A nurse is caring for a client experiencing opioid withdrawal symptoms. Which of the following symptoms should the nurse monitor during this process?

Rationale:
The client’s symptoms of morning stiffness, symmetrical joint involvement (hands and knees), swelling of proximal interphalangeal joints, and elevated ESR and CRP with a positive rheumatoid factor are characteristic of rheumatoid arthritis. This autoimmune condition causes chronic inflammation of synovial joints, leading to pain, stiffness, and decreased function.

Encouraging range of motion exercises helps maintain joint flexibility, prevent contractures, and improve mobility in clients with rheumatoid arthritis. Administering anti-inflammatory medications reduces joint inflammation, alleviates pain, and slows disease progression.

Monitoring pain level provides insight into the effectiveness of treatment and the client’s functional status. Assessing joint swelling helps evaluate the degree of inflammation and progression or improvement of the disease.

Rationale:

A. This is the most critical and first-line priority in managing DIC. DIC is not a primary disease but a complication of conditions such as sepsis, trauma, malignancy, or obstetric emergencies (e.g., placental abruption). The widespread activation of the clotting cascade will continue unless the trigger is removed. For example, administering antibiotics for sepsis or delivering the placenta in obstetric cases directly addresses the root cause. Without this step, supportive treatments alone will be ineffective.

B. Beta blockers are used to manage conditions such as hypertension, arrhythmias, or heart failure. They have no role in correcting the coagulation abnormalities seen in DIC. They do not affect platelet consumption, clotting factor depletion, or fibrinolysis. Therefore, this option is inappropriate and incorrect.

C. Although it may seem counterintuitive in a condition associated with bleeding, heparin can be used in selected cases of DIC, particularly when thrombotic manifestations predominate (e.g., digital ischemia, organ dysfunction from microthrombi, or chronic DIC). Heparin works by inhibiting further clot formation, thereby reducing consumption of clotting factors and platelets. However, it is used cautiously and is generally avoided in patients with severe active bleeding. This makes it a situational but appropriate intervention.

D. Patients with DIC are at high risk for hypovolemia and shock due to bleeding and capillary leakage. Isotonic fluids like lactated Ringer’s help maintain intravascular volume, blood pressure, and organ perfusion. Adequate fluid resuscitation is essential to prevent complications such as acute kidney injury and multi-organ failure. This is a key supportive therapy.

E. In DIC, clotting factors are rapidly consumed, leading to coagulopathy and bleeding. FFP contains all clotting factors and is administered to replace depleted factors, correct prolonged PT/INR and aPTT, and help control bleeding. It is especially indicated in patients with active bleeding or those at high risk for bleeding.