Which finding in the medical record indicates a client has good control of type 1 diabetes mellitus?

Choice A reason: Schizoaffective disorder’s active phase combines psychotic symptoms (delusions, hallucinations) with mood episodes, like major depression or mania, due to dysregulation in dopamine and serotonin pathways. Unlike schizophrenia, mood symptoms are prominent and persistent, defining the disorder’s diagnostic criteria during active phases, distinguishing it from schizophrenia’s primarily psychotic focus.

Choice B reason: Absence of delusions or hallucinations is incorrect for schizoaffective disorder’s active phase, which requires psychotic symptoms like those in schizophrenia. These arise from dopamine dysregulation in the mesolimbic pathway, making their presence essential for diagnosis, unlike this choice’s suggestion of their absence.

Choice C reason: More severe negative symptoms, like flattened affect or avolition, are characteristic of schizophrenia, not schizoaffective disorder’s active phase. Schizoaffective disorder emphasizes mood symptoms (depression or mania) alongside psychosis, with negative symptoms being less dominant, making this choice incorrect for its active phase.

Choice D reason: Anosognosia, or lack of insight into one’s illness, is common in schizophrenia but not a defining feature of schizoaffective disorder’s active phase. Schizoaffective disorder focuses on combined psychotic and mood symptoms, not necessarily more severe anosognosia, making this choice less relevant to its diagnostic criteria.

Choice A reason: Ensuring proper fit of the TLSO is critical to stabilize the spine effectively, preventing further injury. An ill-fitting brace can cause misalignment, pressure sores, or reduced efficacy, as it fails to immobilize the thoracolumbar region, making this a key nursing priority.

Choice B reason: How the patient sleeps with the brace is not a primary nursing priority. While comfort during sleep matters, the TLSO is typically worn as prescribed, and sleep position is secondary to ensuring fit, breathing, education, and skin care, making this choice incorrect.

Choice C reason: Monitoring breathing is essential, as a TLSO can restrict chest expansion, potentially reducing tidal volume and causing respiratory distress. Nurses must assess respiratory rate and oxygen saturation to ensure the brace does not compromise ventilation, making this a critical priority.

Choice D reason: Educating the patient and family about the TLSO’s purpose and care ensures compliance and proper use. Understanding how to wear, clean, and adjust the brace prevents complications like skin breakdown or ineffective stabilization, making this a key nursing responsibility.

Choice E reason: Skin integrity is a priority, as prolonged brace use can cause pressure ulcers or irritation. Nurses must inspect skin under the TLSO regularly, ensuring proper padding and hygiene to prevent breakdown, especially in immobile patients, making this a critical care aspect.