An occupation health nurse provides monthly lunch and learn sessions to employees of a rail transportation manufacturer. This month, they are providing education on the risk factors for peptic ulcer disease. Which risk factors should the nurse include in the educational session? (Select All that Apply.)

A. Eating spicy foods and laid-back attitude: While spicy foods may cause discomfort in some individuals, they are not direct causes of PUD. A "laid-back attitude" is also not a recognized risk factor. Stress, in general, can worsen symptoms, but it does not cause ulcers.

B. Occasional alcohol and cocaine use: Occasional alcohol use may irritate the stomach lining, but it is more commonly chronic alcohol use that is a risk factor. Cocaine use can cause severe gastrointestinal issues, including ulcers, but occasional use is not a primary risk factor.

C. Alcohol abuse and smoking: Both alcohol abuse and smoking are well-established risk factors for peptic ulcer disease. Alcohol can irritate the stomach lining, and smoking reduces the effectiveness of treatments and increases the risk of ulcer recurrence by promoting gastric acid secretion and decreasing mucosal blood flow.

D. Six-month history of H. Pylori: Helicobacter pylori infection is one of the leading causes of peptic ulcers. A six-month history of H. pylori infection increases the risk of developing ulcers, as the bacteria damages the stomach lining and increases acid production.

E. Active lifestyle and smoking: Smoking impairs healing and increases the recurrence rate of ulcers, making it a key factor in ulcer formation. However, the active lifestyle itself does not contribute to the development of ulcers.

A. Potassium 10 meq IV mini bag: The potassium level is at the lower end of the normal range (3.5 mEq/L), but it is not critically low. Potassium supplementation may be needed, but it is not as urgent as managing the elevated INR and low platelet count.

B. Warfarin 5mg by mouth: The patient's INR is elevated at 5.0 (normal range: 2.0-3.0), which significantly increases the risk of bleeding, especially with low platelet levels (50,000/mm3, normal range: 150,000-450,000/mm3). Given the critical low platelets and elevated INR, this order should be brought to the provider's attention to reduce the bleeding risk.

C. Regular insulin 5 units subcutaneously: The patient’s blood glucose is elevated at 240 mg/dL, but insulin administration at 5 units is appropriate for the patient's condition and not an immediate concern compared to the bleeding risk from Warfarin.

D. Discontinue indwelling catheter: The catheter is scheduled for discontinuation, but this is not as urgent as addressing the bleeding risk associated with the elevated INR and low platelet count.