen symptoms.
E. Lying down after meals can increase the risk of reflux and worsen symptoms of a hiatal hernia. It is generally recommended to remain upright for at least a couple of hours after eating to prevent reflux.