A nurse is teaching a client about the manifestations of menopause. Which of the following findings should the nurse include?

Rationale for correct choices:

• Hyperthyroidism: The client presents with classic signs of hyperthyroidism or thyroid storm: heat intolerance, tremors, tachycardia, palpitations, agitation, insomnia, weight loss despite good appetite, diarrhea, and recent illness (influenza) acting as a trigger. These symptoms indicate an acutely increased metabolic state.
• Place client on telemetry: Tachycardia and palpitations suggest cardiac involvement. Continuous cardiac monitoring helps detect life-threatening arrhythmias, such as atrial fibrillation, which are common in hyperthyroid crises.
• Initiate hydration therapy: Hypermetabolism, fever, and diarrhea can cause fluid loss and increase the risk for dehydration. Hydration supports perfusion and reduces cardiac strain during a hypermetabolic state.
• Cardiac dysrhythmias: Excess thyroid hormones increase the heart's sensitivity to catecholamines, heightening the risk for dysrhythmias. Monitoring rhythm helps identify complications early.
• Neurological status: Agitation, tremors, and insomnia may progress to delirium or seizures in thyroid storm. Regular neuro checks allow early recognition of worsening symptoms.

Rationale for incorrect choices:

• Hypoparathyroidism: This typically presents with signs of hypocalcemia such as tetany or paresthesias, not the metabolic hyperactivity seen here. The client's symptoms do not reflect this condition.
• Hyperparathyroidism: It usually causes hypercalcemia, bone pain, and kidney stones, none of which are evident. Diarrhea, fever, and cardiac signs are not typical.
• Hypothyroidism: Presents with fatigue, cold intolerance, constipation, bradycardia, and weight gain—opposite of this client’s hyperactive symptoms.
• Check for Chvostek and Trousseau’s signs: These are used to assess for hypocalcemia, which is not indicated in this scenario. There are no neuromuscular irritability symptoms present.
• Monitor for hypoglycemia: There's no indication of low blood sugar, and the client does not report symptoms like shakiness, confusion, or hunger related to hypoglycemia.
• Provide nutritional support: While the client has lost weight, the priority is stabilizing the acute condition (thyroid storm), not nutritional rehabilitation at this moment.
• Phosphorus levels: These are not directly affected in hyperthyroidism and monitoring them wouldn't provide information relevant to the current crisis.
• Weight gain: This client has experienced weight loss, and tracking weight gain is not a relevant short-term indicator of improvement in acute hyperthyroidism.
• Calcium levels: There is no evidence of calcium imbalance or parathyroid involvement, so monitoring calcium is not pertinent in this case.

A. "If you have a cat, wear gloves when cleaning the litter box.": Cat litter can contain Toxoplasma or Bartonella, which can increase the risk of infection and sepsis in immunocompromised clients. Wearing gloves reduces exposure to potential pathogens.
B. "Floss your teeth after every meal.": Flossing after every meal may be too frequent and could cause irritation or gum injury, which increases the risk of infection. Good oral hygiene is important, but over-flossing should be avoided, especially for clients at risk of sepsis.
C. "Store your toothbrush in a glass filled with distilled water.": Storing a toothbrush in distilled water does not provide additional protection against infection. The toothbrush should simply be kept clean and dry to avoid bacterial growth.
D. "Do not consume cold drinks that have been left out for more than 1 hour.": This advice is generally good for food safety but is not specifically related to sepsis risk. The main focus should be on preventing infections that could lead to sepsis, rather than on drink temperature.