A nurse is teaching a client who has osteoporosis about ways to reduce stress on the skeletal system. Which of the following instructions should the nurse include?

• Wound appearance: The client's wound is consistent in size (3 cm x 4 cm) but the purulent drainage may indicate ongoing infection. However, the key aspect is that the client has a scheduled appointment with a wound care specialist, which suggests that there is a plan in place for managing the wound, indicating that the situation is being monitored and potentially improving with treatment.
• Blood glucose: The blood glucose level decreased from 250 mg/dL two weeks ago to 140 mg/dL today. While still elevated, this reduction indicates better glycemic control, which is essential for overall health and particularly important in the context of healing and managing diabetes.

• WBC: The WBC count increased from 9,500/mm³ to 11,200/mm³. This increase could indicate an ongoing infection or inflammatory process, suggesting that the client's condition is not improving in this regard.
• Urinary frequency: The information provided does not detail any changes in urinary frequency, and given the initial presentation of increased thirst and urination, ongoing monitoring is essential. Without additional context, this does not indicate improvement.
• Temperature: The temperature increased from 38.3°C (100.9°F) to 39.0°C (102.2°F), indicating a worsening state that may suggest infection or systemic response rather than improvement.
• Blood pressure: The blood pressure dropped from 98/74 mm Hg to 90/68 mm Hg, which is concerning and indicates potential hypotension, possibly due to infection or other factors affecting the client’s status.
• Heart rate: The heart rate increased from 104/min to 106/min, suggesting that the client may be experiencing stress, pain, or infection, indicating that their condition may not be improving.

The nurse should first address the client's chest pain followed by the client's irregular heart rate.

Rationale:

Chest pain is the priority concern as it indicates an acute coronary event (ST-elevation myocardial infarction, STEMI). Immediate interventions such as oxygen, nitroglycerin, and pain management are required to reduce myocardial oxygen demand and prevent further cardiac damage.

Irregular heart rate must be addressed next, as tachycardia and arrhythmias can increase myocardial workload and worsen ischemia. Monitoring and possible antiarrhythmic interventions may be required to stabilize cardiac function.

Incorrect:

Troponin levels: Elevated troponin confirms myocardial injury but does not require immediate intervention; managing the ongoing ischemia is the priority.

Oxygen saturation: The client's oxygen saturation is 93% on room air, which is adequate. Oxygen therapy is not the first priority unless levels drop further.

Hyperlipidemia: While a cardiovascular risk factor, it is not an acute concern during an MI. Long-term management is necessary but not the immediate priority.

C-reactive protein: Elevated CRP indicates inflammation but does not require urgent intervention in the acute phase of MI.