A home health nurse is teaching a client who has a new diagnosis of diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

Findings that indicate the client has a potential problem:

• Chest pain radiating to left arm: Chest pain that radiates to the left arm is a classic symptom of a myocardial infarction (MI). The description of pain (tightness) and its radiation to the left arm are a red flag for an acute cardiac event, which requires immediate intervention.
• Pain level of 7 on a scale of 0 to 10: A pain level of 7 indicates significant discomfort, and when combined with other symptoms like chest tightness and radiation to the left arm, it further supports the possibility of a myocardial infarction.
• Started to feel nauseous after breakfast: Nausea can be an associated symptom of acute myocardial infarction (MI), especially in women, the elderly, and those with diabetes. Its presence, along with chest pain, is concerning.
• Diaphoresis: Diaphoresis (excessive sweating) is often associated with myocardial infarction and is a key sign of acute coronary syndrome. This finding, along with chest pain and shortness of breath, suggests an emergent situation.
• Tachycardia with irregular heart rate: The client’s heart rate is 110/min and irregular, which can be indicative of arrhythmias commonly seen in acute myocardial infarction. The irregular and tachycardic rhythm should be immediately evaluated to prevent further complications.
• +1 pedal pulses: While present, +1 pedal pulses are diminished. This could indicate compromised peripheral circulation, possibly related to overall cardiovascular compromise or underlying peripheral artery disease, which is often co-morbid with the client's existing conditions (hyperlipidemia, hypertension, diabetes).
• Skin is cool to touch: Cool skin, especially when accompanied by other signs of poor perfusion like diminished pulses, can indicate reduced peripheral blood flow, which may be a systemic response to decreased cardiac output from a significant cardiac event.

Rationale for Incorrect Findings:

• Lungs clear to auscultation: Clear lung sounds suggest no signs of pulmonary edema or other lung issues at the moment, ruling out respiratory causes of the symptoms.
• Bowel sounds present in all 4 quadrants: The presence of bowel sounds in all quadrants is normal and suggests that the gastrointestinal system is functioning well.
• Capillary refill less than 2 seconds is normal and indicate adequate perfusion, this finding on its own does not require follow up.

Rationale:

A. Decrease traction on the catheter: Decreasing traction on the catheter may help with discomfort from the catheter itself but does not address the potential issue of a blocked catheter, which is likely the cause of the decreased output and bladder spasms.

B. Administer ibuprofen 400 mg for pain relief: While ibuprofen may help with pain relief, it does not address the underlying cause of bladder spasms or decreased urinary output. The priority is to ensure the catheter is functioning properly to prevent further complications.

C. Remove the indwelling urinary catheter: Removing the indwelling urinary catheter is not appropriate in this situation, as the catheter is essential for continuous bladder irrigation and preventing clot formation. Removal could exacerbate the problem.

D. Flush the catheter manually with 0.9% sodium chloride: The decreased output could indicate a blockage, and flushing the catheter with saline can help clear any obstructions, relieving the bladder spasms and restoring normal drainage.