A client diagnosed with Parkinson's disease receives a prescription for carbidopa-levodopa, controlled release (CR) 25/100 mg PO daily each morning. Which information should the nurse include in the client's teaching plan? Select all that apply.

Rationale:

A. Complete a comprehensive history: Gathering a full medical and psychosocial history helps the nurse identify patterns of neglect, dependency, or caregiver control. It also provides critical context about baseline function and recent changes in the client’s condition.

B. Confront the abuser about concerning actions: Directly confronting the suspected abuser may increase the risk of retaliation against the client and compromise the safety of both client and provider. It may also hinder legal investigations if not handled properly.

C. Develop a safety plan: Developing a safety plan is essential when elder mistreatment is suspected. It outlines strategies and resources to protect the client from further harm, including steps to ensure physical and emotional safety within or outside the home.

D. Perform a thorough physical assessment: A comprehensive physical exam allows the nurse to document injuries, skin breakdown, hygiene status, and other signs of neglect. Objective findings support the identification and substantiation of potential mistreatment.

E. Report findings to Adult Protective Services: Mandatory reporting is required in suspected elder abuse cases. Reporting to APS initiates an investigation and can mobilize protective services and interventions, including caregiver support or removal if needed.

F. Question the client in front of the suspected abuser: Interviewing the client in the presence of the suspected abuser can lead to incomplete or falsified responses due to fear, coercion, or shame. Private questioning ensures more honest communication.

G. Throw away soiled clothing: Soiled clothing may contain forensic evidence such as bodily fluids, skin cells, or wound drainage. Disposing of it could compromise the legal investigation or documentation of neglect.

H. Take photographs to document the abuse or neglect: Photographic evidence provides visual documentation that supports clinical findings. This can strengthen the case when authorities investigate, and helps track the healing or progression of injuries over time.

Rationale:
A. Red edematous stomal appearance: A bright red, moist, and mildly edematous stoma is expected in the immediate postoperative period. These features indicate healthy perfusion and normal healing after surgery.

B. Stomal output of 40 mL in last hour: This is a normal output volume for a ureteroileostomy. Urine flows continuously in small amounts, and 30–60 mL per hour is considered within normal limits for adequate renal function.

C. Liquid brown drainage from stoma: Brown liquid drainage suggests fecal contamination or leakage from the bowel, which is abnormal in a urinary diversion and may indicate a serious complication such as bowel injury or fistula formation. This requires urgent evaluation.

D. Mucous strings floating in the drainage: Mucus production from the ileal segment is expected because intestinal mucosa continues to secrete mucus even after being repurposed as a urinary conduit. This finding is not concerning.