A client receives a prescription for vancomycin 500 mg IV every 8 hours. The medication is provided in "500 mg per 100 ml" of dextrose 5% in water.
To administer the medication over an hour, the nurse should set the infusion pump to deliver how many mL/hr?

Choice A rationale:

While some individuals with Crohn's disease may find that avoiding gluten improves their symptoms, this is not a universal recommendation.

Gluten restriction is more often indicated for those with celiac disease or gluten sensitivity.

It's important to individualize dietary recommendations based on personal triggers and sensitivities.

Choice B rationale:

An elimination diet is a systematic approach to identifying foods that may trigger or worsen Crohn's disease symptoms.

It involves removing certain foods from the diet for a period of time, typically 2-4 weeks, and then gradually reintroducing them one at a time to observe any reactions.

This process can help individuals pinpoint specific foods that contribute to their symptoms and make informed dietary choices to manage their condition.

Choice C rationale:

There is no evidence to support a general restriction of calcium and iron in individuals with Crohn's disease.

In fact, these nutrients are essential for overall health and should be consumed in adequate amounts unless a specific deficiency or intolerance is identified.

Restriction of these nutrients could lead to nutritional deficiencies.

Choice D rationale:

Fluid restriction is not a primary dietary limitation for individuals with Crohn's disease.

Maintaining adequate hydration is crucial for overall health, especially during flares when fluid loss through diarrhea may be increased.

Restricting fluids could potentially lead to dehydration and electrolyte imbalances.

Choice A rationale:

Liquefying secretions is the most crucial action to address the client's immediate respiratory concerns. Thickened mucus obstructs airflow, leading to shortness of breath, productive cough, and difficulty breathing upon exertion. Increasing fluid intake thins mucus, making it easier to expel and improving ventilation. This directly addresses the client's current symptoms and promotes airway clearance.

Hydration and Mucociliary Clearance: Adequate hydration is indispensable for optimal mucociliary clearance, the natural mechanism that removes mucus from the airways. Fluids moisten the respiratory tract, allowing cilia (tiny hair-like structures) to effectively move mucus upwards, where it can be coughed out or swallowed.

Thinning Mucus: Water acts as a natural expectorant, thinning mucus and reducing its viscosity. This makes it easier for the client to cough up the mucus, clearing the airways and reducing the sensation of breathlessness.

Decreasing Mucus Production: Dehydration can trigger the body to produce more mucus as a protective response. By staying hydrated, the client can help prevent excessive mucus production, further easing symptoms.

Supporting Overall Respiratory Health: Proper hydration maintains the health of the respiratory system's tissues and cells, promoting efficient gas exchange and reducing inflammation.

Preventing Dehydration-Related Complications: Dehydration can exacerbate respiratory problems and lead to other complications, such as fatigue, headaches, and impaired immune function. Maintaining adequate fluid intake helps prevent these issues.

Key points to emphasize to the client:

Drink fluids throughout the day, even if not feeling thirsty.

Water is the best choice, but clear broths, juices, and herbal teas can also contribute to fluid intake. Avoid caffeine and alcohol, as they can be dehydrating.

Monitor urine output to ensure adequate hydration (urine should be pale yellow or clear).

Increase fluid intake during periods of increased mucus production, such as during respiratory infections or exercise.