A recently widowed diabetic person comments that her blood sugar levels are running higher than usual. Which is the best response from the nurse?

Post-procedure care for arthroscopy focuses on managing postoperative inflammation and preventing excessive intra-articular pressure. The application of cold therapy is standard to induce vasoconstriction, which minimizes bleeding and reduces the metabolic demand of the traumatized tissue. Conversely, the application of heat in the acute phase is contraindicated as it promotes vasodilation and can exacerbate hemarthrosis and edema.

A. "Elevating my leg will reduce swelling after the procedure": Elevation above the level of the heart utilizes gravity to facilitate venous return and lymphatic drainage from the surgical site. This is a correct understanding of postoperative care, as it helps decrease the hydrostatic pressure that contributes to edema. It is a standard non-pharmacological intervention for promoting recovery following orthopedic procedures.

B. "My physician may prescribe pain pills after the procedure": Arthroscopy involves the insertion of a trochar and instruments into the joint capsule, which invariably causes localized pain. Providing pharmacological analgesia is a necessary component of the care plan to ensure patient comfort and facilitate early mobilization. This statement correctly identifies the likelihood of needing analgesic medication during the initial recovery phase.

C. "I should use my heating pad this evening to reduce some of the pain in my knee": This statement indicates a need for further teaching because heat should be avoided for the first 48 hours. Heat increases capillary permeability and blood flow, which can lead to increased swelling and pain in an acutely injured joint. The nurse must instruct the client to use cryotherapy instead to control the inflammatory response.

D. "I may notice some bruising or swelling in my knee": Bruising and mild edema are expected sequelae of the surgical manipulation and the irrigation fluids used during the arthroscopic procedure. Recognizing these as normal findings helps the client monitor their recovery without unnecessary alarm. It is an accurate assessment of the post-surgical clinical presentation and requires no further intervention.

In the absence of insulin, the body shifts from carbohydrate metabolism to lipolysis for energy production. This metabolic pathway releases free fatty acids into the liver, where they undergo beta-oxidation to form acidic compounds. The resulting ketonemia lowers blood pH, leading to metabolic acidosis, and eventually manifests as ketonuria as the kidneys attempt to clear the excess.

A. Creatinine: This is a waste product of muscle metabolism and is used primarily as a biomarker for glomerular filtration rates. It does not relate to fat breakdown or the immediate absence of insulin. While its levels may rise during acute kidney injury associated with severe dehydration, it is not a direct ketogenic byproduct.

B. Cholesterol: This lipid molecule is a structural component of cell membranes and a precursor for steroid hormones. While diabetic patients often have dyslipidemia, cholesterol is not a byproduct of acute fat catabolism for energy. It does not accumulate in the urine under normal physiological conditions or during acute metabolic decompensation.

C. Hemoglobin: This is the iron-containing protein in erythrocytes responsible for oxygen transport throughout the circulatory system. It is not involved in the metabolic breakdown of adipose tissue or the fuel-selection process. Its measurement in diabetes is typically limited to monitoring glycated fractions to assess long-term glucose management over 3 months.

D. Ketones: These acidic molecules, including acetoacetate and beta-hydroxybutyrate, are the direct result of rapid, incomplete fat metabolism. Their accumulation causes the "fruity" breath odor and high anion gap metabolic acidosis characteristic of diabetic ketoacidosis. Detecting these in the blood and urine is essential for diagnosing acute insulin deficiency.