A nurse is reviewing the medical records of a group of clients. Which of the following findings should the nurse report to local authorities?

Choice A rationale:
Hct 45% (Choice A) refers to the hematocrit level, which measures the proportion of blood volume occupied by red blood cells. While dehydration can lead to elevated hematocrit due to hemoconcentration, a hematocrit value of 45% is within the normal range for both males and females. Dehydration might cause a mild increase, but more significant elevations would be expected in cases of severe dehydration.
Choice B rationale:
Urine specific gravity 1.035 (Choice B) is an indicator of concentrated urine, which is a characteristic finding in dehydration. Dehydration reduces the body's water content, leading to more concentrated urine with higher specific gravity values. A normal range for urine-specific gravity is typically between 1.005 and 1.030.
Choice C rationale:
Capillary refill of less than 2 seconds (Choice C) is not a finding consistent with dehydration. Capillary refill time measures the time it takes for color to return to the nailbed after pressure is applied. Prolonged capillary refill time might indicate poor peripheral perfusion, which can be a sign of dehydration, but a refill time of less than 2 seconds is considered within the normal range.
Choice D rationale:
A urine output of 35 ml/hr (Choice D) is not indicative of dehydration. In fact, a urine output of 35 ml/hr is relatively normal and suggests adequate fluid intake and hydration. Dehydration would typically result in reduced urine output as the body conserves water.

Choice A rationale:
Occupational therapy is the appropriate referral for an adolescent with rheumatoid arthritis who is having difficulty feeding themselves. Rheumatoid arthritis is a chronic autoimmune disorder that can lead to joint inflammation and deformities. Occupational therapy focuses on helping individuals improve their ability to perform daily activities, which includes activities like feeding, dressing, and grooming. Occupational therapists work with patients to develop strategies and use adaptive equipment to make these tasks more manageable. In the case of an adolescent with rheumatoid arthritis, occupational therapy can provide techniques and tools to facilitate feeding independently despite joint limitations.
Choice B rationale:
Physical therapy primarily focuses on improving mobility, strength, and function in individuals with musculoskeletal issues. While physical therapy could be beneficial for an adolescent with rheumatoid arthritis to address joint mobility and muscle strength, it might not directly address the difficulty in feeding. Therefore, although physical therapy can be a helpful component of care for patients with rheumatoid arthritis, it might not be the first choice for addressing feeding difficulties.
Choice C rationale:
Speech therapy is not the most appropriate referral for an adolescent with rheumatoid arthritis experiencing feeding difficulties. Speech therapy primarily addresses communication and swallowing disorders. While swallowing difficulties might be relevant in some cases of rheumatoid arthritis due to potential joint involvement in the jaw, the primary focus should be on addressing joint limitations and adaptive techniques for feeding, making occupational therapy a more suitable referral.
Choice D rationale:
A case manager is not the recommended referral for an adolescent with rheumatoid arthritis and feeding difficulties. Case managers typically coordinate and facilitate various aspects of a patient's care, such as arranging appointments and services. While case managers play a valuable role in healthcare, the immediate concern of feeding difficulties in an adolescent with rheumatoid arthritis is best addressed through specialized interventions like occupational therapy.