A nurse in a provider’s office is assessing a client who has rheumatoid arthritis (R

Choice A: WBC Count

Reason: The white blood cell (WBC) count is not directly related to fall risk. WBC count is an indicator of the immune system’s response to infection or inflammation. In this case, the patient’s WBC count is within the normal range (5,000 to 10,000/mm³) on both days. Therefore, it does not contribute to an increased risk of falls.

Choice B: Parkinson’s disease

Reason: Parkinson’s disease significantly increases the risk of falls due to several factors. Patients with Parkinson’s often experience postural instability, which is the inability to maintain balance when standing or walking. This condition is a cardinal feature of Parkinson’s disease and can lead to frequent falls. Additionally, Parkinson’s patients may experience freezing of gait, where they suddenly cannot move their feet forward despite the intention to walk. This can cause them to fall. Other gait abnormalities, such as festinating gait (short, rapid steps) and dyskinesias (involuntary movements), also contribute to the increased fall risk.

Choice C: Potassium level on day 2

Reason: The patient’s potassium level on day 2 is 3.0 mEq/L, which is below the normal range of 3.5 to 5 mEq/L. Low potassium levels (hypokalemia) can lead to muscle weakness, cramps, and fatigue. These symptoms can impair the patient’s ability to maintain balance and increase the risk of falls. Hypokalemia can also cause abnormal heart rhythms, which can further contribute to the risk of falls.

Choice D: Furosemide

Reason: Furosemide is a diuretic medication used to treat conditions such as heart failure by reducing fluid buildup in the body. However, it can also cause orthostatic hypotension, a condition where blood pressure drops significantly when standing up. This can lead to dizziness, lightheadedness, and an increased risk of falls. Additionally, furosemide can cause electrolyte imbalances, such as low potassium levels, which can further contribute to fall risk.

Choice E: Low blood pressure

Reason: The patient’s blood pressure readings indicate orthostatic hypotension, with a significant drop from 128/56 mm Hg while sitting to 92/40 mm Hg while standing. Orthostatic hypotension is a common condition in patients with Parkinson’s disease and heart failure. It can cause dizziness, lightheadedness, and fainting when changing positions, increasing the risk of falls. The patient’s low blood pressure when standing is a clear indicator of increased fall risk.

Choice A reason: Leave the pad in place for at least 40 minutes

Leaving the aquathermia pad in place for at least 40 minutes is not recommended. The typical duration for applying an aquathermia pad is 20 to 40 minutes1. Prolonged exposure beyond this time can lead to complications such as burns or vasoconstriction, where blood vessels constrict instead of dilate, potentially increasing blood pressure and causing discomfort.

Choice B reason: Set the pad’s temperature to 42.2°C (108°F)

Setting the pad’s temperature to 42.2°C (108°F) is too high. The recommended temperature range for an aquathermia pad is generally between 40.5°C to 43°C (105°F to 109.4°F)3. Temperatures above this range can increase the risk of burns and skin damage. It is crucial to follow the manufacturer’s guidelines and institutional protocols to ensure safe and effective use of the pad.

Choice C reason: Use safety pins to keep the pad in place

Using safety pins to keep the pad in place is not safe. Safety pins can puncture the pad, causing leaks and potentially leading to electrical hazards. Instead, the pad should be secured with tape or a cloth cover to ensure it stays in place without causing damage.

Choice D reason: Stop the treatment if the client’s skin becomes red

Stopping the treatment if the client’s skin becomes red is the correct action. Redness of the skin can indicate the beginning of a burn or other skin damage. It is essential to monitor the client’s skin condition frequently during the application of heat therapy and to discontinue the treatment immediately if any signs of adverse reactions, such as redness or discomfort, are observed.