A nurse is reinforcing teaching with a client following an upper gastrointestinal series using barium contrast. Which of the following instructions should the nurse include?

Choice A reason:
A white blood cell (WBC) count of 9,000/mm³ falls within the normal range of 5,000 to 10,000/mm³ and does not necessarily indicate a bladder infection. The WBC count can be elevated in infections, but a value within the normal range, especially without other symptoms, is not a reliable indicator of a urinary tract infection (UTI).

Choice B reason:
Diminished reflexes are not typically associated with a bladder infection. They can be a sign of neurological issues or other systemic conditions. Reflex changes would more likely prompt an evaluation for neurological disorders rather than a UTI.

Choice C reason:
Changed mental status in older adults can be a sign of a bladder infection. Unlike younger individuals, older adults may not exhibit the classic symptoms of a UTI, such as pain or burning during urination. Instead, they may present with non-specific symptoms like acute confusion or altered mental status, which can be a result of the infection's systemic impact.

Choice D reason:
A temperature of 37.3°C (99.1°F) is slightly elevated but is not considered a fever and could be influenced by various factors. While it could be associated with an infection, it is not a definitive sign of a bladder infection without the presence of other symptoms.

Choice E reason:
The first step in tracheostomy care is to explain the procedure to the client. This is crucial for obtaining informed consent and ensuring that the client understands what will happen during the care process. It also helps to alleviate any anxiety or fear the client may have about the procedure. Clear communication is essential for patient-centered care and establishes trust between the nurse and the client.

Choice A reason:
Once the procedure has been explained, the next step is to ensure a method to communicate during the procedure, especially since the client may be unable to speak normally due to the tracheostomy. Communication methods can include writing, gestures, or the use of communication boards. This step is vital for the safety and comfort of the client, allowing them to express needs or concerns during the procedure.

Choice C reason:
After establishing a communication method, the nurse should wear clean gloves to remove the tracheostomy dressing. This step is important to maintain sterility and prevent infection. The nurse must carefully remove the dressing to inspect the stoma site for any signs of infection or irritation and to prepare the site for cleaning.

Choice B reason:
Cleaning the inner cannula is the next step, using a small brush specifically designed for this purpose. The inner cannula must be kept clean to ensure an unobstructed airway and to prevent the buildup of secretions, which can lead to infection or breathing difficulties. This step requires meticulous attention to detail to ensure that all secretions are removed.

Choice D reason:
The final step is to apply clean tracheostomy ties. These ties secure the tracheostomy tube in place, preventing it from moving or being dislodged. Proper application of the ties is critical for the stability of the tracheostomy tube and the safety of the client. The ties should be snug but not too tight, allowing for slight movement and comfort.