A nurse is providing dietary teaching to a patient with ulcerative colitis. Which of the following instructions should the nurse include?

Polyuria/Polydipsia:

• Supports both DKA and HHS as both conditions typically exhibit severe dehydration and excessive thirst and urination.

Heart Rate (tachycardia):

• Consistent with both DKA and HHS due to dehydration and fluid shifts, though heart rate alone does not differentiate the two.

Respirations (Kussmaul's):

• Suggests DKA; deep, labored Kussmaul respirations typically help compensate for metabolic acidosis, which is characteristic of DKA.

Mental Status (confusion, lethargy):

• More common in HHS, where very high glucose and osmolality levels often lead to more profound neurologic changes. Can also occur in DKA.

Serum Glucose >600 mg/dL and Serum Osmolality >320 mOsm/kg:

• Consistent with both DKA and HHS, though more frequently seen in HHS given the higher osmolality. In DKA, serum glucose usually elevated but often lower than in HHS. Osmolality may be increased but not as high as in HHS.

Insidious onset (days to weeks):

• Suggests HHS, as it often has a slower onset than DKA, which typically presents more acutely.

Infection as precipitating factor:

• Could support either condition as infections can precipitate both DKA and HHS.

A. Warfarin. Warfarin (Coumadin) is an anticoagulant used to prevent blood clots, but it typically requires several days to achieve a therapeutic effect and needs close monitoring of INR (International Normalized Ratio) levels. While it can be used for long-term prevention of DVT, it's not the immediate choice for post-operative prophylaxis.

B. Alteplase (tPA). Alteplase is a thrombolytic agent, used to break down existing clots, not prevent their formation. It is typically used in emergency situations, such as for treating ischemic stroke.

C. Clopidogrel. Clopidogrel is an antiplatelet agent, often used to prevent arterial clots, not DVTs. It is more commonly used in conditions like stroke and heart disease.

D. Enoxaparin. Enoxaparin, a low molecular weight heparin, is commonly used to prevent DVT after surgery by inhibiting specific clotting factors. It’s frequently prescribed for DVT prevention in orthopedic surgery patients.