The nurse is caring for a client who is having trouble breastfeeding. Which action by the nurse is the most helpful?

A. Use electric heating pad when pain is at its worse is incorrect because cold therapy, not heat, is recommended during an acute gout attack. Cold packs help reduce inflammation, swelling, and pain, whereas heat can exacerbate inflammation in the affected joint.

B. Support joints in an extended position while resting is inappropriate for acute gout. The affected joint should be kept elevated and in a comfortable position to reduce pain and swelling, rather than forced into extension.

C. Avoid acetylsalicylic acid (aspirin) containing medications is correct. Aspirin can interfere with uric acid excretion, potentially worsening hyperuricemia and triggering additional gout attacks. Patients should be advised to use other pain relievers, such as NSAIDs (e.g., ibuprofen), as prescribed.

D. Limit use of mobility equipment to avoid muscle atrophy is incorrect. Maintaining safe mobility as tolerated is important to prevent deconditioning. Restricting movement unnecessarily does not benefit gout management and may increase the risk of functional decline.

A. Pharmacologic therapy is a cornerstone of GERD management. The client was prescribed famotidine, an H2 receptor antagonist, which reduces gastric acid production and alleviates symptoms. Including medications in the plan of care ensures the nurse monitors effectiveness, educates the client on proper timing and dosing, and evaluates for side effects.

B. Surgery is generally reserved for clients with severe GERD, complications (e.g., strictures, Barrett’s esophagus), or those who do not respond to lifestyle modifications and medication therapy. The current presentation does not indicate the need for surgical intervention at this stage.

C. Dietary modifications are essential for symptom management in GERD. Recommendations include avoiding foods that trigger reflux (e.g., fatty or fried foods, chocolate, caffeine, spicy foods), eating smaller meals, and not lying down immediately after eating. Nutrition planning also helps address the client’s obesity, which is a risk factor for GERD.

D. Lifestyle interventions are critical in GERD management. These include weight reduction (the client has a BMI of 37.8 kg/m²), smoking cessation (the client smokes 1 pack per week), elevating the head of the bed, and avoiding tight clothing. These modifications can reduce symptom frequency and severity.

E. Endoscopic interventions are typically reserved for clients with complications or refractory GERD that does not respond to medications and lifestyle changes. There is no current indication for this client to undergo endoscopic therapy.