A nurse is providing teaching to a group of clients about the prevention of coronary artery disease. Which of the following information should the nurse include in the teaching?

Rationale:
A. "Lie down after meals.": Lying down after eating increases the risk of gastric contents refluxing into the esophagus due to gravity. Clients with GERD should remain upright for at least 2 to 3 hours after meals to minimize symptoms.
B. "Elevate the head of the bed while sleeping.": Elevating the head of the bed by 6 to 8 inches helps prevent nighttime reflux by using gravity to reduce backward flow of stomach acid into the esophagus, which is a key strategy in GERD management.
C. "Eat a snack 1 hour before going to bed.": Eating close to bedtime can exacerbate GERD symptoms by increasing gastric volume and acid production, especially when the client lies down soon after eating. A longer gap between the last meal and sleep is advised.
D. "Eat three large meals each day.": Large meals increase gastric pressure and acid production, worsening reflux symptoms. Clients with GERD should eat smaller, more frequent meals to reduce gastric distension and minimize acid reflux episodes.

Rationale:
A. A client who is newly diagnosed with type 1 diabetes mellitus and cannot afford insulin: This situation requires case management or social work referral to assist with access to medications and insurance. It does not indicate the need for palliative care, as diabetes is a chronic condition that can be managed effectively with proper support.

B. A client who has Meniere’s disease and cannot safely ambulate due to vertigo: While vertigo significantly affects quality of life, it is not life-limiting. This client would benefit more from physical therapy, home safety evaluation, and symptom management, rather than palliative care services.

C. A client who had a stroke and cannot eat or drink without choking: This client may need speech therapy, nutritional support, or possibly enteral feeding, but not necessarily palliative care unless their overall prognosis is poor or complications are expected to worsen.

D. A client whose medications to manage Parkinson’s disease are no longer effective: Palliative care is appropriate for clients with progressive, life-limiting illnesses like advanced Parkinson’s disease, especially when symptoms can no longer be adequately controlled with standard treatments. It focuses on comfort, quality of life, and support for complex symptom management.