The nurse is providing education for a client who is now on a prednisone taper after long-term treatment of systemic vasculitis. What statement will the nurse include in the teaching?

Sickle cell disease(SCD) involves the production of abnormal hemoglobin S, which causes erythrocytes to become rigid and crescent-shaped under stress. This leads to vaso-occlusive crises, where trapped cells cause ischemia and infarction in tissues and bones. The resulting pain is often excruciating and requires aggressive analgesic managementwith opioids to maintain the patient's functional status and physiological stability during the crisis.

Rationale:

A.Telling the client it is too early for medication ignores the subjective nature of pain and the physiological intensity of a vaso-occlusive crisis. Patients with SCD often develop a high tolerance to opioids and may require frequent dosing to manage breakthrough pain. Dismissing the client's request can damage the therapeutic relationship and lead to uncontrolled pain.

B.Giving the pain medication when the dose is due is the best action. The nurse must prioritize the client's report of pain, as pain is whatever the patient says it is. In a sickle cell crisis, managing the severe ischemia is paramount, and the nurse must advocate for adequate analgesia rather than making judgmental assumptions about drug-seeking behavior.

C.Instructing the client not to request medication early is dismissive and fails to address the underlying cause of the distress. It assumes the client's request is behavioral rather than a reflection of unmet physiological needs. Effective pain management in SCD requires a collaborative approach to ensure the patient's pain is consistently controlled.

D.Requesting a placebo is unethical and a violation of professional nursing standards. Using placebos to "test" for pain or addiction is deceptive and erodes the trust between the patient and the healthcare team. In a sickle cell crisis, the pain is rooted in tissue hypoxia, and the use of placebos is medically and ethically inappropriate.

GERD can lead to severe extra-esophageal complications if gastric refluxate reaches the upper airway. During sleep, the protective laryngeal reflexes are diminished, allowing for the microaspirationof acid into the trachea and lungs. This can cause laryngospasm, chronic cough, and nocturnal asthma-like symptoms. Identifying these occurrences is critical to prevent permanent pulmonary damage and to screen for Barrett's esophagus.

Rationale:

A.Reporting the use of lean cuts of meat is a positive finding that indicates the patient is following dietary recommendations to manage their GERD. Lean meats reduce the fat load in the stomach, which helps prevent delayed gastric emptying and minimizes the risk of reflux. This is a sign of effective self-management rather than an alarming finding for the provider.

B.Quitting smoking is a significant health achievement that improves GERD symptoms because nicotine is a known relaxant of the lower esophageal sphincter. This information should be documented as a positive behavioral change in the patient's history. It does not represent a new or worsening complication that requires an urgent medical report or intervention.

C.The nurse must report "waking up gasping for air" because it suggests nocturnal aspirationof gastric contents. This is a serious complication of GERD where acid enters the airway, potentially causing aspiration pneumoniaor bronchospasm. This finding indicates that the patient's GERD is not well-controlled and poses a significant risk to their respiratory health and airway patency.

D.Eating small, frequent meals is a recommended lifestyle modification for GERD. This practice prevents excessive gastric distention, which reduces the pressure against the lower esophageal sphincter and decreases the volume of acid available for reflux. This finding shows the patient is adhering to appropriate non-pharmacological management strategies and is not a cause for medical concern.