A nurse is providing teaching to a school-age child about using an inhaler with a mouthpiece to manage asthma exacerbation. Identify the order in which the nurse should instruct the client to perform the steps. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

A) Manic behavior: Hyperthyroidism can lead to manic or hyperactive behavior due to increased metabolic rate and overstimulation of the nervous system. This may present as irritability, anxiety, or restlessness, making manic behavior a relevant manifestation in this condition.

B) Deep, labored respirations: Hyperthyroidism generally does not cause deep, labored respirations. Instead, it may lead to increased respiratory rate due to heightened metabolic activity. Deep, labored respirations are more indicative of respiratory or cardiac issues rather than hyperthyroidism.

C) Bradycardia: Hyperthyroidism usually causes tachycardia (elevated heart rate) rather than bradycardia (slow heart rate). Tachycardia is a common symptom due to the increased metabolic rate and sympathetic nervous system activity associated with hyperthyroidism.

D) Cold intolerance: Cold intolerance is more characteristic of hypothyroidism, where there is decreased metabolic activity and reduced heat production. Hyperthyroidism typically causes heat intolerance due to the increased metabolic rate and elevated body temperature.

A) Provide instruction on pelvic muscle exercises:
Pelvic muscle exercises are beneficial for urinary incontinence but are not a standard intervention for treating pyelonephritis. Pyelonephritis focuses on managing infection and inflammation of the kidneys rather than strengthening pelvic muscles.

B) Administer skeletal muscle relaxants every 6 hr:
Skeletal muscle relaxants are not typically used in the treatment of pyelonephritis. The focus should be on antibiotics to treat the infection and analgesics for pain relief, rather than muscle relaxants.

C) Encourage fluid intake:
Increasing fluid intake helps flush bacteria from the urinary tract, which can aid in reducing the infection and promoting kidney health. Proper hydration is crucial for clients with pyelonephritis to help manage symptoms and prevent further complications.

D) Monitor vital signs every 8 hr:
While monitoring vital signs is important, it should be done more frequently than every 8 hours, especially in the acute phase of pyelonephritis, to promptly identify any signs of worsening infection or sepsis.