A nurse is planning teaching for a client who has a new diagnosis of HIV. Which of the following information should the nurse include about preventing the spread of the infection?

Rationale for Correct Choices:

• Antibiotic prescription: The client presents with signs of a postoperative wound infection: fever (38.8°C), increased WBC count (14,800/mm³), purulent drainage, and incisional swelling. These findings warrant prompt antibiotic therapy to prevent further complications.
• WBC count: The rise in WBC count from 8,000 to 14,800/mm³ over three days is a key indicator of an infectious process, particularly concerning postoperatively. It supports the need for antibiotics.
• Temperature: The client’s fever (38.8°C/101.8°F) is consistent with a systemic response to infection. In combination with the elevated WBC and wound findings, it confirms the need for antimicrobial treatment.

Rationale for Incorrect Choices:

• IV fluids: While fluids are essential postoperatively, the client shows no signs of hypovolemia or dehydration—mucous membranes are moist and blood pressure is stable. Fluids are not the priority.
• Laxative: Although the client hasn’t had a bowel movement, they are passing flatus and show some motility. The acute concern is infection, not constipation, making laxatives inappropriate as the primary intervention.
• Prescription for IV iron: The client has stable but low hemoglobin levels (around 10.3 g/dL), likely due to surgery. However, there’s no acute drop or symptomatic anemia requiring immediate IV iron over addressing infection.
• Hemoglobin: Although low, the hemoglobin level is stable and does not indicate an acute issue. It does not justify antibiotic use or serve as the primary clinical concern at this time.
• Bowel sounds: Hypoactive bowel sounds are common postoperatively and are not indicative of infection alone. They do not support the use of antibiotics directly.
• Blood pressure: The client’s blood pressure remains within normal limits postoperatively and does not show signs of septic or hypovolemic shock. It’s not relevant to initiating antibiotics.
• Transferrin level: Transferrin reflects protein status and iron transport; although low, it doesn’t indicate acute infection. It is unrelated to the decision to initiate antibiotics.
• Skin turgor: Normal skin turgor suggests adequate hydration. There’s no indication of dehydration or fluid imbalance requiring action.
• Bowel movements: Absence of bowel movement is common postoperatively and expected after colon surgery. While important to monitor for ileus, these are not the primary indicators for an antibiotic prescription.

A. Polyuria: Polyuria results from hyperglycemia, where excess glucose in the bloodstream leads to osmotic diuresis. This causes the kidneys to excrete more water, increasing urination frequency. It is not a feature of hypoglycemia.
B. Fruity breath: Fruity-scented breath is due to ketone buildup in diabetic ketoacidosis, a complication of prolonged hyperglycemia. It signals metabolic acidosis rather than low blood sugar levels.
C. Diaphoresis: Diaphoresis occurs during hypoglycemia as the body releases epinephrine in response to falling glucose. This triggers sweating, tremors, and palpitations as part of the autonomic response.
D. Polyphagia: Polyphagia is a symptom of hyperglycemia, where cells are starved of glucose despite its presence in the blood. This leads to increased hunger, not typically seen in acute hypoglycemia.