A woman with polycystic ovary syndrome tells the nurse, "I hate this disease. Just look at me! I have no hair on the front of my head, but I've got hair on my chin and upper lip. I don't feel like a woman anymore." Further assessment reveals breast atrophy and increased muscle mass. Which nursing diagnosis would the nurse identify as the priority?

A. "I need to avoid driving to and from work every day."

This statement indicates a misunderstanding of how to minimize lymphedema. Driving itself does not directly contribute to lymphedema. However, activities that involve prolonged or repetitive use of the affected arm, such as gripping the steering wheel while driving for long periods, may increase the risk of developing lymphedema. The nurse should clarify that while driving is generally acceptable, the client should take breaks and perform arm exercises during long drives to promote circulation.

B. "Any blood pressures need to be taken in my right arm."

This statement demonstrates correct understanding. Taking blood pressure measurements, administering injections, or obtaining blood samples from the unaffected arm helps prevent trauma or injury to the arm at risk for lymphedema. This practice helps avoid disrupting lymphatic flow and reduces the risk of developing lymphedema in the affected arm.

C. "I need to wear gloves when doing any gardening."

Wearing gloves during gardening is a recommended precaution to minimize the risk of injury and infection, especially if the client has undergone lymph node removal. This statement reflects appropriate understanding and adherence to preventive measures to protect the affected arm from cuts, scratches, and potential infection that could exacerbate lymphedema.

D. "I should wear clothing with elasticized sleeves."

This statement indicates a misunderstanding of how to minimize lymphedema. While elasticized sleeves or compression garments can help manage lymphedema by providing gentle compression and support to the affected arm, wearing tight or constrictive clothing, including elasticized sleeves, can potentially restrict lymphatic flow and exacerbate lymphedema. The nurse should clarify that loose-fitting clothing is preferable to allow unrestricted movement and circulation in the affected arm.

A. Ibuprofen:

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used for pain relief and inflammation. However, its use during pregnancy, especially in the third trimester, is generally not recommended due to the potential risks of fetal harm and complications, such as constriction of the fetal ductus arteriosus and premature closure of the fetal ductus arteriosus. Therefore, its use would be concerning in a pregnant woman, particularly one with SLE.

B. Prednisone:

Prednisone is a corticosteroid medication often used to manage inflammation and autoimmune conditions like SLE. While corticosteroids are generally considered safe for use during pregnancy, they may be prescribed cautiously and in the lowest effective dose to minimize potential risks to the fetus. Pregnant women with SLE may be prescribed prednisone to manage their condition.

C. Hydroxychloroquine:

Hydroxychloroquine is an antimalarial medication that is also used to manage autoimmune conditions like SLE. It is considered relatively safe for use during pregnancy and is often continued in pregnant women with SLE to control disease activity and reduce the risk of flares.

D. Leflunomide:

Leflunomide is a disease-modifying antirheumatic drug (DMARD) used to treat autoimmune conditions such as rheumatoid arthritis. Its use is contraindicated during pregnancy due to its potential teratogenic effects, which can cause serious birth defects. Pregnant women should discontinue leflunomide before attempting to conceive or switch to alternative medications.

E. Methotrexate:

Methotrexate is another DMARD used to treat autoimmune conditions, but it is contraindicated during pregnancy due to its high risk of causing birth defects and pregnancy loss. It can interfere with fetal development and should not be used by pregnant women or women planning pregnancy.