An older adult client who experienced a cerebrovascular accident (CVA) has difficulty with visual perception and eats only half of the food on the meal tray. The client's family expresses concern about the client's nutritional status. How should the nurse respond to the family's concern?

A. Applies prescribed lotions to the radiation site: The use of lotions specifically prescribed by the healthcare team is encouraged, as these formulations are designed to soothe irritated skin without interfering with the effectiveness of radiation therapy or exacerbating skin sensitivity.

B. Washes the radiation site with antibacterial soap and water: Antibacterial soaps often contain harsh chemicals that can irritate sensitive skin, especially when the skin is already compromised by radiation exposure. Mild, unscented soap and lukewarm water are recommended to prevent further skin breakdown and discomfort during the treatment period.

C. Dries the area with patting motions after taking a shower: Gently patting the skin dry, rather than rubbing, helps prevent mechanical irritation to the fragile tissue at the radiation site. This technique supports skin integrity and minimizes the risk of skin damage during hygiene routines.

D. Wears clothing to cover the radiation site: Covering the site with soft, breathable clothing provides protection from environmental elements such as sun exposure and friction, which can aggravate radiation dermatitis. Clothing should be non-restrictive to avoid rubbing or pressure on the affected area.

A. Radiating, sharp pain in right shoulder: This pain is a common symptom of gallbladder inflammation or biliary colic due to referred pain from diaphragmatic irritation. While it should be documented and managed for comfort, it is not immediately life-threatening or indicative of worsening complications.

B. Clay colored stool: Pale or clay-colored stools occur when bile flow into the intestines is obstructed, leading to a lack of stercobilin, the pigment responsible for stool color. This finding confirms bile duct obstruction but is expected in the context of cholelithiasis with jaundice and doesn’t require urgent intervention.

C. Bile stained emesis: Vomiting bile indicates upper gastrointestinal involvement and is often associated with prolonged nausea due to gallbladder or liver pathology. While uncomfortable and noteworthy, it is not as alarming as signs of acute abdominal complications.

D. Distended, hard, and rigid abdomen: This finding suggests peritonitis or a perforated viscus, which are surgical emergencies. A rigid abdomen indicates guarding and possible internal inflammation or infection, requiring immediate medical evaluation and intervention to prevent rapid deterioration.