A nurse is caring for a client with rheumatoid arthritis. The client is having difficulty with self-feeding due to the pain and hand deformities. The nurse would anticipate a referral will be made to which member of the interprofessional team?

A) Speech Therapist: A speech therapist typically works with clients who have communication or swallowing disorders. While they may be involved in assessing and managing difficulties with swallowing, they are not the primary professionals for addressing issues related to hand function or fine motor skills, which are crucial for self-feeding in clients with rheumatoid arthritis.

B) Registered Dietician: A registered dietician is responsible for assessing and planning nutritional needs, which may include recommending dietary modifications for overall health and well-being. However, they do not specifically address the mechanical or functional aspects of eating, such as difficulties due to pain and hand deformities in rheumatoid arthritis.

C) Physical Therapist: Physical therapists focus on improving gross motor function, mobility, and physical strength. While they may help with general mobility and exercise plans to reduce pain and improve joint function, they are not specialists in the fine motor skills and adaptive strategies needed for activities of daily living, such as self-feeding.

D) Occupational Therapist: Occupational therapists specialize in helping clients regain and improve their ability to perform daily activities, particularly those involving fine motor skills. They are well-suited to address issues like pain management, joint protection techniques, and the use of adaptive equipment for self-feeding in clients with rheumatoid arthritis. They work on enhancing the client’s functional independence despite physical limitations.

A) Hyperactive bowel sounds: Hypercalcemia typically leads to decreased gastrointestinal motility, not increased. Clients with elevated calcium levels may experience constipation, abdominal pain, or ileus due to the relaxing effect of calcium on smooth muscle. Therefore, hyperactive bowel sounds are not a common finding in hypercalcemia.

B) Increased blood clots: Hypercalcemia can promote a hypercoagulable state, increasing the risk of thromboembolic events. This occurs because high calcium levels can enhance platelet aggregation and increase the coagulability of blood. Therefore, a client with elevated serum calcium may have an increased risk of developing blood clots.

C) Hyperactive deep tendon reflexes: Hypercalcemia generally leads to reduced neuromuscular excitability, which may manifest as decreased or absent deep tendon reflexes, muscle weakness, and lethargy. Hyperactive reflexes are more commonly associated with hypocalcemia, which causes increased neuromuscular excitability.

D) Positive Chvostek’s sign: Chvostek's sign is a clinical indicator of hypocalcemia, not hypercalcemia. It involves twitching of the facial muscles in response to tapping the facial nerve and is due to increased neuromuscular excitability caused by low calcium levels. Hypercalcemia, conversely, does not typically present with a positive Chvostek’s sign.