The practical nurse (PN) is caring for a client with pyelonephritis who is admitted for parenteral anti-infective therapy. Prior to discharge home with an oral medication regimen, which instruction is most important for the practical nurse (PN) to reinforce with the client?

Choice A reason: Bathing the wound daily with soap and water is a common practice to maintain cleanliness and prevent infection in a wound. However, this is not the immediate priority in this scenario. The presence of a dusky color on the left foot indicates potential vascular compromise, which needs to be assessed first to ensure adequate blood flow to the affected area. Cleaning the wound can be done subsequently, but checking circulation is critical to address any immediate risks.
Choice B reason: Recording the color and temperature of the leg is an important assessment step to monitor the client's condition. These observations can provide valuable information about the client's peripheral circulation and skin condition. However, while this should be done as part of the overall assessment, it is not the most immediate action. Checking the pulses will give more direct information about the blood supply to the affected area, which is crucial for identifying any urgent circulatory issues.
Choice C reason: Performing dorsiflexion and extension exercises can help maintain joint mobility and muscle strength in clients with diabetes. However, it is not the first intervention that should be implemented in this scenario. Before recommending exercises, it is essential to assess the vascular status of the client's foot. Exercises may not be appropriate if there is significant circulatory compromise, and could potentially cause further harm.
Choice D reason: Checking the client's dorsalis pedis and posterior tibialis pulse points is the most critical first intervention. The dusky color of the foot suggests a possible issue with blood flow. By assessing the pulses in the foot, the practical nurse can determine if there is adequate perfusion to the area. If the pulses are weak or absent, it may indicate peripheral artery disease or another vascular issue that requires immediate medical attention. Prompt identification and intervention are crucial to prevent further complications, such as tissue necrosis or limb-threatening ischemia.

Choice A reason: Returning for a urine culture and imaging is an important part of follow-up care for a client with pyelonephritis. These tests can help ensure that the infection has been completely resolved and that there are no underlying structural abnormalities contributing to the condition. However, while follow-up appointments are crucial, the immediate priority for discharge instructions is to emphasize the importance of adhering to the prescribed medication regimen to ensure the effectiveness of the treatment.
Choice B reason: Using nonsteroidal anti-inflammatory drugs (NSAIDs) for pain can help manage discomfort associated with pyelonephritis. However, pain management is secondary to ensuring that the infection is effectively treated. While it is important to address the client's pain, reinforcing the need to follow the prescribed medication regimen takes precedence to ensure that the infection is adequately managed and prevented from worsening or recurring.
Choice C reason: Adhering strictly to the medication regimen is the most important instruction for the client. Ensuring that the client takes the full course of prescribed antibiotics is critical to effectively treating the pyelonephritis and preventing the development of antibiotic resistance or recurrent infections. Reinforcing the importance of completing the antibiotic course as directed helps ensure that the infection is fully eradicated and reduces the risk of complications.
Choice D reason: Ensuring effective perineal hygiene is important for preventing urinary tract infections (UTIs) and maintaining overall urinary health. While it is a relevant aspect of care, it is not the most critical instruction for the client at the point of discharge. The primary focus should be on the adherence to the medication regimen to treat the current infection and prevent further complications. Perineal hygiene practices can be reinforced as part of overall health education but are not the immediate priority compared to medication adherence.