A nurse is preparing discharge teaching for a client who has Crohn's disease and a new ileostomy. Which of the following community resources should the nurse include in the teaching?

• Infection: Poor glycemic control, indicated by an elevated hemoglobin A1c of 9.5%, leads to impaired immune function, delayed wound healing, and increased risk of postoperative infections. Chronic hyperglycemia promotes bacterial growth, reduces leukocyte function, and compromises vascular integrity, further predisposing the client to infections.
• Deep vein thrombosis (DVT): Postoperative immobility, increased coagulation, and endothelial injury increase DVT risk. However, BUN of 15 mg/dL is within the normal range and does not indicate dehydration or hemoconcentration, which would contribute to thrombus formation.
• Hypovolemia: Reduced blood volume typically presents with signs such as hypotension, tachycardia, and elevated BUN/creatinine ratio. Preoperative hypertension does not indicate hypovolemia and is more commonly associated with chronic vascular resistance rather than acute fluid loss.
• BUN of 15 mg/dL: A BUN level within the normal range does not suggest an increased risk for DVT or fluid imbalance. It primarily reflects renal function and hydration status, neither of which are significantly altered in this case.
• Preoperative hypertension: While chronic hypertension is a cardiovascular risk factor, it does not indicate hypovolemia, which would present with dehydration-related signs such as orthostatic hypotension, tachycardia, and decreased urine output.
• Hemoglobin A1c: A value of 9.5% indicates poor long-term glycemic control, which impairs immune function and slows wound healing. Elevated glucose levels reduce neutrophil function, impair macrophage activity, and increase oxidative stress, all of which contribute to a heightened infection risk.

A. Decorticate posturing: This is a late sign of increased intracranial pressure, indicating severe brain dysfunction and potential herniation. Early signs of increased ICP typically involve subtle neurological changes such as restlessness, confusion, or irritability before progressing to abnormal posturing.

B. Restlessness: An early sign of increased ICP, restlessness occurs due to decreased cerebral perfusion and oxygenation, leading to subtle changes in mental status. Clients may also exhibit irritability, confusion, or difficulty following commands before more severe symptoms develop.

C. Papilledema: Swelling of the optic disc, or papilledema, is a later sign of increased ICP and occurs due to prolonged pressure on the optic nerve. It is typically detected on an ophthalmic exam rather than presenting as an early symptom.

D. Projectile vomiting: Vomiting without nausea is a later sign of increased ICP, often associated with brainstem involvement. Early manifestations tend to involve altered mental status before progressing to severe symptoms such as vomiting or posturing.