A client with rheumatoid arthritis (RA) is prescribed methotrexate, a disease-modifying antirheumatic drug (DMARD). What should the nurse include in the teaching plan for this client?

The client with peripheral neuropathy should inspect their feet daily for any injuries or infections, as they may have reduced sensation and pain perception in their lower extremities. This can lead to delayed detection and treatment of wounds, ulcers, or infections, which can result in serious complications such as gangrene and amputation.

Incorrect options:

A) Applying heating pads to the affected areas - This is not an appropriate intervention, as heating pads can cause burns or skin damage in clients with peripheral neuropathy, who may not feel the heat or pain. The client should avoid exposing their feet to extreme temperatures and use warm water instead of hot water for bathing.

B) Massaging the affected areas with lotion - This is not an appropriate intervention, as massaging can cause friction or injury to the affected areas, especially if there are any open wounds or ulcers. The client should apply moisturizer to their feet after bathing, but avoid applying it between the toes, where fungal infections can occur.

D) Wearing tight-fitting socks and shoes - This is not an appropriate intervention, as tight-fitting socks and shoes can impair circulation and cause pressure ulcers or blisters in the affected areas. The client should wear well-fitting, comfortable, and protective footwear, and change their socks daily.

The client with MS should plan activities that require more energy for the morning, when they are likely to have more strength and endurance. Fatigue and muscle weakness tend to worsen as the day progresses, especially in warm or humid weather. The client should also prioritize and pace their activities, and take rest breaks as needed.

Incorrect options:

A) Performing exercises that target the affected muscles - This is not a helpful strategy, as overexertion of the affected muscles can aggravate fatigue and weakness. The client should perform exercises that are moderate, low-impact, and well-tolerated, such as stretching, yoga, or swimming.

C) Taking frequent naps throughout the day - This is not a helpful strategy, as frequent naps can disrupt the sleep cycle and interfere with nighttime sleep quality. The client should aim for seven to eight hours of uninterrupted sleep at night, and limit naps to 20 to 30 minutes in the afternoon if needed.

D) Increasing fluid and caffeine intake - This is not a helpful strategy, as excessive fluid intake can cause bladder problems, such as urgency, frequency, or incontinence, which are common in clients with MS. Caffeine intake can also worsen these symptoms, as well as cause dehydration, insomnia, or anxiety.