The emergency department nurse teaches clients with sports injuries to remember the acronym PRICE. This acronym stands for which combination of treatments?

The timing of a snack for a client on NPH insulin must correspond with the medication's peak action time to prevent hypoglycemia. Since NPH is an intermediate-acting insulin, its maximal effect typically occurs 4 to 12 hours after the subcutaneous injection. Providing a complex carbohydrate and protein snack during this window ensures that exogenous glucose is available to offset the nadir in blood sugar.

A. 0730: This is only 30 minutes after the injection, a time when NPH has not yet begun to exert a significant clinical effect. The onset of NPH occurs approximately 1.5 to 4 hours after administration. A snack at this time would likely cause transient hyperglycemia without serving its intended protective purpose during the insulin peak.

B. 0900: At 2 hours post-injection, the NPH is just beginning its onset of action and is far from its maximal glucose-lowering capacity. Monitoring for hypoglycemic symptoms usually begins later in the morning. Offering a snack this early does not provide the necessary metabolic buffer required during the late afternoon when the insulin concentration is highest.

C. 1500: This time is 8 hours after the 0700 dose, placing it directly within the 4 to 12-hour peak window of NPH insulin. A mid-afternoon snack is essential to counteract the strongest insulin effect and prevent a drop in plasma glucose. This timing is a standard intervention in diabetic care to maintain glycemic stability throughout the day.

D. 1230: While 5.5 hours after the dose is approaching the peak, 1500 is a more appropriate time to cover the sustained peak of intermediate insulin. Many patients eat lunch around 1230, which provides some glucose, but an additional snack at 1500 is often needed. The pharmacodynamic duration of NPH necessitates coverage well into the late afternoon.

Diabetic foot ulcers are highly susceptible to secondary infections due to impaired local immunity and reduced tissue perfusion. Maintaining the integrity of the wound bed requires strict adherence to aseptic protocols to prevent the introduction of multidrug-resistant organisms. Infection in these wounds frequently leads to osteomyelitis and is the primary precursor to lower-limb amputation in diabetic populations.

A. Cleaning the wound with a povidone-iodine solution: While povidone-iodine is an antiseptic, it can be cytotoxic to healthy granulation tissue and fibroblasts in chronic wounds. Repeated use may delay the healing process by damaging the very cells needed for tissue repair. Modern wound care emphasizes using non-toxic cleansers, such as normal saline or commercial wound washes.

B. Using sterile technique during the dressing change: Sterile technique is essential for prevents the introduction of pathogens into a compromised, poorly vascularized area. Given the patient's impaired wound healing and increased susceptibility to sepsis, minimizing bacterial load is the primary clinical goal. This intervention protects the patient from ascending infections and promotes a cleaner healing environment.

C. Debriding the wound three times per day: While debridement is necessary to remove necrotic tissue and biofilm, performing it three times daily is excessive and damaging. Frequent aggressive debridement can destroy newly formed capillary loops and epithelial cells. Debridement frequency is typically determined by the amount of eschar or slough and is usually performed much less frequently.

D. Applying a heating pad: Diabetic patients with peripheral neuropathy often have impaired thermal sensation, making them unable to detect extreme heat. Applying a heating pad carries a high risk of causing severe thermal burns without the patient's knowledge. Furthermore, excessive heat can increase the metabolic demand of the tissue beyond what the compromised microcirculation can provide.