A nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel.
What meal selection indicates that the client is managing this condition well with diet?

While nutritional status is crucial for wound healing, and labs such as albumin (normal range 3.5-5.0 g/dL) and prealbumin (normal range 15-36 mg/dL) are important indicators, assessing the underlying cause of non-healing is a priority. Drawing labs is a subsequent step after a thorough assessment has been completed to rule out circulatory issues as the primary cause.

Choice B rationale

A wound culture is performed to identify pathogens that may be causing a non-healing wound. However, it should only be done after assessing for other potential causes, such as poor circulation, which can compromise the delivery of immune cells and antibiotics to the wound site, making it impossible for the wound to heal regardless of the presence of bacteria.

Choice C rationale

Elevating the foot may be beneficial for reducing edema if present, which can impede circulation. However, this intervention should be based on a comprehensive circulatory assessment. Without first assessing the vascular status of the leg, this action is premature and may not be the most critical first step to take in addressing the underlying problem.

Choice D rationale

Assessing the right leg for pulses, skin color, and temperature is the most critical first step. A non-healing wound on an extremity, particularly an ankle, may indicate underlying peripheral arterial disease. Inadequate blood flow compromises oxygen and nutrient delivery to the wound bed, preventing cellular repair and growth. Ruling out or identifying circulatory compromise is the initial priority.

Choice A rationale

Applying topical medications in a circular motion can cause friction and irritate the compromised skin barrier in eczema. The goal of treatment is to protect the skin and reduce inflammation. Instead, a gentle, downward stroking motion in the direction of hair growth is recommended to avoid folliculitis and further skin damage.

Choice B rationale

Using a gloved hand during the application of topical treatments for a child with eczema prevents the transfer of microorganisms from the nurse's hands to the child's vulnerable skin, reducing the risk of secondary infection. It also protects the nurse from potential absorption of the medication, particularly if it's a steroid, through their own skin.

Choice C rationale

The frequent and liberal application of topical medications can lead to systemic absorption, especially with corticosteroids, due to the child's higher body surface area to weight ratio and thinner skin. This can cause adverse effects such as adrenal suppression and Cushing's syndrome. Medication application should strictly follow the prescribed dosage and frequency.

Choice D rationale

Lanolin is a common allergen and can exacerbate eczema symptoms in some individuals. It's an ingredient derived from sheep's wool and can trigger contact dermatitis in sensitive individuals. Therefore, lanolin-based ointments are not a universally recommended choice for eczema treatment and should be used with caution.